Sarah Palin deserves an apology. When she said that the new health-care law would lead to “death panels” deciding who gets life-saving treatment and who does not, she was roundly denounced and ridiculed.

Now we learn, courtesy of one of the ridiculers — The New York Times — that she was right. Under a new policy not included in the law for fear the administration’s real end-of-life game would be exposed, a rule issued by the recess-appointed Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services, calls for the government to pay doctors to advise patients on options for ending their lives. These could include directives to forgo aggressive treatment that could extend their lives.

This rule will inevitably lead to bureaucrats deciding who is “fit” to live and who is not. The effect this might have on public opinion, which by a solid majority opposes Obamacare, is clear from an e-mail obtained by the Times. It is from Rep. Earl Blumenauer (D-Ore.), who sent it to people working with him on the issue. Oregon and Washington are the only states with assisted-suicide laws, a preview of what is to come at the federal level if this new regulation is allowed to stand. Blumenauer wrote in his November e-mail: “While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet. This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”

Ah, but it’s not a myth, and that’s where Palin nailed it. All inhumanities begin with small steps; otherwise the public might rebel against a policy that went straight to the “final solution.” All human life was once regarded as having value, because even government saw it as “endowed by our Creator.” This doctrine separates us from plants, microorganisms and animals.

Doctors once swore an oath, which reads in part: “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.” Did Dr. Berwick, a fan of rationed care and the British National Health Service, ever take that oath? If he did, it appears he no longer believes it.

Do you see where this leads? First the prohibition against abortion is removed and “doctors” now perform them. Then the assault on the infirm and elderly begins. Once the definition of human life changes, all human lives become potentially expendable if they don’t measure up to constantly “evolving” government standards.

It will all be dressed up with the best possible motives behind it and sold to the public as the ultimate benefit. The killings, uh, terminations, will take place out of sight so as not to disturb the masses who might have a few embers of a past morality still burning in their souls. People will sign documents testifying to their desire to die, and the government will see it as a means of “reducing the surplus population,” to quote Charles Dickens.

When life is seen as having ultimate value, individuals and their doctors can make decisions about treatment that are in the best interests of patients. But when government is looking to cut costs as the highest good and offers to pay doctors to tell patients during their annual visits that they can choose to end their lives rather than continue treatment, that is more than the proverbial camel’s nose under the tent. That is the next step on the way to physician-assisted suicide and, if not stopped, government-mandated euthanasia.

It can’t happen here? Based on what standard? Yes it can happen in America, and it will if the new Republican class in Congress doesn’t stop it.

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>>Bioethicist: Coma Recovery Case Offers Ethical Lesson (Christian Post, 091201)

The miraculous case of the Belgian man who was fully conscious during the 23 years medical professionals thought he was brain dead should be a lesson to families to be wary of diagnosis of vegetative state, said a bioethicist.

“Ethical treatment decisions required as the result of serious injury or illness requires accurate medical information,” wrote John Kilner, director of the bioethics program at Trinity International University in Deerfield, Ill., in an e-mail. “Hopefully this case can alert people to the fact that doctors and families must be careful not to jump too quickly to a diagnosis of ‘permanent vegetative state.’”

The former president of the Center for Bioethics & Human Dignity highlighted that sophisticated testing is now available to give a more specific diagnosis on whether the patient has “locked in syndrome,” is in a “minimally conscious state,” or has other conditions that require different levels of support than a patient in a coma.

“Many patients have long been mistakenly to be permanently unconscious – in an unhelpfully named ‘persistent vegetative states,’” wrote Kilner, who noted that referring to someone as “vegetables” can easily lead people to be thought of as sub-human and promote diminished respect and care for them.

According to Dr. Steven Laureys, the neurological researcher who discovered that the Belgian man, Rom Houben, was fully conscious but unable to communicate, as many as four out of ten similar patients may have been misdiagnosed.

Houben, now 46, was an engineering student when he got into a car accident that caused him to be unable to move any of his voluntary muscles, including his eye lids. Medical professionals had written him off as being in a coma when he in fact had normal brain activity.

Laureys, as part of his study on patients in comatose, conducted a brain scan on Houben and found his brain to be normal. The discovery occurred three years ago but the story was only recently known when Laureys, with the permission of Houben, released a scientific paper on the case.

“I screamed, but there was nothing to hear,” Houben told the Daily Mail newspaper in an interview. “All that time I just literally dreamed of a better life.”

“Frustration is too small a word to describe what I felt.”

Houben called the day that the medical professionals discovered his real situation as his “second birth.”

“I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead,” he said.

Houben’s story has caused pro-life groups to revisit the contentious case of Terri Schiavo, the American woman whose case divided the nation and politicians on how to treat someone diagnosed of persistent vegetative state.

Pro-lifers point to Houben’s case as support for treating patients diagnosed with PVS more humanely and for conducting more tests on their physical and mental health.

Houben, who is still unable to move most of his body, now communicates with the help of a speech therapist who helps him move his hand to type out messages on a touch screen. He plans to write a book.

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>>SUMMARY OF 1996 COURT DECISIONS

Decision by 9th and 2nd US circuit courts of appeals

March 1996: 9th circuit (California) : struck down law prohibiting assisted suicide, using Supreme Court precedent on abortion to affirm the right to control one’s body. [right to privacy argument]

April 1996: 2nd circuit (New York): using “equal protection” clause in the Constitution to group terminally ill persons irrespective of whether they are on life support systems or not [equal protection argument]

Canada

October 1993: Supreme Court (case of Sue Rodrigues) decided against assisted suicide

June 1995: Senate committee decided against assisted suicide

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**Parliament, the courts, and matters of life and death (National Post, 110809)

It’s a troubling trend, inspired by Evangelical Christians.

A judge of the British Columbia Supreme Court has agreed to fast track the lawsuit of Gloria Taylor, who suffers from ALS and is seeking to have a doctor assist her in ending her life.

What’s troubling is that the House of Commons has defeated proposed legislation to legalize physician assisted suicide three times in the last six years, most recently in April 2010. Because the will of Parliament, the peoples’ representatives, isn’t bending on this issue, Ms. Taylor has resorted to the courts – where, by the way, the Supreme Court of Canada decided in 1993 that Parliament was the appropriate place to make the decision (Rodriguez v British Columbia).

Will the courts of British Columbia accept the decisions of Parliament and the Supreme Court of Canada as conclusive? One used to be able to answer this question with a strong and emphatic “yes.” That’s no longer the case, however, because the argument “times have changed” seems to be carrying an authority that has been used to outweigh the stability provided through the nation being able to rely on precedent. i.e. “Yes, I know that’s what Parliament decided and what the Supreme Court of Canada said. But times have changed since those decisions were made, and people now feel differently.”

I say this is a trend because it follows on the heels of the unanimous decision of the House of Commons on another issue that was reversed through the courts. In 1999 Parliament decided not to change the definition of marriage. In 2004 the Supreme Court of Canada ruled that Parliament alone had jurisdiction to determine the definition. (Reference re Same-Sex Marriage). But the courts of Ontario, Quebec, British Columbia, etc decided that same-sex marriage was to be recognized province by province by province, one decision at a time. In 2005, Parliament changed the definition of marriage; partly to avoid the checkerboard that was emerging in Canada as a result of the decisions of courts with jurisdiction only within their province – who based their decisions on “changing times.”

This case also sits in the wake of Parliament passing revisions to the Criminal Code in regard to prostitution in 1985. The Supreme Court of Canada decided in favour of the law’s constitutionality in 1990 (Reference re ss. 193 and 195.1(1)(C) of the criminal code (Man.) ). Yet an Ontario Superior Court judge found the law lacking in September 2010, concluding that “times had changed” since the Supreme Court of Canada’s earlier ruling. The appeal of the 2010 decision was recently heard by the Ontario Court of Appeal and their decision is pending.

The concepts of parliamentary supremacy and prevailing precedent of the higher courts (i.e., all courts submit to decisions of the Supreme Court of Canada, courts in the provinces submit to decisions of the province in question’s Court of Appeal, etc) have long established stability in the legal system for all Canadians. “Times have changed” appears as a standard of convenience to allow some wiggle room to bypass the obstacles of parliamentary rule and stare decisis (the latin legal term for “the matter has already been decided and one should not disturb that which has been settled”).

This troubling “times have changed” trend creates legal uncertainty.

Today’s challengers are engaging the courts largely because of personal self-interest (an ALS sufferer seeks assistance in her death; two people of the same-sex seek marital status; a dominatrix seeks to legally operate her existing and illegal indoor prostitution “business” – yes, all deserving of some form of sympathy for their situation). Not finding success with elected representatives, these individuals seek another forum where their objectives can be pursued – the courts. The trend is disconcerting, not only because it ignores the will of Parliament but because the courts are engaging in the creation of legal uncertainty by reversing fairly recent legal decisions – at least recent by historical standards – and they are doing so based on the requests of individuals who readily admit that those requests are looking at the best interests of self (and perhaps a small community of like-minded individuals), not the best interests of society.

Two centuries ago the challengers were focused on others. They were also focused on using precedents of the courts – not overturning them – to build arguments that might persuade the will of Parliament, not overrule it.

It was the campaign to abolish the slave trade that saw Evangelical Christian lawyer Granville Sharp in the courts seeking declarations that recognized the human value of slaves, previously only recognized as property, while Evangelical Christian politician William Wilberforce engaged the battle for freedom in the British Parliament.

Today’s troubling trend – unfortunately focused on self-interest – was inspired by creative, caring Evangelical Christians who were focused on others; not people like themselves, but people whose humanity and basic freedoms were not being recognized. People, whose recognition by both courts and Parliament would result in the betterment of society not simply the satisfaction of self-desire.

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**Euthanasia Nurses Give Life-Ending Drugs, ‘Assume’ Patients Want to Die (Foxnews, 100611)

Nearly half of euthanasia deaths in Belgium hospitals are directed by nurses who have not received consent from the patient to administer life-ending drugs, the Vancouver Sun reported.

In interviews with 248 nurses, a fifth admitted they had taken part in a euthanasia procedure based on the “assumption” that the patient wanted to die. Almost half of the nurses (120) confessed to “terminations without request or consent.”

When euthanasia was made legal in Belgium in 2002, the law stated two conditions — that the patient give consent and the life-ending drugs be administered by a doctor. But the study published in the Canadian Medical Association Journal found the euthanasia is commonly carried out by nurses, “operating beyond the legal margins of their profession.”

Euthanasia accounts for two percent of deaths in Belgium annually.

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**Suicide: The Logic of a Nightmare (townhall.com, 100303)

by Michael Gerson

WASHINGTON— Americans, always fascinated by celebrity suicides, have a number of recent excuses for sympathetic voyeurism. Andrew Koenig, 41-year-old son of actor Walter Koenig, hanged himself in a Vancouver park after leaving a despondent note. Days later, Michael Blosil, the 18-year-old son of singer Marie Osmond, jumped from his eighth-floor apartment after writing that his depression had left him feeling friendless.

A few years ago, Brad Delp, lead singer for the band Boston, killed himself after writing, “I am a lonely soul.” South Korean supermodel Daul Kim wrote before her suicide last year, “The more I gain, the more lonely it is. ... I know I’m like a ghost.”

People seem naturally interested in news indicating that the famous share our struggles. In this case, it is true. Suicides outnumber homicides in America, making self-hatred more lethal than violence by others. In 2009, the Substance Abuse and Mental Health Services Administration reported that 1.1 million Americans had attempted suicide during the previous year. By one estimate, “successful” suicides have left behind 4.5 million family survivors, who live with ghosts each day.

Suicidology is a well-studied academic field. Suicide is most prevalent among the young and the old. It is associated with depression, feelings of hopelessness, substance abuse and low levels of serotonin in the brain. Females attempt suicide more often than males. Males complete it more often than females. Suicide rates are higher among people who are divorced, separated or widowed, and lower among the married.

But such quantification provides only the illusion of control. The mind does not experience itself as a scientific object, but rather as an interpreter of reality. One’s brain can contemplate one’s spleen objectively. One’s brain cannot consider one’s brain objectively, because its judgments seem real even when they are distorted.

The rational arguments against suicide are compelling. It causes intense suffering for loved ones that few would intend in their right mind. It is not a valid expression of autonomy or choice, because it ends all autonomy and choice. It represents the tyranny of one moment of hopelessness over every future moment of possibility.

But it is the peculiar cruelty of hopelessness and severe depression that they attack insight and perspective. People can experience themselves as someone they hate and cannot escape, except by shedding the self. In “The Savage God: A Study of Suicide,” A. Alvarez argues, “The logic of suicide is different. It is like the unanswerable logic of a nightmare, or like the science-fiction fantasy of being projected suddenly into another dimension: Everything makes sense and follows its own strict rules; yet, at the same time, everything is also different, perverted, upside down. Once a man decides to take his own life he enters a shut-off, impregnable but wholly convincing world where every detail fits and each incident reinforces his decision.”

For those who yield to the logic of the nightmare, it is difficult to be harsh or judgmental. Empathy, like grace, can reach to the grave.

Yet suicide is often preventable. Coping can be learned. Medication can treat underlying depression. But precisely because despair can rob individuals of judgment, it may require family and friends to intervene. This task is complicated by the pervasive loneliness of our society. Americans have become more mobile, more isolated and more likely to live in single-person households. When a 1985 survey asked, “How many confidants do you have?” the most frequent response was three. In 2004, the most popular answer was zero. John Cacioppo of the University of Chicago calls this trend “frightening.” It leads, he says, to a “pernicious feedback loop” in which loneliness leads to depression, which causes further lethargy and withdrawal. There are a lot of lonely souls.

The suicidal may actively withdraw from family and friends or alienate them with unfair burdens. At some point, loved ones are tempted to respond, “Just get over it.” But persistence, in these cases, is the primary evidence of love and friendship. Suicide is usually preceded by warning signs: suicide threats, seeking access to firearms or pills, increased use of alcohol or drugs, purposelessness, rage, recklessness, recent loss or humiliation, writing a will, giving away prized possessions. Those whom we wish to save we must first notice. (The National Suicide Prevention Lifeline is 1-800-273-TALK.)

Walter Koenig’s message following his son’s death is apt: “For those families who have members who they fear are susceptible to this kind of behavior, don’t ignore it, don’t rationalize it, extend a hand.”

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**Early Data Suggests Suicides Are Rising (Foxnews, 091122)

Early signs suggest the number of suicides in the U.S. crept up during the worst recession in decades, according to a Wall Street Journal survey of states that account for about 40% of the U.S. population.

Available data, still incomplete, suggest that this recession, like past ones, coincided with an uptick in suicides. The data from 19 states find an increase in suicides in the recessionary year of 2008 from 2007. Those states historically account for about half of annual suicides in the U.S. Calls to suicide hotlines are rising. And suicides in the workplace and the military — a small sliver all of self-inflicted deaths — were up in 2008.

Official data on suicides in the U.S. lag, and a 2008 national tally isn’t yet available. In 2007, there were 33,185 suicides, according to preliminary estimates from the U.S. Centers for Disease Control and Prevention, compared with an average of about 32,800 in the previous three years.

A Journal survey of the 33 largest states by population found 19 have data for 2008. In all, those 19 reported a total of 15,335 suicides in 2008, up about 2.3% from the previous year.

Thirteen states, accounting for 30% of the U.S. population, reported more suicides in 2008. In Florida, for instance, suicides were up 6%, in Georgia, up 2.3%, and in North Carolina, up 7.8%. In six smaller states, which account for about 9.5% of the population, the number of suicides fell.

The precise reasons for the rise in suicides aren’t yet known. But suicide rates have historically risen during tough economic times, when unemployment is high, suicide experts say.

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**Brain rewired itself in coma miracle: New study of man who spent 19 years in ‘vegetative state’ (WorldNetDaily, 060705)

In a new medical study sure to remind the world of the debate surrounding the forced dehydration death of Terri Schiavo, researchers found the injured brain of a man in a “vegetative state” for 19 years rewired itself, permitting him to renew communication with his loved ones.

The findings by Nicholas Schiff and his colleagues at Weill Medical College at Cornell University suggest the human brain shows far greater potential for recovery and regeneration then ever before suspected.

In 1984, 19-year-old Terry Wallis was thrown from his pick-up truck in an accident near his Massachusetts home. He was not found until 24 hours later, in a coma with massive brain injuries.

Within a few weeks he had stabilized in what was alternately characterized as a “minimally conscious state” or a “permanent vegetative state.” Most doctors saw little hope he would ever improve.

And he didn’t – for 19 years. Then, in 2003, he started to speak.

Over a three-day period, Wallis regained the ability to move and communicate, and started getting to know his 20-year-old daughter, only 1 year old at the time of the accident. Wallis awoke believing Ronald Reagan was still president.

To find out what was happening in Wallis’s brain, Schiff and other researchers used a new brain imaging technique called diffusion tensor imaging. The system tracks water molecules, revealing the brain’s white matter tracts – like a wiring diagram. They combined this with more traditional PET scanning, to show which brain areas were active.

The team’s findings suggest Wallis’ brain had gradually developed new pathways and unusual anatomical structures to re-establish functional connections, compensating for the normal brain pathways lost in the accident.

They found that new axons – the branches that connect neurons together – seemed to have grown, establishing new working brain circuits. In short, his brain had rewired itself.

Wallis was frequently classified as being in a permanent vegetative state. Though his family, like Schiavo’s, fought for a re-evaluation after seeing many promising signs that he was trying to communicate, their requests were turned down.

Wallis, now 42, still needs help eating and cannot walk, but his speech continues to improve and he can count to 25 without interruption.

Wallis’ sudden recovery happened three years ago at a rehabilitation center in Mountain View, Ark.

Wallis’ father said his son is now able to make jokes.

“That was something he wasn’t able to do early in his recovery,” Jerry Wallis said. “He now seems almost exactly like his old self. And he very often tells us how glad he is to be alive.”

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9th Circuit Lifts Ban on Doctor-Aided Suicide (LA Times, 960307)

COURT: In 8-3 ruling, judges say Washington law denies terminally ill adults due process under 14th Amendment. Supreme Court abortion decisions are cited as basis for ruling affecting nine western states.

For the first time in U.S. history, a federal appeals court on Wednesday ruled 8-3 that a mentally competent, terminally ill adult has a constitutional right to utilize a doctor’s assistance in hastening his death.

Stepping boldly into “a controversy that may touch more people more profoundly than any other issue the courts will face in the foreseeable future,” the U.S. 9th Circuit Court of Appeals in San Francisco held that the Washington law that makes physician-assisted suicide a felony is a denial of due process of law under the 14th Amendment to the federal Constitution.

“A competent, terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent,” appellate Judge Stephen Reinhardt of Los Angeles wrote in his majority opinion. “If broad general state policies can be used to deprive a terminally ill individual of the right to make that choice, it is hard to envision where the exercise of arbitrary and intrusive power by the state can be halted.”

Reinhardt’s analysis relies heavily on language drawn from U.S. Supreme Court abortion cases because the issues have “compelling similarities,” he wrote.

The decision, which may become the Roe vs. Wade of “right to die” jurisprudence, is applicable in nine western states, including California. This means that California’s ban on assisted suicide, which is comparable to Washington’s, is also unconstitutional.

Enhancing its magnitude, Wednesday’s ruling states that in addition to doctors, others “whose services are essential to help the terminally ill patient obtain and take” medication that will hasten death are covered by the decision and thus are not to be prosecuted. They include pharmacists who fill the prescriptions and family members who assist the patient.

The three judges in the minority wrote separate dissents. The lengthiest was by Robert Beezer of Seattle, who contended that Reinhardt incorrectly extrapolated from prior abortion rulings and predicted that the decision would have negative consequences for society.

Washington officials said they are considering an appeal to the U.S. Supreme Court.

USC constitutional law professor Erwin Chemerinsky said he thought the possibility of Supreme Court review is high because of the sweeping nature of the ruling.

“It is a dramatic change in the law in allowing people to not only refuse medical treatment but to take affirmative steps to hasten the end of life,” Chemerinsky said. “Potentially, this decision affects all of us someday.”

Although the decision has no immediate impact on the pending criminal trial of Dr. Jack Kevorkian in Michigan, its rationale would provide a strong defense for the conduct of Kevorkian, who has become a lightning rod nationally in the debate over the merits of physician-assisted suicide. Kevorkian has filed a constitutional challenge to California’s assisted suicide ban in Los Angeles federal court and a judge has deferred action pending the 9th Circuit’s ruling in the Washington case.

The ruling immediately intensified the controversy over assisted suicide. Praise came from civil libertarians and AIDS organizations and criticism from the American Medical Assn. and the Catholic Church.

Abortion Rulings Cited

Wednesday’s ruling reinstates a 1994 decision by U.S. District Judge Barbara Rothstein in Seattle. She agreed with the contentions of three terminally ill patients, four physicians who regularly treat such patients and Compassion in Dying, a nonprofit organization that provides support, counseling and assistance to mentally competent, terminally ill adults considering suicide. Rothstein found that Washington’s law violated due process and placed an undue burden on people seeking to hasten their death with the help of a doctor. (The three patients died while the case was pending.)

Nearly a year later, Rothstein’s ruling was overturned 2 to 1 by a panel of 9th Circuit judges, whose majority opinion stressed, “in the 205 years of our existence no constitutional right to aid in killing oneself has ever been asserted and upheld by a court of final jurisdiction.”

Soon thereafter, the plaintiffs’ attorney, Kathryn L. Tucker of Seattle’s Perkins Coie, persuaded the 9th Circuit to grant a rehearing before a larger panel of judges, setting the stage for Wednesday’s ruling.

“I’m really pleased by the decision,” Tucker said Wednesday.

William L. Williams, Washington’s senior assistant attorney general, said his office will take a while to decide whether to appeal to the Supreme Court. “Obviously, we’re disappointed.. .. The court seemed to understand that as difficult an issue as it is. .. it belongs to the people through the initiative or through their elected representative.”

Writing for the majority, Judge Reinhardt acknowledged the decision’s gravity:

“This case raises an extraordinarily important and difficult issue. It compels us to address questions to which there are no easy or simple answers, at law or otherwise. It requires us to confront the most basic of human concerns—the mortality of self and loved ones—and to balance the interest in preserving human life against the desire to die peacefully with dignity. People of good will can and do passionately disagree about the proper result, perhaps even more intensely than they part ways over the constitutionality of restricting a woman’s right to have an abortion.”

In a lengthy and scholarly opinion, Reinhardt acknowledged that the liberty interest recognized by the majority “must be weighed against the state’s legitimate and countervailing interests, especially those that relate to the preservation of human life.”

But Reinhardt said the state’s interest in preserving life “is not always controlling.”

“As the laws in state after state demonstrate, even though the protection of life is one of the state’s most important functions, the state’s interest is dramatically diminished if the person it seeks to protect is terminally ill or permanently comatose and has expressed a wish that he be permitted to die without further medical treatment.. .. When patients are no longer able to pursue liberty or happiness and do not wish to pursue life, the state’s interest in forcing them to remain alive is clearly less compelling.”

Reinhardt said the Supreme Court’s 1992 decision in Planned Parenthood vs. Casey, which upheld the basic right to legalized abortion established by Roe vs. Wade, provided “a powerful precedent” for Wednesday’s decision.

“The fundamental message of that case,” Reinhardt wrote, “lies in its statements regarding the type of issue that confronts us here: ‘These matters, involving the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, are central to the liberty protected by the 14th Amendment.’ “

Reinhardt added, “Like the decision of whether or not to have an abortion, the decision how and when to die is one of ‘the most intimate and personal choices a person may make in a lifetime,’ a choice ‘central to personal dignity and autonomy.’”

Reinhardt frequently cited Supreme Court Justice Sandra Day O’Connor’s opinion in the Planned Parenthood case, including passages that argue that the reach of the due process clause has expanded numerous times since it was enacted in 1868.

The majority also relied on the Supreme Court’s 1990 Cruzan decision that permitted the withdrawal of life-sustaining medical assistance under some circumstances. “We conclude that Cruzan, by recognizing a liberty interest that includes the refusal of artificial provision of life-sustaining food and water, necessarily recognizes a liberty interest in hastening one’s death.”

Dissenting Opinion

Beezer, based in Seattle, wrote the dissent on what he called “one of the most difficult, divisive and heart-wrenching issues” facing the courts and American society today.

“Given the tremendous advances in 20th century medical technology and public health, it is now possible to live much longer than at any time in recorded history,” Beezer wrote. “We have controlled most of the swift and merciful diseases that caused most deaths in the past. In their place are a host of diseases that cause a slow deterioration of the human condition: cancer, Alzheimer’s disease and AIDS are but a few.

“This change has forced us to step back and reexamine the historic presumption that all human lives are equally and intrinsically valuable,” Beezer stressed. “Viewed most charitably, this reexamination may be interpreted as our struggle with the question whether we as a society are willing to excuse the terminally ill for deciding that their lives are no longer worth living. Viewed less charitably, the reexamination may be interpreted as a mere rationalization for housecleaning, cost-cutting and burden-shifting—a way to get rid of those whose lives we deem worthless.”

Beezer said that this dilemma ought to be resolved by the nation’s citizens, either in the voting booth or in the legislature, on a state-by-state basis. “To declare a constitutional right to physician-assisted suicide would be to impose upon the nation a repeal of local laws,” he said.

Thirty-three states have statutes formally prohibiting such suicides. The District of Columbia and 10 other states have banned them by case law. The law is unclear in six states, according to Choice in Dying, a New York-based information group. In 1994, Oregon voters enacted the only statute in the nation permitting physician-assisted suicide. But a federal trial judge ruled it unconstitutional last year, a decision that is currently on appeal, as is a federal court ruling in New York that rejected a suit similar to the one filed in Washington.

To support the majority’s position that the Washington law imposed an undue burden on terminally ill patients and those seeking to help them end their lives, Reinhardt quoted declarations submitted under oath by the four physician plaintiffs. For example, Dr. Peter Shalit said that he wanted to help a terminal AIDS patient who “begged for assistance” to hasten his death, but Shalit felt he could not act because of the Washington law.

Shalit said his patient “lingered in the hospital for weeks, his lower body so swollen from oozing Kaposi’s lesions that he could not walk, his genitals so swollen that he required a catheter to drain his bladder, his fingers gangrenous from clotted arteries. Patient Smith’s friends stopped visiting him because it gave them nightmares. Patient Smith’s agonies could not be relieved by medication or by the excellent nursing care he received.. .. He died after having been tortured for weeks by the end-phase of his disease.”

Reinhardt said that although the Washington statute deterred physicians from prescribing drugs for the purpose of hastening death, it had not necessarily deterred the patients who requested drugs from committing suicide by other means.

In this regard, Reinhardt cited the declaration of a woman who said her terminally ill father killed himself in a secretive and lonely fashion in order to spare his family from possible criminal charges if they helped him hasten his death. She described her father’s death this way:

“When he realized that my family was going to be away for a day, he wrote us a beautiful letter, went down to his basement, and shot himself with his 12-gauge shotgun. He was 84.. .. My son-in-law then had the unfortunate and unpleasant task of cleaning my father’s splattered brains off the basement walls.”

‘The Right to Choose’

In essence, the majority framed the issue as removing the government from an intensely personal sphere.

“By permitting the individual to exercise the right to choose we are following the constitutional mandate to take such decisions out of the hands of the government, both state and federal, and to put them where they rightly belong, in the hands of the people,” Reinhardt wrote.

In this regard, Reinhardt wrote that “until relatively recently, while physicians routinely helped patients to hasten their deaths, they did so discreetly because all such assistance was illegal.”

Beginning about 20 years ago, Reinhardt noted, “a series of dramatic changes took place,” which gave individuals greater control in how and when they die, “in part as a result of legal actions and in part as a result of a growing recognition by the medical community and society at large that a more enlightened approach was essential.”

A 1976 case first drew national attention to these issues. The New Jersey Supreme Court ruled unanimously that the mechanical respirator keeping Karen Anne Quinlan alive could be disconnected if her attending physicians and a panel of hospital officials agreed that there was “no reasonable possibility” that she would recover from extensive damage she suffered when she suddenly stopped breathing a year earlier.

The same year, California became the first state to legalize by statute a patient’s right to refuse life-prolonging treatment when the state Legislature enacted the Natural Death Act, which permits “living wills,” a directive requesting that a doctor withhold or withdraw certain life-sustaining treatment.

In reality, Reinhardt said that numerous doctors, at the request of their patients, have gone further by utilizing morphine drips to relieve pain in dosages sufficiently high that death was inevitable. Reinhardt chided the American Medical Assn. for maintaining what he called a specious distinction between permissible “double effect” procedures—pain alleviation leading to death—and impermissible “single effect” procedures—prescribing medicine with the direct intent of causing death at the patient’s request.

Reinhardt’s analysis of those developments led him to one of the most crucial elements of the ruling. He rejected the Washington attorney general’s contention that there is a significant legal distinction between withdrawing life-sustaining medical assistance such as a respirator or a feeding tube and the prescription or administration of life-ending medication.

“The line between commission and omission is a distinction without a difference now that patients are permitted not only to decline all medical treatment, but to instruct their doctors to terminate whatever treatment, artificial or otherwise, they are receiving,” Reinhardt wrote. “In disconnecting a respirator, or authorizing its disconnection, a doctor is unquestionably committing an act; he is taking an active role in bringing about the patient’s death.”

Dissenter Issues Warning

Reinhardt, a staunch liberal appointed by President Jimmy Carter, was joined by seven other judges. Five—James Browning, Procter Hug, Mary Schroeder, Betty Fletcher and Harry Pregerson—were appointed by Democratic presidents and two—Charles Wiggins and David Thompson—appointed by Republican presidents. All three dissenters—Beezer, Ferdinand Fernandez and Andrew Kleinfeld—were appointed by Republican presidents.

Beezer warned at the end of his dissent that Wednesday’s ruling could create a death-oriented culture. “If physician-assisted suicide for mentally competent, terminally ill adults is made a constitutional right, voluntary euthanasia for weaker patients, unable to self-terminate, will soon follow,” he predicted.

“After voluntary euthanasia, it is but a short step to a ‘substituted judgment’ or ‘best interests’ analysis for terminally ill patients who have not expressed their constitutionally sanctioned desire to be dispatched from this world,” Beezer wrote. “This is the sure and inevitable path.. .. It is not a path I would start down.”

Beezer asserted that the poor and minorities would be particularly vulnerable to pressure to end their lives early. His opinion quotes the 1994 New York State Task Force on Life and the Law which came out against sanctioning physician-assisted suicide:

“It must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care. Those who will be most vulnerable to abuse, error or indifference are the poor, minorities and those who are least educated and least empowered.”

Reinhardt took issue with virtually all of Beezer’s positions. “The argument that disadvantaged persons will receive more medical services than the remainder of the population in one, and only one area—assisted suicide—is ludicrous on its face,” he wrote.

“Nor is it likely that the disabled will be pressured into committing physician-assisted suicide. Organizations representing the physically impaired are sufficiently active politically and sufficiently vigilant that they would soon put a halt to any effort to employ assisted suicide in a manner that affected their clients unfairly.”

Reinhardt acknowledged that the risk of undue influence from “callous, financially burdened or self-interested relatives” or other individuals who have influence over an infirm or elderly person is real. However, he said that risk already exists and that Wednesday’s decision “would not increase that risk unduly.”

The state of Washington could deal with the risks and protect its legitimate interests “by adopting appropriate, reasonable and properly drawn safeguards,” Reinhardt wrote.

For example, he said the state might require witnesses to ensure voluntariness, reasonable, though short, waiting periods to prevent rash decisions, and second medical opinions to confirm a patient’s terminal status and also to confirm that the patient has been receiving proper treatment.

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Reactions Strong and Divided (LA Times, 960307)

Religious organizations condemned the ruling; civil libertarians applauded it. The American Medical Assn. attacked it; individual doctors supported it. Bioethicists were split.

But from all directions, the reactions to the federal appeals court decision approving physician-assisted suicide were swift and emotional. The one thing everyone agreed on was the decision’s enormous import.

“Hallelujah,” proclaimed Kelly Scott, public policy director of the Northwest AIDS Foundation in Seattle, which filed a friend-of-the-court brief in the case. “I’m not sure if this will lead to more physician-assisted suicides by those with AIDS. But for those who are facing death with AIDS, or even having to think about it, court recognition of their private right to die with dignity will give them a lot of peace.”

“I’m appalled,” reacted Sara DiVito Hardman of Tarzana, state director of the Christian Coalition. “Has human life such little value? Where is this going to lead now? Scripture does not make allowance either for killing the unborn or for euthanasia.”

Burke Balch, director of the National Right to Life Committee’s Department of Medical Ethics, predicted dire consequences. “No one should think that this ruling can be applied only to those who ‘voluntarily’ say they seek death,” he said, forecasting that guardians or trustees will have the power to authorize the deaths of persons declared mentally incompetent.

“Exercising a right to die is not like choosing Pepsi over Coke,” said Joni Eareckson Tada, the wheelchair-using leader of JAF Ministries in Agoura Hills and a popular speaker in evangelical Protestant circles.

“The end-of-life issues are so complex, so subjective and hugely arbitrary that is impossible to frame such freedoms within legislation. It would allow too many wrong decisions by too many people,” she said, predicting that the U.S. Supreme Court will have similar doubts.

Patrick Nichelson, professor of religious studies at Cal State Northridge, praised the decision, however, citing personal experiences “with family and friends who had death struggles, prolonged by medicine.”

“What we are trying to do in society is find an open way to talk about and legitimate humane practices [of assisting death] that have been underway for ages between doctors and patients,” Nichelson said.

Dr. Thomas A. Preston, a Seattle cardiologist and a plaintiff in the case, also applauded the decision, saying the ‘slippery-slope’ arguments being advanced by opponents of physician-assisted suicide parallel those made 15 years ago “when doctors started to withdraw ventilators from patients who requested it. The fact is that nobody really has charged that the medical profession has abused this practice since we have been allowed to do it.”

Nonetheless, the American Medical Assn., which has long opposed physician-assisted suicide, lamented the ruling: “We would stand by our stance that it would be unethical for a physician to participate in an assisted suicide, which would be the active killing of a patient.”

Dr. Bob Leibowitz, a Tarzana-based cancer specialist, expressed fears that the decision opens a window that some families may try to force even wider.

“If you don’t have safeguards, then you’re going to have euthanasia that is not in the patient’s best interest,” he said. “Family members who want to obtain an estate quickly can be very persuasive at telling a mother or father that they should die sooner than they really have to.”

Leibowitz also said he feared that health-maintenance organizations, finding it cheaper to let people die who could lead full lives for years on expensive medication, “will be pressuring doctors to recommend to patients that no care is the best care.”

The response in the religious community was particularly strong, even though the 9th Circuit decision specifically said that it was not granting broad license for euthanasia, also called mercy killing.

The Catholic Church has long opposed euthanasia, branding it “a grave violation of the law of God” in a 1995 Papal Encyclical.

Mark Chopko, general counsel of the U.S. Catholic Conference, called the ruling “a novel and dangerous expansion of the law” that obliterates “a distinction that has long been recognized—not just in the law but in medicine—” between withdrawing medical assistance and taking active steps to hasten death.

Similar opposition came from a spokesman for the 5.2-million-member Evangelical Lutheran Church in America and Rabbi Lawrence Goldmark, incoming president of the Board of Rabbis of Southern California.

While religious leaders are overwhelmingly opposed to assisted suicide, opinion is by no means unanimous. In January, the Episcopal Diocese of Newark led by liberal Bishop John Spong declared that committing suicide or helping someone else commit suicide may be morally acceptable for Christians in some circumstances. But that is not the position of the national Episcopal Church.

Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics, observed that “a courtroom is a terrible place to resolve deeply divisive social issues such as assisted suicide. If we’ve learned anything from the national agony over abortion, it is that tough, contentious questions of morality need to be settled at the ballot box, not by a judge or a panel of judges.”

In Sacramento, Assemblywoman Kerry Mazzoni (D-Novato), who authored a bill last year to legalize assisted suicide, said she was encouraged by the court’s decision. But she said the issue remains so controversial among legislators that the best approach to put an assisted-suicide law on the books is through a ballot initiative. Four years ago, California voters rejected such a measure by a 54%-46% margin.

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Doctors Divided Over End of Ban on Aided Suicide (LA Times, 960308)

MEDICINE: Many hail landmark court ruling, but worries about potential abuses are widespread.

The landmark federal court ruling lifting the ban on physician-assisted suicide was hailed by many physicians Thursday for granting terminally ill patients much-needed control over their fate. But it also revealed deep divisions within the healing profession, with some doctors worrying that it might touch off a wave of unnecessary and perhaps grisly suicides abetted in the name of mercy.

“Doctors are not in the business of speeding people on their way out of their lives,” said Dr. Jack Lewin, chief executive of the California Medical Assn., which opposes physician-assisted suicide.

“This act has a tremendous potential for abuse,” he said. “In today’s for-profit health-care world, one could imagine in the future a corporation wanting to save money on hospital beds by hastening a patient’s death.”

At the heart of Wednesday’s ruling by the U.S. 9th Circuit Court of Appeals, which was prompted by a challenge to the state of Washington’s ban on physician-assisted suicides, was an observation that few doctors dispute: Far from always easing suffering, high-tech medicine seems increasingly to plunge gravely ill people into a sort of dark tunnel of futile care with no exit.

By holding that “a competent, terminally ill adult. .. has a strong liberty interest in choosing a dignified and humane death,” the court has given great new impetus to death-with-dignity measures by arguing that they are protected by a constitutional right to personal liberty.

* * *

Still, the ruling does not automatically render physician-assisted suicide legal. It is likely to be challenged, with the Supreme Court having the final word, legal experts say. And even doctors who have hesitated to provide such assistance out of fear of penalty are expected to wait until states and medical licensing boards draw up guidelines regulating the practice.

In California, no such professional or legal guidelines are currently in place.

The controversy concerns how doctors should usher sick people through their last days. Some see physician-assisted suicide—in which a doctor prescribes lethal drugs to a mentally competent adult with a certifiable terminal illness—as merely a logical extension of their practice.

“Some people with cancer are in their last stages of life and their existence becomes completely miserable and excruciatingly painful,” said Dr. C. Ronald Koons, an Orange County radiation oncologist. “They’ll ask you, “How much longer must I go through this? Can’t you make it stop?’ “

Dr. Lonny Shavelson, a board member of the San Mateo-based advocacy group Death With Dignity, said, “This is a medical procedure. It should be regulated very carefully like other medical procedures.” He added that the ruling should make doctors confronting the dilemma feel “easier” about helping dying patients end their lives.

Many doctors were ambivalent about the ruling, saying they were glad to have the issue so prominently debated but also concerned that doctors do not know enough about how to perform the task adequately.

That was reflected in a survey of Oregon physicians published last month in the New England Journal of Medicine. Although 60% of those surveyed were in favor of legalizing assisted suicide, more than half of them said they were not sure they could rule out the possibility that a patient’s request to die reflected depression, which may be treatable.

“The physician must have convincing evidence that the person is competent and not. .. irrational,” said Dr. Ron Miller, director of UCI Medical Center’s medical ethics program, who opposes the decision.

“This shows that we are disrespectful of life and sends the wrong message at a time when we do not even guarantee health care to everybody in the country,” he said.

And half of those in favor said they would not know which drugs to prescribe to help patients end their lives, raising the specter of botched suicides. “I’m concerned that there will be a number of bungled attempts,” said Dr. Miles Edwards, an ethicist and emeritus professor of medicine at the Oregon Health Sciences University. “What do you do then? What does an emergency room physician do if someone comes in comatose? Resuscitate him? Should he back off?”

* * *

Another potential problem that lawmakers will have to grapple with is that patients may be subtly coerced into ending their lives by physicians, hospitals, even family members.

Most ominous, numerous doctors said, is the possibility that facilitated suicide might someday be viewed as a cost-cutting measure. “I’m sure there will be pressure from the business side” to turn to physician-assisted suicide, said Dr. Victor Dorodny, president of the Pacific division of the National Assn. of Managed Care Physicians. “Something like 70% of expenditures occur in the last six months of life.”

The Rev. Brad Karelius of Episcopal Church of the Messiah in Santa Ana agreed.

“Money will move the decision to kill people,” he said. “These days you are dealing with a doctor who, most likely, doesn’t know you well. How will he know if you are really suffering?”

Dr. Linda Emanuel is an internist at Massachusetts General Hospital and an incoming vice president of the ethics standards committee of the American Medical Assn., which opposes physician-assisted suicide. She said that all of the patients who have asked for her help in committing suicide have later withdrawn the request once she discussed with them other options, such as aggressive pain management. “Once they understood that I was not about to abandon them, and that there were [natural] ways of dying that were not burdensome or painful,” they changed their minds.

Ironically, Shavelson, who applauded the new ruling, speculated that physician-assisted suicide, which is today practiced in secret, may become less common if it’s legalized. He recalled a patient with an inoperable brain tumor whose ability to swallow was fast disappearing. She killed herself by swallowing morphine pills while she still could.

Shavelson said that if she had been able to trust that a physician was ready to help her in the end, “She would have had a better chance at a natural death.”

“The most significant thing we can offer patients,” he said, “is the reassurance that no matter what, they’ll be OK.”

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Debate: Self-Determination Is Affirmed (LA Times, 960308)

ASSISTED SUICIDE: This compassionate alternative to suffering ‘a bad death’ rests on human decency and carefully drawn laws.

By DEREK HUMPHRY, Hemlock Society (Pro-euthanasia)

When I started out in 1980 on the campaign to legalize physician-assisted suicide, I knew it would be a long-term struggle. There were plenty of cheap remarks and jibes about this being just another flaky California group.

This week, when the U.S. 9th Circuit Court of Appeals said that there was a constitutional right to this procedure, it was a major steppingstone toward national acceptance of what is, at root, just common sense behavior by one human to a less fortunate other.

But if that time span is what it takes to achieve this ultimate civil liberty, then it has been worth it. It is obvious that the ending of a human life is an awesome decision and must be approached with great caution.

By striking down Washington state’s prohibition against assisted suicides, the appellate court indirectly approved a law for the dying who express a desire to shorten their suffering with lethal drugs. These drugs are available only from physicians and there must be appropriate counseling, waiting periods and documentation to accompany the decision to die.

The assisted suicide movement never has sought approval of accelerated death for the mentally or physically handicapped, the depressed or for the poor or elderly. Let me put that canard firmly to rest. What we are now close to getting in America is choice in dying for those unfortunate few—perhaps 5% of all who die—whose suffering and/or indignities the medical profession is unable to alleviate.

Hospices will flourish, pain management will improve, medical life-support systems will be used more discreetly, as all health professionals instinctively struggle to reduce the number of requests for assisted suicide.

It is fair to ask whether pain management and hospice care would be as good as they are now if it had not been for the noisy intervention of the right-to-die movement.

Legalizing assisted dying will remove it from the present secret crime of the bedroom and enable doctors to stop acting covertly. Jack Kevorkian may be the only one who faces court trials but he is one of hundreds of American doctors who quietly assist suicides.

Even more important, doctors will be able, with legalization, to call for second opinions, get psychological evaluations and talk with the dying person’s family or spiritual advisors before prescribing the lethal drugs. Today, the help is given to the dying by one doctor acting alone without team backup, an unfair and unwise responsibility.

It may be asked if we need this procedure for only 5% of the dying population. But more than 2 million Americans die every year in the normal cycle of birth, life and death, making 5% a sizable number.

The greatest boon of legalization is the real comfort it will bring to those who are told that they are terminally ill. They will know that even if they are destined to become one of the unlucky few to meet “a bad death,” there is now a compassionate escape hatch.

Is this the start of the slippery slope toward killing off the burdensome—our expensive elder folk, our physically and mentally handicapped, our citizens on welfare? If you believe that, it would be best to leave the country now, because you have no faith in the goodness of human nature or the ability of the American democratic system to protect the weak.

Assisted dying must come into being with carefully drawn laws, accompanied by sensitive guidelines. This will be the mark of America as a great civilization: when it can allow the right to die with fairness and responsibility while at the same time saying “thus far and no farther.”

Derek Humphry founded the Hemlock Society and is author of “Final Exit.” He Lives in Junction City, Ore.

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Debate: There Is No Right to Kill (LA Times, 960308)

ASSISTED SUICIDE: The Supreme Court is sure to reject this perversion of the Constitution by compassionate impulse.

By DOUGLAS W. KMIEC

Contrary to the startling opinion of appellate Judge Stephen Reinhardt for the U.S. 9th Circuit Court of Appeals in San Francisco, there is no constitutional right to commit suicide. Neither the foundational principles of the American republic nor the common law sustain Reinhardt’s reasoning. The U.S. Supreme Court has shown little hesitancy in reversing this judge in the past, and for the sake of a culture and a community increasingly scarred by senseless death, the court should do so again.

The Reinhardt opinion arose in a case challenging a Washington statute that makes it a crime to promote the suicide of another. An appellate panel earlier rejected the challenge, but Reinhardt reversed that decision with the proposition that the right to choose death is simply an aspect of personal choice.

Nominally, the Reinhardt opinion is limited to the terminally ill, but once the right to take one’s life is claimed as a matter of personal liberty, it will prove difficult to limit. The category of terminally ill, itself, is vague at its core. A terminal illness can vary from days to years with AIDS and some forms of cancer. Other illnesses related to heart disease are curable with a transplant; are they terminal illnesses? There is much wisdom in the sentiment that life itself is a terminal condition.

Reinhardt’s newly minted suicide right has no support in the two centuries of our constitutional existence. It is a prime example of judicial lawmaking unknown to the common law and antithetical to human life. The Declaration of Independence declares life an “unalienable right.” And unalienability precisely means that life is incapable of being forfeited or transferred by anyone.

Beyond its distortion of the Constitution and disregard of the “self-evident” truths in our declaration of national purpose, the invented suicide right is a serious affront to the democratic process. In this, it is not surprising that Reinhardt finds his principal support in the rulings on abortion. However one may feel about that emotional issue, it is plain that the intervention of federal judges here, as there, imperiously preempts the democratic decision-making of state and local governments, a majority of which treat assisting suicide as a crime, not a liberty.

Tragically, the existence of the putative suicide right puts enormous psychological pressure on the elderly and the disabled. We do what the doctor orders, and as a New York commission found, “Once the physician suggests suicide or euthanasia, some patients will feel that they have few, if any alternatives, but to accept the recommendation.”

This is especially true of the poor. Pain can be a strong encouragement for suicide, and the poor have far less means of alleviating severe pain. In these days of reduced public expenditure, there is but a short distance between the false proclamation of a personal suicide right and the generalized calculation that this might well reduce the overall cost of public assistance.

The law has always recognized a right to be let alone in the sense of allowing each of us to avoid infliction of medical procedures against our will. Faith traditions differ as to when medical assistance can be morally declined, with many drawing the line at extraordinary care of no benefit to the patient. But neither the law nor morality has ever likened the informed withdrawal or withholding of useless or extraordinary medical treatment with assisted suicide.

The doctors and family members who seek the right to take the lives of others no doubt are motivated by a desire to end horrendous suffering. In this, they act out of compassion. But compassion is not the totality of life. Indeed, compassion can lead to tragedy when it is unguided by the common sense of the common law and restraining virtue. Reinhardt proclaims himself for freedom. But freedom untethered from responsibility is license—even, apparently, license to kill.

Douglas W. Kmiec is a Distinguished Visiting Professor of Law at Pepperdine University. He is on leave from the University of Notre Dame.

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A Matter for Lawmakers That Won’t Die (LA Times, 960408)

LEGISLATION: State lawmakers can no longer avoid the intense debate over doctor-assisted suicide.

Probably few issues have more confounded the medical profession over the years than what to do when terminally ill patients ask doctors for compassionate help in ending their lives. Physician-assisted suicide and euthanasia are matters that can no longer be ignored or papered over. Patients, doctors and now the courts have forced the issue. Ruling in Washington state and New York cases recently, federal appeals courts have issued strong, well-reasoned decisions that offer protection to doctors who agree to help a patient commit suicide. This means that such actions are legal now in 12 states. At least until the Supreme Court finally comes to grip with the question.

This is an issue whose time has come, despite deeply principled opposition from the American Medical Assn., many individual doctors and ethicists and the Roman Catholic and other churches. As any doctor knows, for decades colleagues have quietly complied with patient requests to die. Euthanasia is legal in the Netherlands, a pioneer in this regard, but in the United States many of those who have pushed it have faced legal consequences.

Now a new study from Washington state documents the extent to which such requests are made and honored. It found that 16% of doctors annually received one or more requests for help in suicide or euthanasia. Moreover, 24% of such requests were granted by the doctors despite legal risks, the study asserts, only slightly less than the 33% granted by legally protected Dutch doctors.

Interestingly, the reasons for suicide requests have changed dramatically in recent years. In the past, most requests were from people suffering intractable pain from cancer and other diseases. Now, however, pain is largely controllable. Patients fear more the loss of control and dignity, and the dependence and financial burden often associated with the end stage of fatal ilness. As the Washington study, published in the Journal of the American Medical Assn., put it: “Notably, neither severe pain nor dyspnea [shortness of breath] was a common patient concern, suggesting that intolerable physical symptoms are not the reason most patients request physician-assisted suicide or euthanasia.”

Or as Judge Stephen Reinhardt wrote in his majority opinion for the 9th Circuit appeals court, which struck down a Washington state law against assisted suicide: “A competent terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent.” As a result of Reinhardt’s ruling and a similar one issued by the more conservative 2nd Circuit last week in New York, the matter is ripe for Supreme Court review.

No longer should patients be reduced to finding ways to secretly do themselves in; the botched results of a failed suicide attempt can be horrific and expensive. Liberalizing state laws has been hampered by memories of the Nazi years in Germany, where, to their eternal shame, once-respected doctors collaborated in the elimination of the elderly, dwarfs and other “defectives.” Lacking such a dreadful history, this country should be able to arrive at a just legal resolution. Legal experts say the New York ruling, based on constitutional safeguards guaranteeing equal protection under law, was more narrowly drawn and therefore more likely to survive Supreme Court scrutiny than the 9th Circuit ruling, which was based on due-process rights.

In any case, it is time for the states to stop resisting. Washington state is likely to appeal the 9th Circuit ruling, and Atty. Gen. Dan Lungren of California, which is part of the 9th Circuit, is expected to defend the California laws against assisted suicide. The better course would be for the governor and the state Legislature to recognize the inevitable and start crafting new laws. Organized medicine must also play a role; welcome is news that the AMA has begun to review its long-standing ethical objections to doctor-aided suicide.

The big concern is that doctors would acquiesce with relatives who wanted to lift the burden of caring for a sick parent or to accelerate an inheritance. Therefore, the appropriate committees of the Legislature should start now drafting legislation requiring second medical opinions and ironclad layers of medical protection against abuses. Otherwise, the Legislature will yet again find itself relegated to irrelevance by a voter initiative or the courts.

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U.S. Court Strikes Down N.Y. Ban on Assisted Suicide (LA Times, 960400)

WASHINGTON—In another victory for advocates of a constitutional right to die, the U.S. appeals court in New York on Tuesday struck down that state’s law barring doctors from helping terminally ill persons end their lives.

In a 3-0 ruling, the appeals court said it made no sense to allow doctors to end the lives of those who are hooked up to respirators, while requiring them to preserve the lives of other terminally ill patients who are not on life-support systems.

This discrimination by law violates the Constitution’s equal protection guarantee, the appeals court said, because it “is not rationally related to any legitimate state purpose.”

“Physicians do not fulfill the role of ‘killer’ by prescribing drugs to hasten death any more than they do by disconnecting life-support systems,” wrote Judge Roger J. Miner of Albany, N.Y.

Three doctors and three dying patients—one with cancer and two with AIDS—brought the lawsuit challenging New York’s ban on assisted suicide as unconstitutional.

The 36-page opinion in their favor strengthens the fast-evolving constitutional right to die in two ways.

First, the opinion adopts a second reason—discrimination—for striking down state laws that bar all doctor-assisted suicides. This approach is grounded in a long line of Supreme Court decisions forbidding different treatment for people in similar situations.

By contrast, the U.S. 9th Circuit Court of Appeals for nine Western states, including California, relied on previous abortion rulings last month when it decided Americans have a right to personal liberty and privacy that gives them—rather than the government—the right to decide to end their suffering when they are terminally ill.

Judge Stephen Reinhardt of Los Angeles, writing for the 8-3 majority, quoted from Supreme Court rulings upholding the privacy right.

Harvard law professor Laurence H. Tribe said that the equal-protection argument may stand up better in the Supreme Court.

“While I find much to admire in Judge Reinhardt’s opinion, this [equal protection] provides a more modest and narrow path for getting there. There is something utterly arbitrary and unintentionally cruel in condemning some competent terminally ill patients to continue their suffering because they have not been put on respirators,” said Tribe, who supports the “right to die.”

Secondly, Tuesday’s opinion emerged from a more conservative appeals court and was written by an appointee of former President Reagan, meaning that now both conservative and liberal judges have upheld a right to die.

Miner, 61, was appointed as district judge by Reagan in 1981 and elevated to the appeals court in 1985. He was joined in the ruling by former Yale Law School Dean Guido Calabresi, an appointee of President Clinton, and senior U.S. District Judge Milton Pollack, who was appointed by former President Johnson.

“We are elated at this second sweeping civil rights victory for terminally ill patients who wish to have. .. assistance in hastening death. .. to end their suffering,” said Ralph Mero, executive director of Compassion in Dying, a Seattle-based group that sponsored the legal challenges in New York and Washington state.

But others remain opposed to the idea of a right to die. Opponents include the Catholic Church and the American Medical Assn. Leaders of both groups questioned the authority of judges to nullify long-standing laws that forbid assisted suicide.

Dr. Nancy Dickey, AMA president, said doctors draw a sharp distinction between using technology to keep alive a dying person and actively using drugs to end a patient’s life.

“Stepping over that line [to assist a suicide] is not in the best interest of patients or society,” she said.

Tuesday’s ruling almost assures that the Supreme Court will take up the issue within the next year.

The 9th Circuit Court ruling declares that a constitutional right to die exists in the nine Western states, including California. Attorneys for Washington state said they would appeal to the Supreme Court by June.

The 2nd Circuit ruling extends the right to die to include New York, Connecticut and Vermont.

“It’s the population of about half the country between these two decisions,” said Kathryn Tucker, an attorney for the right-to-die advocates.

The lead plaintiff in the New York case, Dr. Timothy E. Quill, was investigated by a grand jury after he published an article in 1991 in the New England Journal of Medicine in which he described giving barbiturates to a dying cancer patient. The three patients included George Kingsley, a 49-year-old publishing executive with AIDS; William A. Barth, a 28-year-old fashion editor, also with AIDS; and a 76-year-old cancer patient known as Jane Doe. All have since died.

On the other side, the Michigan Supreme Court has said that no right to die exists in American law. It has upheld that state’s move to prosecute retired pathologist Jack Kevorkian for aiding terminally ill patients in ending their lives.

Yale Kamisar, a University of Michigan law professor opposed to the right to die, said he continues to believe the Supreme Court will not strike down the traditional state laws against assisted suicide. “But I must confess I’m less sure of my position than I was a month ago,” he said.

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High Court Hears Assisted Suicide Case (New York Law Journal, 970109)

Vacco Defends State Law, Tribe Argues Challenge

STATE ATTORNEY General Dennis C. Vacco defended New York’s ban on physician-assisted suicide yesterday during a two-hour oral argument in the U.S. Supreme Court, telling the Justices that “the common law has long recognized the right to refuse treatment,” springs from the “right to be free of battery and the right to be let alone.”

Mr. Vacco directly disputed a conclusion by the U.S. Court of Appeals for the Second Circuit that New York’s ban was an unconstitutional violation of equal protection because the prescription of life-ending drugs in the final stages of a terminal disease can be equated with the withdrawal of life-sustaining treatment.

Drawing a bright-line distinction, Mr. Vacco told the Court, which also weighed a similar ban from the State of Washington, that individuals have “no right to have a third-party physician help them kill themselves.”

Arguing on behalf of the three physicians and three patients, all of whom died before their challenge to the New York statute was adjudicated by the lower courts, Harvard Law School Professor Laurence H. Tribe did his best to muddy the distinction made by Mr. Vacco.

Typically, in modern medical practice, Mr. Tribe argued, patients make decisions to accept all sorts of elaborate life-extending procedures, such as chemotherapy and transplants, which they are free to refuse. The notion that there is a “closed class of cases that lack a plug to be pulled is fantasy,” he said.

Moreover, he contended, an accepted but unregulated medical practice, called terminal sedation, has developed which is indistinguishable from helping terminally ill patients end their lives. Under that procedure, sedatives are used to render the terminally ill patient comatose. Then water and nutrition are withheld, which is allowed under the Supreme Court’s 1990 decision in Cruzan v. Missouri Department of Health, 497 U.S. 261, until, over a course of two weeks, the patient starves to death.

The two cases argued yesterday, Vacco v. Quill, No. 95-1858, from the Second Circuit and Washington v. Glucksberg, No. 96-110 from the Ninth Circuit, bring to the High Court a combustible mix of issues. The right to die, in and of itself an emotionally explosive subject, has at its doctrinal core the Supreme Court’s latest abortion ruling in Planned Parenthood v. Casey, 505 U.S. 833 (1992).

Criminal Act

The Ninth Circuit accepted the argument that Casey’s finding of a liberty interest in the abortion context should be extended to the right of competent, terminally ill patients to receive medication from their doctors to allow them to end intolerable suffering. The Second Circuit, although it rejected the due process liberty argument, struck New York’s law on equal protection grounds.

New York’s law, Penal Law §125.15(3), classifies the provision of assistance to another to commit suicide, as second-degree manslaughter, a crime punishable by a maximum sentence of 5-to-15 years in prison. Thirty-four other states have laws making it a criminal act to help another person commit suicide.

The Second Circuit found the New York statute defective in that it could potentially punish doctors for giving competent, terminally ill patients, in the final stages of their illnesses, pills which they themselves could take to end their misery.

The challengers’ efforts to keep the case on as narrow grounds as possible gave the argument an odd twist, with both Professor Tribe and Katheryn Tucker, who argued the Washington case, rejecting the right to die in any but the narrowest circumstances. They both contended that the state could punish as suicide self-inflicted deaths in a variety of other circumstances, including patients in severe pain, but not yet in the end stages of a fatal disease.

The right-to-die issue has been widely popularized by Dr. Jack Kevorkian, who has not so carefully circumscribed his practice. Dr. Kevorkian has helped 46 patients commit suicide and been acquitted three times of criminal charges in Michigan. He faces charges in two more cases.

One of the plaintiffs in the New York case, Dr. Timothy Quill, also helped bring the issue to the forefront, at least within the medical profession, with a 1992 article in the New England Journal of Medicine in which he described how he had prescribed a life-ending dose of barbituates for one of his patients.

Three statewide referenda on proposals to allow doctor-assisted suicide have also helped the issue gather steam. Voters in Washington and California rejected the concept, while voters in Oregon adopted a law allowing doctors to engage in the practice. The Oregon law, however, has been stayed pending the outcome of the cases in the Supreme Court.

State Decisions

Judging from the questions of at least two Justices, David Souter and Stephen Breyer, the Court may not be anxious to resolve the far-reaching issues until more information is developed through experimentation with physician-assisted suicide at the state level. Both Justices Sandra Day O’Connor and Anthony Kennedy asked pointed questions, suggesting the issue be left to state legislatures to resolve.

Typical of the tenor of much of the argument was Justice Souter’s comment in response to an exchange between Professor Tribe and Justice Breyer. Professor Tribe rebuffed Justice Breyer’s suggestion that more state experimentation was needed, saying “the lights are out” in the 50 state laboratories.

That prompted Justice Souter to comment that only “fairly recently” has the question surfaced as a “serious legislative issue.”

In another series of exchanges that must have given the challengers pause, Ms. Tucker ran into heavy fire as she sought to argue that the liberty interest recognized in Cruzan to withdraw life-sustaining treatment should be extended to the right to die. Both Chief Justice William Rehnquist and Justice Kennedy pointedly reminded her that the liberty interest she was positing had only been “assumed” by the Court in Cruzan.

Justice Ruth Bader Ginsburg then jumped into the argument to note that in Cruzan the Court had upheld Missouri’s scheme for allowing the rejection or withdrawal of life support mechanisms. What the Court said about a liberty interest in Cruzan does not seem “at all helpful” to the challengers’ efforts to strike down laws in New York and Washington, she said.

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What’s Liberty’s Scope? (National Law Journal, 970120)

Assisted suicide was court’s focus, abortion the subtext.

WASHINGTON —With less than a minute remaining in back-to-back, two-hour-long arguments on the constitutionality of physician-assisted suicide, U.S. Supreme Court Justice John Paul Stevens leaned forward and asked Harvard Law School’s Laurence H. Tribe the $64,000 question: “What is the liberty interest?”

It was a question Professor Tribe clearly had been hoping to address from the beginning of his 30-minute appearance but never had the chance to because of the justices’ fast-paced questioning on other issues. And the question was one to which Professor Tribe, even though he was defending an appellate decision based on equal protection principles, had devoted most of his merits brief.

It was also the question that had to be answered first in these challenges, not last, Justice Anthony M. Kennedy had noted nearly two hours before Justice Stevens spoke, explaining, “The analysis is usually to determine whether there is a liberty interest at the outset.”

The liberty interest protected by the Constitution, Professor Tribe told Justice Stevens, is the interest of the terminally ill, mentally competent individual, “when facing imminent death,” not to be forced by the government to endure agonizing pain and suffering that can be relieved only by drug-induced unconsciousness.

This liberty interest, he and co-counsel, Kathryn Tucker, of Seattle’s Perkins Coie, contend, implicates a “constellation of interests” flowing from personal autonomy and human dignity, all of which are within the substantive sphere of liberty protected by the 14th Amendment.

“Lovely philosophy,” said Justice Antonin Scalia. “All of this is in the Constitution?” “Casey said as much,” Professor Tribe answered, referring to the high court’s most recent abortion ruling, Planned Parenthood v. Casey, 505 U.S. 833 (1992). Unless Casey is isolated to the abortion context, he and others believe, the high court must recognize the protected liberty interest of this category of patients who want and need a physician’s assistance in carrying out this most personal decision.

Abortion Loomed Large

Casey and the high court’s experience with post-Roe v. Wade abortion litigation loomed in the background of the intense and complex arguments Jan. 8 in Vacco v. Quill, 95-1858, and Washington v. Glucksberg, 96-110—the two cases in which Professor Tribe and Ms. Tucker defended, and New York and Washington challenged, circuit court rulings that struck down the two states’ bans on assisted suicide.

Although abortion precedents were invoked less than a handful of times during the two hours, they clearly were never far from the justices’ minds.

For example, when Ms. Tucker told the court she was asking it to protect the terminally ill patient’s choice but not to legislate its regulation, Chief Justice William H. Rehnquist predicted that ultimately, “You’re going to have the same thing as in abortion. How far do we go in regulating this? It will be a constitutional case in each one.” And Justice Sandra Day O’Connor added, “I have no doubt it would result in a flow of cases for heaven knows how long.”

By the end of the arguments, it appeared that many justices were reluctant to overturn the laws in 49 states. What was less clear was whether they would, in the words of Professor Tribe, isolate Casey, heavily relied on by the 9th U.S. Circuit Court of Appeals in Glucksberg.

“Like the decision of whether or not to have an abortion, the decision how and when to die is one of ‘the most intimate and personal choices a person may make in a lifetime,’ a choice ‘central to personal dignity and autonomy,’” the appellate court said, quoting Casey.

‘Casey’ at the Bar

In the privacy of their conference room and chambers, the justices face the question of whether a liberty interest exists here, made perhaps more complicated by the urging of some staunch Casey proponents to isolate the decision, say some constitutional scholars.

Supporting the state bans on assisted suicide, the solicitor general of the United States nevertheless argued that a competent, terminally ill adult does have a liberty interest in obtaining relief from severe pain or suffering. But that interest cannot be equated with the interest recognized in Casey, he contended.

Although relief from pain and suffering is also part of the interest underlying the right to choose an abortion, he argued, that right implicates much more than the interest at stake in the assisted-suicide context. It implicates the ability of women to participate equally in the nation’s economic and social life. He urged the justices to look to another line of precedents and its last right-to-die case, Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990), to find the liberty interest he defined.

But ultimately, the solicitor general concluded, “overriding state interests,” such as preventing abuse, justify state assisted-suicide bans.

On the opposite side, the New York-based Center for Reproductive Law & Policy—whose vice president, Kathryn Kolbert, argued and won the reaffirmation of the right to abortion in Casey—agrees with the solicitor general’s characterization of the abortion right as unique and stresses the “important differences” between the two liberty interests.

The justices don’t even have to consider its abortion precedents to decide the Washington case, Ms. Kolbert insists. By relying on other bodily integrity and personal autonomy precedents, primarily Cruzan, the court will find that a terminally ill person has a protected liberty interest in seeking medication to hasten death.

Both the Clinton administration and pro-abortion rights advocates have a common interest in ensuring no erosion of Casey, says constitutional law scholar Douglas Kmiec, of Notre Dame Law School.

“The solicitor general sought to convince the court it could decide these cases by declining to find a right to assisted suicide and in so declining, it would not jeopardize the abortion precedent,” he says. “In order to do those mental gymnastics, the solicitor general had to re-center the Roe and Casey analysis from liberty to equality. But that is not the rationale the court has used.”

Casey says that at the heart of liberty is the right to define one’s own existence or place in the universe, Professor Kmiec explains, adding, “If that’s the operating principle, it’s very hard to distinguish the abortion cases from assisted-suicide cases.”

Protecting ‘Casey’

Abortion supporters may feel Justice Kennedy might be in “an uncomfortable position if he had to take Roe at its core and say there is a right of personal autonomy that says I can do what I want with my body,” adds Supreme Court and abortion scholar Associate Dean Christine Kellett, of Dickinson School of Law.

“I think they want to hold onto Kennedy [David H.] Souter and O’Connor—who wrote Casey—in future cases,” she says. “While the court hasn’t taken an abortion test lately, some states are now pushing a raft of laws testing the envelope of Casey, and the court is bound to see it again.”

But Ms. Kolbert says she has no fear Casey will be eroded if linked to the assisted suicide cause: “Frankly, the effort to rely on Casey shows its central position within the jurisprudence of privacy, and that’s a very good development.”

Since the decision in 1992, Casey has stood, outside of the abortion context, not so much for substantive due process and privacy as for its discussion of stare decisis, say some scholars.

But Casey has appeared in some cases involving implied constitutional rights, says Professor Kmiec, most recently in parental rights litigation. He and others believe it will figure in future cases involving gay rights and school finance.

Besides the assisted suicide challenges, the high court may have something more to say about Casey’s reach when it decides a case argued the day before those challenges—U.S. v. Lanier, 95-1717. Dissenting 6th Circuit judges relied on the abortion precedent to dispute the majority’s holding that the Supreme Court has never specifically held there is a federal constitutional right to be free from interference with bodily integrity and so freedom from sexual assault cannot be a part of the right.

Decisions in the assisted suicide cases are expected by early summer.

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Courts and The Terminally Ill (970603)

NEW YORK — Does a terminally ill patient have the constitutional right to end their life with the help of their doctor? The Supreme Court is currently wrestling with the issue, and is expected to issue a ruling later this year.

But the argument that prompted two lower courts to decide in 1996 that, yes, a patient does indeed have a right to doctor-assisted suicide is deeply flawed, according to a report in this week’s issue of the Journal of the American Medical Association.

Last year, two U.S. courts of appeals found that allowing some patients to hasten death by refusing medical treatment, but not allowing other patients to hasten death by taking lethal prescription medication violated the Fourteenth Amendment’s guarantee of liberty.

There’s no difference “between a doctor’s pulling the plug on a respirator and his prescribing drugs which will permit a terminally ill patient to end his own life,” according to the Second Circuit Court regarding New York State’s law prohibiting assisted suicide.

But there is a difference, argue Dr. Bernard Lo and Ann Alpers, of the Program in Medical Ethics at the University of California, San Francisco.

“The courts wanted to give all terminally ill patients the power to choose the time and manner of their deaths,” they wrote. “However, neither medicine nor law can assure equality in dying.”

Most often terminally ill patients are seeking “a dignified dying process” when they refuse treatment, rather than a way to hasten death, according to the researchers. And “by foregoing treatment, they do not guarantee an immediate death the way pulling the plug of a lamp immediately extinguishes light,” they wrote.

“The courts failed to recognize that terminal illness is a process with distinct phases, marked in some cases by disease progression beyond the control of patients and physicians.”

SOURCE: Journal of the American Medical Association (1997;277:1705-1708)

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Experts call for changes in the American way of death (970605)

WASHINGTON (AP) — New drug laws and added training for doctors are needed to reduce the indignity, needless pain and senseless treatment that often marks the way Americans die, according to a government advisory group.

A fear of the typical American dying process is what drives many terminally ill to seek out doctors who will help them die, Dr. Christine Cassel, a Mount Sinai Medical Center geriatrics expert and chairman of the Institute of Medicine committee that studied death and dying in America.

“Americans have come to fear that they will die alone and that they will die in distress or pain,” Cassel said at a news conference Wednesday. “It is perverse that fears of both overtreatment and abandonment have driven the current debate over physician-assisted suicide.”

She said that “no one should feel that suicide is the only option.”

In a report by Cassel’s committee, experts said doctors and hospitals are poorly prepared to give appropriate care to patients who are hopelessly ill and dying.

There are problems with providing pain relief, with allowing patients and their families to control elements of the dying process and a lack of medical understanding of how to keep people alert and comfortable as they approach the end of life.

In many states, said Cassel, laws restrict the use of narcotics needed to relieve pain, leading doctors to inhibit drugs that could bring relief.

“We still have a real problem in this country with untreated pain,” she said. Doctors, she said, are “unreasonably fearful of addiction” even though in a dying patient “it is not a relevant point.”

Bureaucratic barriers that inhibit the use of pain relievers for the dying, said Cassel, include filling out many forms, limiting the amount of drugs issued, forbidding telephone refills and medical board regulations that control how doctors prescribe pain drugs.

“Many doctors decide it is just too much of a hassle or a risk” to treat pain in terminally ill patients, she said.

Robert Burt, a law professor at Yale and a member of the committee, said, “There is a tension between the need to control illegal drugs and the need to control pain. Controls are much more rigid than they need to be.”

A good death, however, is more than just controlling pain and warehousing critically ill people until they are dead, the committee said.

Properly handled, death can be as meaningful as all of the life that went before it, said committee member Joanne Lynn of George Washington University.

“We have to start telling stories about good dying,” said Lynn. People need to know that their final hours, properly aided by experts, can include talking with their families, closing out personal issues and even reading or watching television.

“People can enjoy a high quality of life during the period that they are dying,” said Dr. Neil MacDonald, a cancer specialist at McGill University in Montreal.

Cassel said that to improve the process of dying in America, medical workers need to change professional attitudes and culture that often equate death with a failure of science.

There are no awards for excellent care given to the dying, she said, noting “the feeling of professional satisfaction is not based on easing death for the hopelessly ill.”

Many in the medical community, she said, need to recognize the value to “being able to sit at the bedside, of comforting the family and of answering the questions from the family of what they can expect” as the patient dies.

“Biomedical and clinical research have focused almost exclusively on prolonging life, while research on symptom relief and the end stages of disease have received negligible funding,” she said.

The committee report is being released by the Institute of Medicine under the title “Approaching Death — Improving Care at the End of Life.” The Institute of Medicine is a private organization of experts that provides medical policy advice under a congressional charter granted to the National Academy of Sciences.

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Dutch Doctors Support Suicide for Mentally Ill (970620)

BOSTON — Two-thirds of psychiatrists surveyed in the Netherlands believe physican-assisted suicide is an acceptable outcome for some who suffer a mental illness, a study in Thursday’s New England Journal of Medicine found.

The study by Dr. Johanna Groenewoud and colleagues at Erasmus University in Rotterdam also found that one-third of the psychiatrists had received a persistent request from a patient to assist in a suicide attempt. Only 6% had complied with the request, and usually those patients were in the final stages of a serious physical illness as well.

The doctors who refused to help with suicide said it was because the patients’ mental problems were treatable, the suffering did not seem unbearable or hopeless or they were philosophically opposed to suicide.

The survey was sent to 673 psychiatrists, 552 of whom responded. The Dutch Supreme Court ruled in 1994 that physician-assisted suicide might be justifiable for patients with an unbearable mental illness even if they had no physical illness.

“Although nearly two-thirds of the Dutch psychiatrists who responded to the survey considered assisted suicide for psychiatric patients acceptable, and a majority of them could conceive of a situation in which they would be prepared to assist, physician-assisted suicide in Dutch psychiatric practice is extremely rare,” the Groenewoud team concluded.

Proposals in the United States that would permit physician-assisted suicide involve only people who are suffering with a terminal illness and are mentally competent.

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Easing the Process of Dying (970620)

NEW YORK — Two physician ethicists believe many patients in the terminal stages of illness are ill-served by the medical community. But they see hope for change, as the debate on physician-assisted suicide throws the spotlight on the dying process itself.

“Health care has a moral imperative and a political mandate to provide better care for the dying,” write Drs. Daniel Sulmasy and Joanne Lynn in an article in the current issue of the Journal of the American Medical Association (JAMA).

Sulmasy is director of the Center for Clinical Bioethics at Georgetown University Medical Center in Washington, D.C. Lynn directs the Center to Improve Care of the Dying at the George Washington University Medical Center, also in the nation’s capital.

Both have some harsh words for the current medical climate surrounding terminal care. Citing the Hippocratic tenet that doctors refrain “from attempts at cure when patients were overmastered by disease,” the JAMA authors say “physicians, unfortunately, seemed to interpret this as advice to avoid those who are dying.”

They point to various studies which found that “half of conscious patients suffered severe pain near death. Serious chronic illness threatens almost everyone with impoverishment. Most oncologists report feeling unskilled at pain management.”

They say this end-of-life scenario of pain, poverty, and lack of properly trained staff has become all too common as patients live longer due to technological advances in life-support. “Most of us now die of progressive chronic illness, mostly in old age ... and mostly after a substantial period of disability,” say Sulmasy and Lynn. And while expensive technology keeps bodies alive, “supportive services and palliative care are inadequately compensated.”

Finally, the experts believe that the current managed care-health care model is uniquely designed to ignore the dying. “Dying patients are undesirable to enroll or retain in capitated health plans,” they explain, “since they incur major expenses without bringing additional income.”

It’s a frightening scenario for most of us. But the Washington ethicists say the ongoing controversy surrounding Dr. Jack Kevorkian’s crusade for physician-assisted suicide is placing end-of-life issues in the foreground of the public’s attention. “The suicide debate might galvanize medical and social forces to effect real improvement in the care of the dying,” they say.

Change may be on the way. A 1996 international conference on palliative care, held in Montreal, ended in the signing of a declaration (by 40 professional and lay medical organizations) that placed responsibility for the care of the dying squarely in the hands of health care organizations and individual clinicians.

Education of those clinicians is also improving, say Sulmasy and Lynn. Representatives from regional specialist-certification review are adding palliative care questions to the examinations which must be passed before certification takes place. And Sulmasy and Lynn say “(palliative care) initiatives for medical students are underway at multiple medical schools.”

They add that an increasing emphasis on hospice care for those with chronic, terminal illness may help ease the financial burden on the dying and their loved ones as well.

Of course, we must all face the inevitability of death and dying. Sulmasy and Lynn say this means “all of us have an interest in being confident that our suffering and pain will be compassionately addressed, and that we will find our time at the end of life conducive to the experiences of being loved and finding meaning.”

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Doctors want to set Hippocrates to verse (London Times, 970704)

DOCTORS have begun a search for a poet who can set pulses racing with an updated version of the medical oath that will ring down the centuries and inspire all who enter the profession.

The Hippocratic Oath starts by swearing to “Apollo the physician, and Aesculapius and Health, and All-heal and all the gods and goddesses” that the doctor will follow a system for the benefit of his patients, abstain from mischievous behaviour and will pass life in purity and holiness.

Producing abortions and giving deadly medicines are not allowed. Confidentiality is crucial. Seduction of females or males, freemen or slaves is forbidden.

Hector Spiteri, a GP from Redbridge, east London, said the oath could be summed up in two sentences: “The physician shall selflessly practise medicine for the sole benefit of the patient and shall avoid causing him harm. He shall do so with respect, integrity and compassion and without any form of prejudice. That is enough.”

The Hippocratic Oath is largely out of use, but that did not stop some of Britain’s leading poets saying that they were ready to take up the BMA’s challenge. Lavinia Greenlaw, the daughter of two doctors, who was Writer-in-Residence at the Science Museum in 1995, was the first to throw her hat into the ring. She had already worked up a lyrical alternative to the new oath last night, using lines from both the old and the new ones.

Oath poem

I will answer as truthfully as I can.

Whatever I see or hear, I will not divulge.

I will acknowledge my mistakes.

With purity and holiness will I practise my art.

I will not provide treatments that are pointless.

I will give no deadly medicine nor suggest it.

I will not put personal profit or advancement first.

I will impart a knowledge of the Art to my own sons.

By Lavinia Greenlaw, Writer-in-Residence at the Science Museum, 1995

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Author says euthanasia now a common ‘cure’ in Holland (Ottawa Citizen, 970723)

Dutch courts and physicians have turned euthanasia into a “cure” for chronic illnesses like depression and diabetes, says the author of a new book on euthanasia in Holland.

Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention, said the Dutch like to boast that their suicide rate has dropped in the 20 years since their courts became the first in the world to sanction euthanasia.

But he says they have “cured” suicide by “ending patients’ lives rather than treating depression.

“What was supposed to be intended for exceptional cases has become a routine way of dealing with serious medical problems. “

Dr. Hendin said Dutch courts first sanctioned assisted suicide as a compassionate way to deal with exceptional cases, those few hundred patients per year who were dying in extreme pain and wanted some solution other than total sedation.

But he said Holland has since made euthanasia a routine way of ending the lives not only of the terminally ill but also those with treatable chronic illnesses like depression, arthritis, multiple sclerosis and diabetes. Euthanasia has also been legally sanctioned to end the lives of some deformed infants.

Dr. Hendin said that, like German physicians and philosophers of the Nazi era, the Dutch view euthanasia as a sign of compassion for suffering people.

“The Germans considered they were acting with compassion too, because idiots and mentally ill people couldn’t enjoy living.”

Ironically, during the Second World War, Holland was the only occupied country whose doctors refused to go along with the German euthanasia program.

Dr. Hendin said that, unlike Canada, the U.S. and other countries, Holland has little palliative care for the dying because death has become the more accepted way of dealing with the terminally ill.

Today, Dutch physicians help end the lives of about 6,400 people every year in ways that in Canada probably would be considered both unethical and criminal.

A 1995 government-sponsored study showed about 3,000 people in Holland died of euthanasia, and 540 by assisted suicide.

Physicians ended the lives of another 950 terminally ill patients without their request, and gave another 1,900 people pain-killers with the intention of causing death.

Dr. Hendin said Holland is the only country in the world with widespread legally sanctioned euthanasia.

“Once you make euthanasia a right for some people, you have to extend it to others,” said Dr. Hendin. “Legally, morally and medically, it’s not possible to have euthanasia for some people and not for others. It has to be a right for everybody.”

Dr. Hendin has been studying euthanasia in Holland for five years, and In his new book, Seduced by Death: Doctors, Patients and the Dutch Cure, he cites these examples of Dutch patients whose lives were ended by their physicians:

* a nun whose physician ended her life without consent because her religious convictions would not allow her to ask for death, and he judged her to be in excruciating pain.

* a woman with breast cancer who said she did not want euthanasia. Her physician ended her life because he said “It could have taken another week before she died. I just needed this bed.”

* a 50-year-old social worker, Hilly Bosscher, whose psychiatrist gave her drugs to end her life when she was depressed by the deaths of her two sons. A Dutch court ruled the psychiatrist was medically justified.

Dr. Hendin did not study the euthanasia of infants in Holland, but in a 1993 case, Dutch courts also refused to punish a physician who put to death a disabled newborn, known as Baby Martja. Her parents were saddened by having a child with hydrocephalus, spina bifida and leg deformities, and the courts said the physician’s action could “reasonably be considered as justifiable.”

Euthanasia has been legally sanctioned in Holland through a series of court cases in the 1970s and 80s which allowed the welfare of the patient to be used as a legal justification for committing what the penal code considered the crime of assisted suicide or euthanasia.

Those cases have also gradually widened the grounds for justifiable euthanasia or assisted suicide.

Dr. Hendin said even some Dutch advocates of euthanasia say the U.S. should think twice before bringing in euthanasia, because of differences in the medical care and legal systems. He says some Dutch euthanasia advocates also admit palliative care is a better way of dealing with terminal illness, and fear the poor and elderly in the U.S. would be more likely to be pressured into euthanasia because of their lack of medical care.

Marilynne Seguin, head of Dying with Dignity, a pro-euthanasia lobby group in Toronto, said that some of the criticisms Dr. Hendin makes of the Dutch experience are true. “There were some, not mistakes, but inappropriate decisions made in the early years,” she said.

But she said decisions about cases like euthanasia for a deformed infant are now handled by the parents and multidisciplinary committees of professionals.

She said the Dutch courts and the Royal Dutch Medical Society have had the courage to take difficult cases like infants with Downs Syndrome and decide whether euthanasia is warranted.

“I don’t think Canada is near ready for that complexity of decision-making right now,” she said.

“We will be doing very well with the mature, rational person making those decisions for themselves. Sometime down the road we will have to deal with those other questions,” said Ms. Seguin.

The Liberal government has announced that it has no plans to deal with euthanasia in the next Parliamentary session; however, a number of governments in the Western world, including South Africa, Colombia, and the U.S. state of Oregon are currently considering legislative proposals regarding euthanasia. The pressure for euthanasia in Canada is also expected to grow in Canada this fall as Saskatchewan farmer Robert Latimer is re-tried in the murder of his disabled daughter, and as Halifax respirologist Nancy Morrison returns to court on charges of murdering a terminally-ill cancer patient.

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Potassium chloride overwhelmingly used for mercy killings (Ottawa Citizen, 970725)

Potassium chloride is best known as a fertilizer, a road salt, and an aid for kidney and heart patients. But many health workers call it the “perfect poison.”

“There’s no way to detect its presence in the body after death. That’s why it’s called the perfect poison,” says Dr. L.J. Dragovic, the chief medical examiner for suburban Detroit’s Oakland County.

In the last 10 years, he has been involved in the autopsies of 17 cases of potassium chloride poisoning, 15 of them clients of Dr. Jack Kevorkian and his “suicide machine.” The other two cases involved terminally ill patients put to death in hospital by doctors who thought they were doing them a favour.

Potassium chloride has been used for surreptitious mercy killings by health workers in many countries, including Canada. It’s also used in executions by Texas and some of the other 31 U.S. states that practise capital punishment by injection.

Dr. Dragovic says health workers use it for mercy killings because “it’s readily available, it cannot be detected, and it’s quick-acting.”

Kathi Hamlon agrees. She calls potassium chloride “the lethal injection of choice.” She’s a spokeswoman for the U.S.-based International Anti-Euthanasia Task Force, and says the substance has been used in euthanasia cases not only in Michigan, but also in Florida, California, and other U.S. states. Nurses and physicians in Germany and Britain are also among the many health workers convicted of using it to cause the deaths of patients.

Since 1991, there have been three criminal cases in Canada involving hospital deaths caused by the use of potassium chloride.

In October 1991, Mary Graham, 70, was dying from throat cancer and asked to be withdrawn from a respirator keeping her alive in a Timmins, Ont., hospital. Dr. Alberto de la Rocha, her thoracic surgeon, removed the respirator as Mrs. Graham’s family sat around the bed, and administered morphine to ease the pain. Dr. De la Rocha then injected Mrs. Graham with potassium chloride without the family’s knowledge. Her heart stopped a few minutes later. Dr. De la Rocha was charged with murder, but the charge was later reduced to administering a noxious substance. He pleaded guilty and received a suspended sentence. The court heard he had told nurses that euthanasia “was the way of the future.”

In November 1991, Joseph Sauder, 78, was taken off a respirator in Toronto’s Wellesley Hospital. He was in a coma with no hope of improvement, and his wife agreed he should be allowed to die naturally. But Mr. Sauder took longer than expected to die. When he began choking on his own mucus, his nurse, Scott Mataya, picked up the potassium chloride already on the patient’s tray, and injected it. Four minutes later, Mr. Sauder’s heart stopped. Like Dr. De La Rocha, Mr. Mataya was charged with murder, but later pleaded guilty to administering a noxious substance and received a suspended sentence. Mr. Mataya said he did it because he didn’t want Mr. Sauder’s wife to come back and see him suffocating to death.

Last November, Paul Mills, 65, died at Victoria General Hospital in Halifax after a long battle with cancer of the esophagus. A later affidavit by a Halifax police constable, Tom Martin, included the results of an internal hospital review into Mr. Mills’ death, which said the administration of potassium chloride to a patient in his circumstances was “outside the bounds of medical practice and was unacceptable.” In May, Dr. Nancy Morrison, 41, a respirologist, was charged with murder and is expected to go to a preliminary hearing Feb. 9.

Potassium chloride was also involved in other cases involving health workers, including Beverly Allitt, a British nurse convicted of killing three of her child patients, and West German nurse Michaela Roder, dubbed the “angel of death” for her role in the deaths of up to 17 people.

Dr. Ernesto Pinzon, a Florida physician, is one of the few health workers acquitted in a death involving potassium chloride. In June, a jury in Sebring, Florida, found him not guilty of murder for injecting morphine and potassium chloride into a 70-year-old patient near death from cancer. Dr. Pinzon said he gave the injection for pain relief.

In diluted liquid form in an intravenous drip, potassium chloride regulates the heartbeat and replaces the potassium essential to proper functioning of the kidneys.

“You can drink a couple of gallons of potassium chloride and you won’t die, any more than you would by drinking a couple of gallons of orange juice,” says Dr. Dragovic.

However, when it’s injected in concentrated form, even in very small amounts, potassium chloride goes straight to the heart, interrupts what Dr. Dragovic calls “the electrical activity in the heart” and causes death within minutes. “It’s not a poison poison. It’s an electrical poison,” he says.

He says health workers are foolish to think it’s a perfect poison.

“There’s no such thing as the perfect poison. Anything can be detected if there is enough knowledge and accuracy on the part of medical examiners.”

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Latimer convicted of murder (971106)

BATTLEFORD, Sask. —A second jury has found Saskatchewan farmer Robert Latimer guilty of murder in what he called the mercy killing of his disabled daughter, Tracy.

The jurors took five hours yesterday to find him guilty of second-degree murder.

As the verdict was delivered last night, Mr. Latimer’s wife, Laura, leaped from her chair in the courtroom, ran to the jurors’ rail and cried, “No! No! No! No!”

Mr. Latimer left the prisoner’s box to console his wife before the stunned, silent spectators.

The judge, Mr. Justice G.E. (Ted) Noble, said he was obliged to sentence Mr. Latimer to life imprisonment. Mr. Latimer was released on his own recognizance under previous bail conditions.

Mr. Latimer, 44, pleaded not guilty to second-degree murder in the killing of his disabled 12-year-old daughter. He was convicted in 1994 of second-degree murder after being charged with first-degree murder, but that verdict was overturned after concerns about the Crown’s role in selecting the jury.

Mr. Latimer first told police that Tracy died in her bed, but later confessed that he gassed the child in the cab of his truck on the family farm near Wilkie on Oct. 24, 1993. He told police he did so to relieve her pain and said that caring for her had become increasingly difficult.

The court heard that Tracy loved music, could smile, laugh and move her hands, relate to her friends and siblings and was in no immediate mortal danger from the debilitating effects of cerebral palsy.

There was conflicting evidence as to Tracy’s overall state of health in the last months of her life, but there is little question she suffered severe intermittent pain from a dislocated hip. And the prospect of further surgery to correct the hip problem was more than her parents could bear, the child’s mother, Mrs. Latimer, testified.

A psychiatrist said Mr. Latimer had a phobia about needles and bodily injury and that Mr. Latimer killed Tracy because he felt he had no alternative.

Defence lawyer Mark Brayford also argued that Mr. Latimer killed his daughter because he could see no reasonable legal alternative to end her suffering. In Canadian law, the defence of necessity sometimes allows for the infliction of a greater harm to avoid a lesser evil; for example, when a battered spouse kills a partner.

But from a strictly legal point under Canadian law, the killing was murder, the Crown argued. “Pain is a condition of life, not a reason for death,” prosecutor Eric Neufeld said.

Advocates for Canada’s disabled groups argued that the killing was clear-cut murder and a grievous moral offence. Contending the case had nothing to do with euthanasia, disabled people watched the trial from wheelchairs in the courtroom. They said they feared an acquittal might place the lives of disabled people at risk and in a different category from other Canadians.

The case garnered widespread public interest as it came to be seen as touching on the question of whether society should approve the mercy killing of disabled people. Advocates of euthanasia have championed Mr. Latimer as a compassionate hero, accepting his assertion that it was a mercy killing.

As part of the defence strategy, Mr. Latimer had been in the habit of meeting reporters outside the courthouse for interviews. Because he did not testify in his own defence, this was the only opportunity to ask about his story.

Asked outside court last week why he had first told police his daughter died in bed, Mr. Latimer paused 10 seconds and replied, “Why?” He paused another 10 seconds and said: “I think you just have to appreciate the situation and what was going on. There was a lot of stuff going on. I said she passed away in her sleep. She just went to sleep. At that time, I didn’t feel like a long-winded whole bunch of business with 14 police officers that day. Tracy had passed away that day and I wanted to deal with it in a more normal way.”

During the second trial, the jurors heard that Mr. Latimer was a kind, loving father and devoted family man who did not trust doctors and was at the end of his rope at the prospect of his daughter’s continued suffering.

Police said he seemed “very matter of fact” and calm when they arrived at the farm to investigate Tracy’s sudden death. Mr. Latimer was smoking a cigarette on his deck, they said, and at one point became concerned at the prospect of an autopsy. They said he later appeared very nervous, spilling coffee beans on the kitchen floor. He later burned part of the hose used in the gassing, which he had timed on his wrist watch.

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Fewer oncologists support assisted suicide (980521)

LOS ANGELES — The number of cancer specialists who support the use of physician-assisted suicide is declining, according to a new survey presented at the American Society of Clinical Oncology (ASCO) annual meeting.

A recent survey found that 22% of oncologists support physician-assisted suicide for patients in unremitting pain, down from the 45% of cancer specialists who said they supported assisted-suicide in a similar survey conducted 3 years ago.

The decline in support for physician-assisted suicide may be partially explained by the increasing efforts to legalize the practice, according to one researcher, Dr. Ezekiel Emanuel, of the National Institutes of Health.

“Doctors, especially oncologists, realized they would likely be the ones called upon to do it, and became a lot more nervous,” Emanuel said. “When it’s a hypothetical possibility out there, it’s one thing; when you might actually have to do it, you become, I think, much more reluctant.”

Almost two thirds of the 3,200 oncologists surveyed reported receiving requests for euthanasia or physician-assisted suicide. Thirteen percent of those surveyed said that they had provided assistance in ending life during their careers, and 4% of them had done so within the last year.

Inadequate education among physicians about proper end-of-life care, as well as poor access to services designed to relieve pain are key factors in the decision to assist a suicide, according to Dr. Robert Mayer, ASCO president.

“In fact, the less access physicians have to such services, the more likely they are to grant requests for physician-assisted suicide and euthanasia,” he said. “We must continue to improve palliative care in order to render euthanasia and assisted-suicide unnecessary,” he said. He noted that most medical students do not learn about end-of-life care either in courses or in clinical rotations.

The study, conducted by researchers at the University of Massachusetts, surveyed oncologists in the United States, Britain, and Canada, and turned up some discrepancies between what the physicians say and how they actually practice. For instance, while 95% of the physicians felt competent to manage pain, only 75% provided optimal pain treatment, according to their responses to a hypothetical case.

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Kevorkian awaits sentence after conviction of second-degree murder (CNN, 990327)

PONTIAC, Michigan (CNN) — Dr. Jack Kevorkian is free on bond Saturday after a jury found him guilty of second-degree murder Friday in the death of a terminally ill man suffering from Lou Gehrig’s disease.

An Oakland County jury deliberated more than two days before finding him responsible in the death of 52- year-old Thomas Youk.

The assisted suicide advocate was also found guilty of delivering the illegal substance that he fatally injected Youk with on September 17. He showed no emotion when the verdicts were read.

Kevorkian, 70, is scheduled for sentencing April 14. Although he escaped a mandatory life sentence that goes with a first-degree murder conviction, he still faces a minimum of 10 to 25 years and a maximum life term in prison.

Oakland County Circuit Judge Jessica Cooper told Kevorkian he was free on bond on the condition he refrain from assisting in or being present at any suicides during that time.

Kevorkian, who last November said he would starve himself to death in jail, plans to appeal the verdict, which could take years.

“This case does resolve the issue of whether a jury of Kevorkian’s peers are willing to allow him to commit the crimes of second-degree murder and the delivery of a controlled substance under the guise of pain management. They were not,” said Oakland County Prosecutor David Gorcyca.

“The verdict is proof that our first commitment as a nation is to the protection of human life,” he said.

Gorcyca said he and his family have been threatened since charges were brought against Kevorkian.

Defense Attorney David Gorosh, relegated to the role of an adviser for most of the proceedings, called Kevorkian “a hero.”

“Dr. Kevorkian is certainly no murderer. We believe it’s certainly unjust to equate an act of compassion to an act of murder,” he said.

A tape of the incident was aired on the CBS program “60 Minutes” and shown to the jury in the trial.

Kevorkian, serving as his own attorney through most of the trial, did not testify or call any witnesses for the defense.

Cooper rejected a defense request to allow testimony from Youk’s widow and brother about his deteriorating health, painful condition and consent to Kevorkian’s plan.

During closing arguments, Assistant Prosecutor John Skrzynski called Kevorkian a “medical hit man in the night with his bag of poison.”

Kevorkian repeatedly acknowledged that his action caused death but denied that it was a “killing,” as Skrzynski told the jury.

“I intended to do my duty. Not murder,” said Kevorkian, who likened his efforts to those of civil rights activists who fought against what they considered immoral laws.

Kevorkian has admitted to being present at 130 deaths since 1990. He was tried four times on assisted suicide charges. Three proceedings ended in acquittals and a fourth in a mistrial.

The death in this case, which resulted in the first murder charges against him, was the first time Kevorkian said he administered the fatal injection himself.

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Doctors fall prey to assisted suicide ‘copycat effect,’ study suggests Fallout from two deaths (National Post, 990521)

Highly publicized cases of doctor-assisted suicide prompt copycat assists, a scientific study suggests.

Researchers writing in the current issue of Suicide and Life-Threatening Behavior investigated two landmark assisted deaths — one of a cancer patient and the other of a comatose crash victim. They found dramatic increases in fatalities among patients facing similar medical conditions immediately after widespread public attention.

One patient, a 45-year-old woman with leukemia, was prescribed a lethal dose of a drug by Dr. Timothy Quill in 1991, after she requested help dying.

The case was covered extensively in the media, and Dr. Quill wrote an editorial in the influential New England Journal of Medicine about the experience.

In the month immediately afterward, there was a large rise in the number of leukaemia patients who died when compared to normal death rates.

The more the other patients resembled Dr. Quill’s patient, the larger the statistical jump; 11.3% more female leukaemia patients died, and almost 34% more female leukaemia patients who were in their 40s died.

The other case was a ruling by the Missouri Supreme Court in 1990 allowing a doctor to remove a comatose woman — a car crash victim — from life-support machinery.

The following month saw 57% more coma patients dying than expected. In both cases, the increase lasted only one month, with death rates then returning to normal.

David P. Phillips, a professor of sociology at the University of California at San Diego, who headed the research team, admits he can’t be certain of how many of the unexpected deaths were doctor-assisted suicides.

The jump is significant enough, however, to discount other factors, and his study has the advantage of assessing something that many doctors are unwilling to openly discuss, he said.

Sociologists have long noted that people like to copy others, and public examples of certain behaviour often leads to similar acts.

Dubbed the “copycat effect,” the phenomenon became the focus of much discussion in the wake of the recent Littleton, Colo., high school shootings.

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Forbes to ask Princeton not to hire ‘Professor Death’ (Washington Times, 990526)

Steve Forbes, the Republican presidential candidate and a member of the board of trustees at Princeton University, has stepped into a growing controversy, saying he will ask Princeton’s president to rescind the appointment of Peter Singer, a bioethicist who advocates killing certain disabled babies within the first month of their lives.

Mr. Singer, 52, who teaches at Monash University in Melbourne, Australia, is scheduled to arrive at the university July 1 and will teach as a tenured faculty member in the fall semester.

His views, which challenge the moral values of Judeo-Christian faiths and most secular philosophical systems, have been the subject of growing criticism and have sparked protests at Princeton. Opponents of his appointment hint that Princeton’s June 1 outdoor commencement ceremony may be disturbed by protests.

As Mr. Singer’s arrival on campus draws near, students and other groups representing disabled persons are calling on wealthy trustees, including Mr. Forbes and Sen. Bill Frist, Tennessee Republican, to use their influence — and financial clout — to force the university to withdraw its appointment of Mr. Singer.

“I don’t have any doubt that if Steve Forbes and Bill Frist said we don’t want to be a part of this trustee board and they took away their money . . . this decision would be rescinded,” says graduate student Christopher Benek, 23, who serves as president of Princeton Students Against Infanticide.

Dr. Frist, a heart transplant surgeon who received his bachelor’s degree from Princeton in 1974, recently donated $25 million to fund a new student center at the school, Mr. Benek said. A spokeswoman for Dr. Frist did not respond to repeated calls from The Washington Times asking for his views on Mr. Singer’s appointment.

Mr. Forbes, who received a degree in history from Princeton in 1970 and contributes substantially to the university, lives in New Jersey and one of his daughters attends the Ivy League school. He said he would talk to Princeton University President Harold T. Shapiro to voice his opposition to Mr. Singer’s tenured appointment at a private meeting, his spokeswoman Juleanna Glover Weiss said.

“Steve would encourage those students who are protesting to continue those activities in support of Mr. Singer’s removal,” Mrs. Weiss said.

Mr. Benek said he will urge Democratic presidential prospect Bill Bradley, another famous Princeton trustee, to make his views about Mr. Singer known. New Jersey Gov. Christine Todd Whitman serves as an ex officio member of the trustee board, but does not attend meetings or vote on university business. She has not been involved in the controversy regarding Mr. Singer’s appointment, her spokeswoman said.

Mr. Singer, an Australian, has been known heretofore mostly as an animal rights advocate. A vegetarian, he argues that ignoring the suffering of animals just because they are not human is a bigotry like racism and sexism. “Even an abortion late in pregnancy for the most trivial of reasons is hard to condemn unless we also condemn the slaughter of far more developed forms of life for the taste of their flesh,” he has written in his several books and essays.

But it is his theories on the value of human life that have drawn fire, not only abroad but also in this country where he has earned the label of “Professor Death.” Others have called him “a bigot against people with disabilities.

Most contentious of his teachings is the suggestion that parents should have the right to kill their infants up to 28 days after birth if they have “severe” disabilities. At that age, he says, children don’t understand what it means to be alive. Those with serious health and physical concerns may ultimately be burdens on society and themselves, and the goal, he asserts, is to eliminate suffering in the world.

“Killing a defective infant is not morally equivalent to killing a person,” Mr. Singer has written. He will fill an endowed professorship at the university’s Center for Human Values.

Such assertions have drawn the rage of the disabled and their advocates, including spokesmen for the Roman Catholic Church who say his views violate the sanctity and value of all life. They say that a prominent university like Princeton giving credence and validation to his views is akin to acceptance of his views.

Others in his field who have defended his selection describe the Oxford-educated Mr. Singer as a “gentle man” and “brilliant mind” who has been mischaracterized by reporters. They say they don’t have to agree with his views to respect his intellect and contributions to scholarship. His critics scoff that these professors would not countenance the teaching of Nazi or racist views on the Princeton campus.

For his part, Mr. Singer says he welcomes the opportunity to teach in the United States. In a statement to the Catholic Spirit, a newspaper published for the Metuchen diocese in Central New Jersey, he said:

“At Princeton . . . I hope to challenge my students and stimulate them to form their own conclusions. . . . In my students, I look for the ability to think independently, and I assess my students on the quality of their argument, not on whether I agree or disagree with the conclusions they reach. . . . Those interested in my views are encouraged to read me in the original, rather than in accounts by opponents, which often present a distorted picture.”

His critics include Princeton Students Against Infanticide, the New Jersey Right to Life organization, and Not Dead Yet, which lobbies for the rights of the disabled. They staged two large and angry protests on campus this spring, their rallies attracting many disabled persons. Some in wheelchairs clutched signs that read, “My Life is Worth Living.”

“This is getting close to Hitler’s policies,” observed New Jersey police officer John Scaturro, who attended an April 17 protest at Princeton with his wife and child and was interviewed by the National Catholic Register. “[Hitler] did the same thing in Nazi Germany to the deformed and disabled, with the support of academics.”

Mr. Shapiro, Princeton’s president and head of the National Bioethics Advisory Commission, writing in a column this spring for the student newspaper, the Daily Princetonian, defended the hire. Mr. Singer, he said, was internationally “revered,” and would spark a vigorous debate among students. He characterized Mr. Singer’s views on the efficacy of killing the disabled as “provocative.”

“An important part of our purpose as a university is to ask the most difficult and fundamental questions about human existence, however uncomfortable this may be,” he wrote.

But Mary Jane Owen, a disabled person who serves as director of the National Catholic Office for Persons With Disabilities, says Mr. Singer’s hiring was a disservice not only to Princeton but the nation.

Mr. Singer “lacks knowledge and sensitivity about the commonality of human vulnerability and fragility,” she said. “Probably he has never celebrated the personal victories of adults as we learn new ways of compensating for lost functions.

“The American spirit is that we’ve always admired persons who overcome challenges,” said Miss Owen, who is blind, hard of hearing and who uses a wheelchair. “Peter Singer just doesn’t get that.”

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Sanctity of life tests mettle of philosophers (London Times, 990624)

BY CHOOSING self-awareness as one of the signs that a patient is alive and deserves treatment, the BMA has plunged into one of the oldest philosophical disputes of all.

“It is a very odd definition to use,” said Professor Nicholas Humphrey, of the London School of Economics, author of The History of the Mind. “How could it be applied to babies of less than two, who are not yet self-aware? If this is a definition of life, it excludes all animals, except perhaps chimpanzees.”

The BMA’s difficulties arise because the classical vital signs - a pulse, chest movements caused by breathing, the constriction of the pupil of the eye when a light is shone on it - are all present in those in a persistent vegetative state. Yet are they truly alive?

Until now, a different vital sign has been used to answer that question. So long as brain activity could be detected, the patient was deemed to be alive. But brain activity can be sustained indefinitely on a life-support system.

Such patients, the BMA report says, “may remain stable for many years if life-prolonging treatment is provided, but with no hope of recovering more than very minimal levels of awareness.”

So it sets such signs as awareness of self and surroundings as criteria for continuing treatment, and defines two tests: the ability to interact with others, however expressed; and the capacity for self-directed action or ability to take control of any aspect of his or her life.

It is only relatively recently in human history that self-awareness, or consciousness, has been considered diagnostic of life. Cogito ergo sum - I think therefore I am - was the declaration of Descartes; it was not an axiom of the classical philosophers.

Before the 17th century there was no word for consciousness, or anything like it. The Oxford English Dictionary lists no earlier uses of the word, nor does it have a direct equivalent in Latin or Greek. Aristotle, the first philosopher to write systematically about the mind, saw no need of the concept.

“The Romans used the word in exactly the opposite sense to us, to mean shared rather than private knowledge,” Professor Humphrey says.

“ ‘Caesar and his generals were conscious of their battle plans’ meant that they all knew about them,” he says. “It was only later that consciousness came to mean private, personal feelings rather than public ones.”

But he points out that using consciousness or self-awareness as the definition of a life worth preserving raises practical as well as philosophical problems. If consciousness defines life, what happens when we go to sleep? We are unconscious, but not dead.

Fortunately, in view of the intractable difficulties of definition, doctors will not have to become philosophers before they can practise, although a little philosophy would do them no harm.

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Euthanasia, assisted suicide, never justified-Pope (990930)

VATICAN CITY, Sept 30 — Pope John Paul on Thursday strongly condemned euthanasia and assisted suicide, telling doctors that not even a patient’s request could justify the practices.

The Pope, addressing an international conference of physicians, also said doctors should not resort to abortion even when the life of a pregnant woman appeared to be threatened.

The 79-year-old conservative Pope reserved his toughest words in his speech for euthanasia and assisted suicide, burning issues that have divided people in a number of developed countries.

Calling doctors “servants and guardians of human life,” the Pope said nothing could sanction their participation in euthanasia or assisted suicide.

“Nothing, not even a patient’s request — which more often than not is a cry for help — can justify the taking of a life which is precious in the eyes of God and which can be a great gift of love to a family even in the suffering of the final days,” he said.

“Let me stress that to concur with the intention of another person to commit suicide and to help in carrying it out through so-called assisted suicide means to cooperate in and at times be the actual perpetrator of an injustice which can never be excused, even if it is requested,” he said.

The Catholic Church teaches that life begins at the moment of conception and ends at the moment of natural death.

Doctors could not encourage what the Pope called “so-called self-determination” of the dying person or justify medical assistance to help terminate life.

“Both reason and faith require that we resist every temptation to end a patient’s life by a deliberate act of omission or by active intervention, because euthanasia is a grave violation of the law of God....,” he said.

He called euthanasia “the deliberate and morally unacceptable killing of a human person.”

Catholic Church canon (law) 2,278 says extraordinary, costly and dangerous life-support systems for a terminally ill person can be discontinued at the patient’s or family’s request, but actively ending a life is always morally unacceptable.

A number of developed countries are divided over the emotionally wrenching issue of euthanasia or physician-assisted suicide.

Perhaps the world’s most famous right-to-die crusader is Dr Jack Kevorkian, a retired U.S. pathologist based in Michigan who has admitted to helping more than 130 people die.

He was sentenced to 10-25 years in prison last April for giving a fatal injection to a terminally ill man.

In another section of his address to the doctors, the Pope asked them not to resort to abortion even in cases where the mother’s life was threatened.

He said that today there was “strong social pressure” to use the least sign of risk to the mother’s life as justification to perform an abortion even when effective forms of treatment were available.

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Poll Shows Little Support for Assisted Suicide (Euthanasia Website, 000300)

Utica, N.Y. — March 2000 — According to a Zogby poll, only one-in-three Americans, if stricken with a painful terminal disease, would prefer assisted suicide to letting nature take its course.

In the March poll of 1,031 nationwide, 30.4% of those surveyed would rather have a doctor put a merciful end to their suffering than wait for a natural death.

A much larger 63.5% would prefer to tough it out against the painful disease, and 6.1% were not quite sure what they would decide if put in this situation. Men and women were almost exactly similar in their choices.

Respondents aged 18-29 and over 65 were less likely to consider assisted suicide than were those aged 30-64. Blacks were far less likely than whites to choose euthanasia over a protracted death by terminal disease.

The Zogby poll asked:

“If you had a disease that was fatal, and was causing great pain and discomfort, which of the following courses of action would you prefer: Physician assisted suicide, wait and let nature take its course, or not sure?”

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No illness found in Kevorkian patients (National Post, 001207)

Study of autopsy reports finds most suicides not terminally ill, five not physically sick at all.

A study of 69 assisted suicides conducted by Jack Kevorkian, the American doctor who advocated legalizing euthanasia, has concluded that 75% of his patients were not terminally ill at the time he helped them to die.

And in five of those cases, autopsies could find no confirmed presence of any physical disease, according to the study reported in a letter to be published in today’s edition of The New England Journal of Medicine.

The study is likely to stoke the debate over euthanasia and assisted suicide, which was reignited last week with the passage of a Dutch bill clearing the way to make it the first country in the world to legalize euthanasia.

Lori Roscoe, a professor at the University of South Florida’s Ethics Centre, said the study looked at the people who died with Kevorkian’s assistance in Oakland County, Mich., near Detroit, between 1990 and 1998.

Kevorkian, who was nicknamed “Dr. Death” in the media after he claimed to have helped more than 130 people commit suicide, is now serving a prison sentence of 10 to 25 years after being convicted of second-degree murder in 1999.

He was charged following an appearance on national television during which he administered a lethal injection to a 52-year-old man suffering from Lou Gehrig’s disease and dared the criminal justice system to arrest him.

The study suggested that women and men who are divorced or unmarried were more likely to turn to Kevorkian for an assisted suicide, which the researchers said raised troubling questions.

“Persons who were divorced or had never married were overrepresented among those who died with Kevorkian’s help, suggesting the need for a better understanding of the familial and psychosocial context of decision-making at the end of life,” Ms. Roscoe and her colleagues said.

Of the 69 patients looked at in the study, 71% were women and 67% were unmarried, divorced or widowed.

“Our findings underscore the vulnerability of women and groups of men (i.e., those not married and those coping with serious illness) to physician- assisted suicide and euthanasia,” the letter reads, “particularly when clinical safeguards are lacking.”

In a telephone interview yesterday, Ms. Roscoe said Kevorkian had no clinical safeguards.

“There was no one looking over his work and offering a second opinion,” she said.

Ms. Roscoe began the study out of interest in what led Kevorkian’s patients to decide to end their lives. “The study is not about him. It’s about the patients,” she said.

Ms. Roscoe said she was surprised to find that autopsy reports indicated that only 17 of the 69 patients were terminally ill, or likely to live less than six months.

The other people’s wish to die may be explained by the fact that many of them “had had a recent decline in health status,” the researchers said.

A spokeswoman for the Hemlock Society U.S.A., a group dedicated to promoting the right to die, dismissed the study as uninformed.

“I think they just don’t understand the process Dr. Kevorkian used,” said Lois Schafer, the society’s director of community services. “Dr. Kevorkian didn’t go looking for vulnerable people ... they came to him begging and pleading to please end this pain and suffering.”

The society, which refers to suicide as “hastened death,” during which people “self-deliver from their pain,” has supported Kevorkian throughout his legal tribulations.

Ms. Schafer insisted the patients who were “self-delivered” by Kevorkian were carefully screened to ensure they were not simply depressed and that they really were terminally ill. “He refused many more people than he actually helped.”

She could not explain how autopsies could find nothing wrong with five of those Kevorkian helped to die, but suggested the medical examiners might have missed the signs of their diseases.

Kevorkian is a controversial figure even among advocates of assisted suicide.

Marilynne Seguin, who founded Dying with Dignity, a Canada-wide association, was critical of Kevorkian before her death in 1999.

She said she counselled each of the more than 2,000 dying patients who contacted her, sometimes for months before their deaths. “I don’t just walk in like Kevorkian, sit down for 10 minutes, make a video and then, whap!” she said in a 1997 interview. “I think he’s done a great disservice to the cause.”

Last week, the Dutch parliament approved a bill allowing mercy killings and doctor-assisted suicides.

The bill includes guidelines that say a patient must be undergoing irremediable and unbearable suffering, be aware of all other medical options and have sought a second professional opinion.

No other country has attempted to legalize euthanasia, although it is tolerated in some. Voters in Oregon approved doctor-assisted suicide for the terminally ill in 1994. Since the law took effect in 1997, 43 people have died in Oregon in assisted suicides.

There have been a few celebrated assisted-suicide cases in Canada, most notably that of Sue Rodriguez, a British Columbia woman suffering from amyotrophic lateral sclerosis, better known as Lou Gehrig’s disease.

In 1993, the Supreme Court of Canada ruled 5-4 against her right to assisted suicide. A year later, a still-anonymous doctor agreed to give her a lethal injection of morphine and secobarbital.

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Dutch Parliament Passes Euthanasia Bill (Fox News, 010410)

THE HAGUE, Netherlands — The upper house of the Dutch parliament approved a euthanasia bill Tuesday, making the Netherlands the first country to allow doctors to end the lives of patients suffering unbearably and without hope.

About 10,000 pro-life protesters surrounded the parliament building, praying, singing hymns and quoting the Bible. Inside, the Dutch Senate voted 46-28 in favor of the legislation.

Before the Senate vote, Health Minister Els Borst gave a final assurance that the law could not be abused by doctors because of careful supervisory provisions. The law presupposes a long doctor-patient relationship, and excludes the possibility of euthanasia for nonresidents of the Netherlands.

The law, likely to take effect this summer, formalizes guidelines adopted in 1993 under which doctors have been assisting suicides with tacit approval, said Justice Minister Benk Korthals.

“This law will remove the uncertainty for patients and for doctors,” Borst told senators.

Outside the parliament building, activists wore black ski masks and carried oversized syringes dripping with blood-red liquid. Several Christian schools canceled classes to allow students from across the country to participate in the demonstrations.

“We don’t have the right to decide about matters of life and death, but God does,” said 19-year-old Henrico van der Hoek as he walked passed Parliament. “As Christians, we simply cannot support this law.”

Arguing for the bill, government ministers cited public approval ratings of nearly 90%.

In the weeks preceding the debate, the upper house was swamped with more than 60,000 letters, most of them urging the legislators to vote against the bill. The anti-euthanasia group “Cry for Life” gathered 25,000 signatures on a petition.

After 30 years of public debate on mercy killings, the lower house passed the bill in November by a vote of 104-40. Its progress has been closely watched in Europe and the United States.

Germany’s Justice Minister Hertha Daeubler-Gmelin criticized the Dutch legislation, and said on ARD television that the emphasis should remain on therapy to reduce suffering.

The Vatican strongly denounced the bill after it was passed by the lower house last year.

Egbert Schuurman, of the Netherlands’ conservative Christian Union, called the bill “a historic mistake.” Being the first country to legislate euthanasia “is something to be ashamed of. Others may be proud, but we will expect that some may wonder later how could they have walked this path.”

Several countries — Switzerland, Colombia and Belgium — tolerate euthanasia, although it has not been legalized. In the United States, Oregon has allowed doctor-assisted suicide for the terminally ill since 1996, but its law is more restrictive than the Dutch bill. In Australia, the Northern Territories enacted a law in 1996, but it was revoked in 1997 by the federal parliament.

Under the Dutch law, a patient has to be experiencing irremediable and unbearable suffering, be aware of all other medical options and have sought a second professional opinion. The request must be made voluntarily, persistently and independently while the patient is of sound mind. Doctors are not supposed to suggest it as an option.

The new law also allows patients to leave a written request for euthanasia, giving doctors the right to use their own discretion when patients become too physically or mentally ill to decide for themselves.

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Seventy-Nine Percent of Canadian Support Doctor-Assisted Suicide (Gallup, 020215)

Gallup Canada has recently released figures on a public opinion poll about the support for doctor-assisted suicide. This survey consisted of 1,000 telephone interviews with adults, 18 years old and older, during January 15-20, 2002.

One of the questions asked was: “When a person has an incurable disease that is immediately life threatening and causes that person to experience great suffering, do you, or do you not think that competent doctors should be allowed by law to end the patient’s life through mercy killing, if the patient has made a formal request in writing?, the majority of Canadians (79%) said yes, 19% said no and 2% had no opinion. Highest yes responses: Quebec: (85%), B.C and Atlantic region (77%).

When asked “ When a person has an incurable disease that is not immediately life threatening and causes that person to experience great suffering, do you, or do you not think that competent doctors should be allowed by law to end the patient’s life through mercy killing, if the patient has made a formal request in writing?, 61% said yes, 38% said no and 2% had no opinion. Highest yes responses: Quebec: (68%), Ontario (63%).

[Kwing Hung: A leading question on the use of “great suffering” as only a few would experience great suffering with the modern technology on pain-killing. This is how polls can be manipulated to get results that you want.]

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Conference Announcement: Making Sense of Dying and Death (021100)

14 to 16 November 2002, Rome, Italy

Marking the launch of a new annual conference, research and publication series, this inter-disciplinary and multi-disciplinary project aims to create a forum for examining the links between living and dying, and some of the contradictions and paradoxes which arise that we appear to accept without question.

Areas of interest will focus on different kinds of dying and death, the experience of carers and care workers, the changing role of medicine, palliative care, the work of the hospice movement, the work of the funeral industry, and the nature of grief and mourning. Interest will also focus on philosophical, ethical, and legal issues which surround the processes of dying and death, the role of religion, and the diverse range of historical, social, and cultural perspectives and practices.

Papers, presentations, reports and workshops are invited on any of the following indicative themes:

* Contradictions and paradoxes. Indicative examples include sudden death vs our ability to postpone death; horror at genocide vs our appetite for films about ending lives in violent ways; cremation vs internment; pain management vs our reluctance to facilitate death.

* Dealing with and responding to different kinds of death and dying, for example, suicide, homicide, neonatal and infant death, violent death, natural disasters, sudden death, terminal illness, capital punishment, acts of terrorism; death of a child, parent, spouse; old age and death.

* Technology, dying and death. The impact of advances in medical technology; types of medical technology; post war social and cultural expectations of medical possibilities; the double-edged sword - technology as helper vs technology as killer (e.g., lethal injection, mass killing).

* Institutions, dying and death. Problems of ageing populations; ageing and dying; care homes vs waiting rooms for death; hospitals and the limits of responsibility; intensive care; palliative care; the hospice movement; limits to the humanising of death; whose decisions?

* Legal issues in dying and death. Legal definitions of death, court rulings and decisions, the right to die, natural death and brain death statutes, advance directives and living wills; organ donation; organ transplantation.

* Philosophical and ethical issues in dying and death. The nature of dying and death (e.g., does an aborted foetus die?), philosophies of dying and death, personal identity and sense of self, euthanasia and the notion of ‘dying well’, death by choice, informed consent, truth-telling, ‘autonomy’, ‘dignity’, and related issues; understanding, justifying and/or condoning death (e.g., suicide); what is the difference between seeking death and facing death bravely? Is death to be feared more than living or vice versa? Choosing death in order to kill others.

* The management of dying and death. Understanding the processes of dying; first person issues (‘I’ve been told I have two weeks left to live’) and the context and needs of the individual; second person issues (‘You’ve got two weeks left to live’) and the role and place of family, friends and carers; communication and interaction with professionals; third person issues (‘his funeral is on Thursday’) and the question of who deals with death. The management of and changes within the funeral industry; funeral practices across cultures; funerals, cards and wakes; the loss of ritual; the sanitization of death; the hiddenness of death.

* Who deals with bereavement? Religious and non-religious counselling; bereavement, grief, and loss; the nature of grief, ‘models’ and theories of grief, ‘stages’ of grief and the grieving process; can grief be shared? Grief counselling and grief therapy; forms of remembrance, sites of remembrance.

* Religious issues; concepts of afterlife and their influence on the dying, rituals and practices in religious communities, theologies of death, near death experiences; the role of hope.

* The representation of dying and death in media - art, cinema, music, radio and television; the portrayal of dying and death in all forms and types of literature; death and dying in children’s literature; children’s concepts of mortality; the importance of narrative.

Perspectives are sought from those engaged in

* Anthropology, art, creative writing, English literature, history of medicine, law and legal studies, media studies, the performing arts (dance, music, theatre), philosophy and ethics, psychology and social psychology, social history and social sciences, sociology, theology and religious studies.

* Interested members of the public who have personal experience of terminal illness and/or death; care providers, care workers and care volunteers; doctors and GP’s; funeral directors and services; health and social services, health professionals, hospice workers, members of the judiciary, legal professionals, police and law enforcement agencies, mental health professionals, monumental masons, policy makers, government and non-governmental organisations, clerics and members of religious traditions.

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Doc Only Gets Slap on the Wrist in Euthanasia Case (LifeNews, 030709)

Randolph, Vermont (LifeNews.com) — Pro-life advocates in Vermont are outraged that the president of the Vermont Medical Society is not being charged in connection with the euthanasia death of a patient.

Dr. Lloyd Thompson, of Lyndon, Vermont ended the life of his patient last August. The patient was an 85 year-old woman who had signed a written document requesting that no extraordinary measures be taken to preserve her life in the event of a terminal illness. She also requested that end of life treatment be designed for her care and comfort.

Thompson took a series of steps to wean his patient from the ventilator and made her, according to official accounts, “comfortable, sedate and not in any apparent distress.”

He then admits administering a dose of Norcuron, a paralytic drug, that in no way was related to treating the patient’s pain. The patient died within minutes of the injection.

The family of the patient does not wish to press charges, though neither the patient nor her family asked Thompson to hasten her death.

Following an investigation by the Medical Practice Board and the Attorney General’s Office, Dr. Thompson has been lightly reprimanded and will continue his practice uninterrupted.

Pro-life advocates in Vermont say Thompson’s actions constitute euthanasia.

Mary Hahn Beerworth, executive director of Vermont Right to Life, says her phone has not stopped ringing and Vermont residents are outraged at Thompson’s actions. Beerworth said Thompson knew the drug was inappropriate for palliative care.

Another representative of the pro-life group says the state has devalued the woman’s life with it’s slap on the wrist to one of its own.

“Attorney General, Bill Sorrell, by his actions claims to have sent a strong message to every doctor in Vermont cautioning them against these kinds of unethical and possibly illegal actions,” explained Frank Hasler, president of Vermont Right to Life. “It’s hard to see how.”

“Neither Sorrell’s inaction, nor the weak response of the Medical Practice Board does anything to adequately protect medically disabled and dependent patients from abuse,” Hasler explained.

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British Doctor Found to Have Murdered at Least 215 of His Patients (Foxnews, 020719)

LONDON — A public inquiry announced Friday that family doctor Harold Shipman — Britain’s worst serial killer — murdered 215 of his patients.

The inquiry’s head, High Court judge Dame Janet Smith, said there was also a “real suspicion” Shipman had killed 45 more people between 1975 and 1998.

Shipman, 56, was convicted in January 2000 of murdering 15 of his patients — all elderly women — by injecting them with heroin. But police said he may have killed scores more.

The yearlong inquiry has investigated the deaths of 494 of Shipman’s patients between 1974 and 1998.

In her interim report Friday, Smith said Shipman began his killing spree in 1975, a year after he entered practice. His victims, ranging in age from 41 to 93, included 171 women and 44 men.

Smith said it was “deeply disturbing” that the deaths did not arouse suspicion for so many years.

“No one reading this report can fail to be shocked by the enormity of the crimes committed by Shipman and to feel, as I do, the deepest sympathy for his victims and their families,” Smith said.

“His activities have brought tragedy upon them and also upon the communities in which he practiced and which gave him their trust.”

For more than 20 years Shipman was a respected member of the community in Hyde, a working-class town of 22,000 just outside Manchester in northwest England. In 1992 he set up a busy one-man practice in the town.

In March 1998 another doctor, who had been asked by Shipman to cosign some cremation certificates, expressed concern at the number of deaths. Police concluded there wasn’t enough evidence to pursue charges.

The investigation was reopened months later after the daughter of an 81-year-old widow discovered that her mother apparently had changed her will to leave everything to Shipman. That led to exhumations and eventually to Shipman’s trial and conviction.

Shipman maintained his innocence, but a jury found that he deliberately injected heroin into 15 elderly women — many in good health — during routine checkups in their homes or at his office, falsifying computer records to create fictitious symptoms to explain their deaths.

A government-commissioned report found last year that he had 297 more deaths among his patients than would be expected during a normal 24-year medical career.

Prosecutors have ruled out further trials for Shipman, who is already serving 15 life sentences with no possibility of parole.

The inquiry will continue to consider how Shipman was able to escape detection for so long. Its final report is due late next year.

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Assisted Suicides on the Rise in Europe (LifeNews, 030804)

Paris, France (LifeNews.com) — Europe’s permissiveness towards euthanasia is revealed in a new study showing that the number of assisted suicides there is on the rise.

The study, published in the British weekly journal The Lancet, focuses on more than 20,000 deaths in six European countries, including Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Euthanasia is legal in the Netherlands.

The study, led by the Dutch researcher Agnes van der Heide at Erasmus University in Rotterdam, examined those who died who were 80 years or older.

Approximately one-third of deaths involved doctors withholding treatment or prescribing drugs for the patient that would hasten death. Only two-thirds of the deaths were by natural causes.

The number of euthanasia deaths may be higher as many doctors may be unwilling to report such illegal practices

In Switzerland, euthanasia deaths accounted for 51% of those who died, the highest in the study. Italy had the lowest, 23%.

The other countries were closer to Switzerland in terms of the percentage of deaths in which euthanasia or assisted suicide were a factor: 38% in Belgium, 41% in Denmark, 44% in the Netherlands and 36% in Sweden.

Most of the euthanasia deaths involved withdrawal of treatment. The percentage of deaths involving drugs prescribed to hasten death were low and accounted for about 1% of deaths in Denmark and 3.4% in Holland.

Nancy Valko, a leading pro-life nurse in the U.S. who monitors end-of-life issues, says the results depend on what was defined as natural deaths and doctor-induced deaths.

“From my experience, it seems likely that such studies include such ethically allowable ‘end of life’ decisions as appropriate DNR orders, withdrawal of truly futile or burdensome treatments and necessarily high doses of pain medications along with deliberate decisions to hasten death in an attempt to convince people that hastening death is routine and widely accepted,” Valko explained.

“From there, it’s just a short step to convincing people that active euthanasia is just another medical option to hasten death,” Valko concluded.

Another study published in the Lancet, also conducted by Dutch doctors, claims the demand for assisted suicide and euthanasia has not risen since 1995 when doctors began tolerating the practice.

Euthanasia became legal in Holland in April 2002, the first country to legalize it nationwide. In 2002, 1,882 cases of euthanasia were reported there, compared with 2,054 cases in 2001 and 2,123 the previous year.

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Poll Shows Canadians’ Support for Assisted Suicide on the Decline (LifeNews, 030908)

Ottawa, Canada (LifeNews.com) — A new poll shows a majority of Canadians still favor assisted suicide, but the numbers are on the decline.

Pollara, a Canadian polling firm, conducted the survey and found that 49% of Canadians backed assisted suicide while 37% opposed it. Thirteen percent remained undecided.

Some 53% of men favored legalization while only 45% of women agreed.

Michael Marzolini, the president of Pollara, said previous surveys were conducted after high-profile assisted suicide cases that may have artificially inflated the level of support. The current poll may be a more accurate reflection of how Canadians stand on the issue.

“This is not something that’s top of mind, yet this is a good period to be taking these surveys on moral values, Marzolini said. “People have been re-evaluating their attitudes to many of these issues.”

A 1997 poll taken shortly after Robert Latimer was sentenced for killing his disabled 12-year-old daughter, Tracy, found 70% of Canadians said assisted suicide was allowable in some circumstances and 60% favored legalizing it. Only 32% opposed legalization then.

Pro-life groups say the language of the terms used in the polls can produce different outcomes.

A January 1999 poll for the Toronto Globe and Mail found that 56% of Canadians opposed assisted suicide.

Yoseph Thomson of the British Columbia-based Euthanasia Prevention Coalition said the Pollara “polls were not reliable because they failed to accurately define terms.” He said the Toronto Globe poll more accurately defined “mercy killing,” and produced more accurate results.

Dr. Will Johnston of EPC agreed saying, “Canadians don’t want to terminate the sick and disabled, they want to care for them.”

“There is no consensus about so-called mercy-killing.” Johnston stated. “But there is definitely a public consensus for better palliative care services to relieve the suffering of dying persons. That’s where we should be focusing our attention instead of frightening sick and disabled Canadians with proposals to eliminate them.”

A June 1997 poll conducted for EPC found that 71% of the public were opposed to assisted suicide when it was more clearly defined. A large majority (81%) wanted the government to guarantee palliative care and pain relief for the dying as an alternative to more drastic measures such as euthanasia.

A 1995 government panel put together to study the issue split over its findings with some members saying the law should remain the same and a few others advocating legalizing assisted suicide.

The latest Pollara survey of 1,263 Canadians was conducted Aug. 5-7.

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Will ‘Terri’s Bill’ save her life now? (WorldNetDaily, 031020)

Legislation would would put immediate moratorium on dehydration, deprivation deaths in Florida

Will Terri Schindler-Schiavo, the brain-disabled woman who is being starved to death, get a reprieve from Florida lawmakers?

Florida’s Speaker of the House Johnnie Byrd is expected to introduce “Terri’s Bill” during a one-day special session of the state legislature being held today in Tallahassee.

The legislation would put an immediate moratorium on all dehydration and starvation deaths currently pending in Florida until the legislature goes back into regular session.

Terri responding to her mother in video clip available on terrisfight.org

Schindler-Schiavo is being slowly starved to death under a court order initiated by her husband, Michael Schiavo, who is also her legal guardian. Terri has had no food or liquid since Wednesday when the feeding tube that sustains her was removed.

The special session was originally slated to handle another topic unrelated to her case, but Byrd sensed the urgency of Terri’s plight and added his resolution to the agenda.

“I can’t think of anything more important than saving someone’s life because life is precious,” Byrd told Tampa Bay’s Fox News affiliate, WTVT-TV.

Florida law requires a two-thirds majority vote of each house for a topic to be accepted for discussion and vote.

Byrd, a Republican from the Plant City area, was elected to the House in 1996 and subsequently re-elected. He has set his sights on Washington, D.C., and kicked off his campaign for U.S. Senate at a barbecue Saturday before a hometown crowd, where he promised to fight for “common sense, conservative values.”

Volunteers with the Terri Schindler-Schiavo Foundation have learned that Senate President Jim King is opposed to the bill and has said he would not present it to the upper house for a vote.

According to his website, King is a member of the Florida Hospice Board of Directors and the Florida Task Force on Government-Financed Health Care, and is a recipient of the Hospice Hall of Fame Award.

Last year he wrote an amendment to the Advanced Directives Law expanding the definition of “proxy.”

“The way it reads now, a total and complete stranger that doesn’t even know the patient can come into the institution and say it’s in the patient’s best interest to die – that was his contribution to the law,” said Pat Anderson, attorney for Terri’s parents, Robert and Mary Schindler.

A Republican from the Jacksonville area, King served in the Florida House of Representatives from 1986 through 1999 and was elected to the state Senate in March 1999.

Volunteers with the Terri Schindler-Schiavo Foundation urge all concerned Floridians to contact their senators and House members and encourage them to support “Terri’s Bill.”

Telephone numbers and e-mail addresses of legislators are listed on the Florida Legislature’s website.

Advocacy Center enters fight for life

A federal judge at noon Eastern today will hold an emergency hearing requested by the Advocacy Center for Persons with Disabilities, a nonprofit group charged with defending the rights of disabled persons.

Regarded as the “big dog” in advocacy for the disabled, the center receives the bulk of its funding through five federal programs.

Yesterday the center filed a two-page complaint in federal court in Tampa, stating it had compelling information and evidence that Theresa Marie Schiavo is a past and present victim of abuse and neglect, and that as a group they are mandated to investigate such charges.

But to do this it is imperative Terri lives long enough for them to do their investigation, and they intend to start immediately.

The center is asking U.S. District Judge Steven D. Merryday of the Middle District of Florida for an injunction to keep Michael Schiavo from interfering in their investigation and an order to immediately resume Terri’s feeding and hydration.

Is it too late?

If Judge Merryday agrees with the center’s complaint, then help will be on the way. But Terri’s family and supporters worry that if it comes, it will be too late.

Christine Brundage, a retired registered nurse who handles the correspondence for the Schindler family, told WorldNetDaily people who have seen Terri say she is beginning to fade and they fear she can’t hold out much longer. She is reported to be alert still and vocalizing, but her face is thinner and her skin is becoming drawn, showing the effects of five days of dehydration.

Soon her kidneys will collapse, says Brundage, and her other internal organs. Her brain, too, will be damaged even more than it was before her forced starvation.

“It’s a miracle she’s in as good condition as she is,” remarked Brundage. “I just hope she can hold out a bit longer, if help is on the way.”

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Terri Schiavo (NR, 031110)

It is a sad story, and an ugly dispute. Terri Schiavo lost much of her brain function 13 years ago. In October, her husband had her feeding tube removed so that she would die of dehydration. The husband thinks she is, irreversibly, a vegetable. Her parents and siblings think she has some awareness, and that rehabilitation should be given a chance. Each side has its own experts. Schiavo’s family says that the husband won a $1.3 million medical-malpractice lawsuit on the assumption that the money would be used to take care of her for the rest of a normal lifespan. They say he wants to inherit what’s left of the money that was to be spent on her care — and to marry his fiancée, with whom he has had one child and is expecting another. They even say he may have caused her disablement through abuse. They wanted the State of Florida to intervene, and it did so, forcing the resumption of Mrs. Schiavo’s feeding. The legal battle does not appear to be over, however. Being in no position to judge the family’s allegations, we can only offer a general thought: that it is one thing to turn down medical interventions that would prolong suffering, and another to withhold food and water. It is the difference between accepting death, and willing it.

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Doctors: Terri case not ‘death with dignity’ issue (WorldNetDaily, 031022)

Removal of feeding tube called ‘state-sponsored euthanasia’

A physicians’ group has added its voice to the din of reaction to Florida Gov. Jeb Bush’s intervention in the case of Terri Schindler-Schiavo, the brain-disabled woman whose life-sustaining feeding tube was removed last week at the request of Terri’s husband and guardian, Michael Schiavo.

Schiavo, who maintains his wife is in a persistent vegetative state and would want to be allowed to die with dignity, has been locked in a 13-year legal battle with Terri’s parents and siblings who argue Terri is alert, wants to live and, given appropriate therapy, can be rehabilitated. Terri left no written directive.

Within hours of the state legislature’s historic passage of a measure, known as Terri’s Bill, which empowered the governor to take executive action in the matter, Bush ordered the feeding tube reinserted last night.

While hailed as a “miracle” by Terri’s sister and other supporters, the surprise development – coming on Day 7 of Terri’s judge-ordered starvation – angered right-to-die attorney George Felos, who represents Michael Schiavo.

Felos called the eleventh-hour law and Bush’s subsequent intervention “absurdly unconstitutional” and maintains Terri has a right under the Florida Constitution not to be kept alive artificially.

“The governor of the state of Florida does not have the right to trump a patient’s personal choice,” he said at a press conference. “The citizens of Florida should be alarmed by what is happening. What is happening here is a gross and illegal intrusion into the private liberty of citizens. ... This is not the former Soviet Bloc where you don’t have the liberty to control your own body.”

Following two unsuccessful attempts by Felos to get circuit judges to block the reinsertion of the feeding tube, Terri was transferred from the hospice where she has been a patient for three years to a local hospital and rehydration efforts were reportedly launched.

“She was literally absconded from her death bed in the middle of her dying process,” Felos told ABC’s “Good Morning America” this morning, calling the rehydration efforts “cruel.”

But Dr. Jane Orient with the Association of American Physicians and Surgeons, or AAPS, claims the opposite is true: “Dehydration is a cruel, painful death.”

“It is unconscionable that the state ordered removal of her feeding tube in the first place – it’s nothing less than state-sponsored euthanasia,” maintains Orient. “She is not dependent on advanced medical interventions. Nothing is mechanically pumping her blood, or forcing oxygen into her lungs. She is simply being fed through a gastrostomy tube.”

Last week the General Assembly of the Catholic Medical Association passed a resolution that concurred with Orient’s view. It declared removal of Terri’s feeding tube “without first undertaking rehabilitation therapy to ascertain her ability to swallow and digest nourishment” constitutes “depriving her of life without due process of law,” according to Florida Statutes Section 744, 3211.

Would we allow a retarded child to be starved to death?” queries Orient. “Where are the ‘compassionate end-of-life’ groups such as the Robert Wood Johnson ‘Last Acts’ initiative, and why aren’t they weighing in on this?”

Multiple physicians solicited by the Schindlers believe Terri, who vocalizes, laughs and appears to respond to her parents, could be rehabilitated to some extent. Some have even offered pro bono treatment, even though Michael Schiavo was awarded nearly $1.5 million dollars in malpractice suits to pay for Terri’s rehabilitation and nursing expenses shortly after her mysterious collapse at home in 1990 during which oxygen was cut off to her brain for several minutes.

WorldNetDaily has reported that during court testimony last year, Victor Gambone, Terri’s attending physician hired by Michael Schiavo in 1998, testified he was unsure whether his patient had even had her teeth cleaned in recent years and said she hadn’t received therapy. He said he accepted Michael Schiavo’s word that therapy had been deemed unnecessary.

“Although severely disabled, some believe that she does have the capacity to communicate a desire to live. The husband has obstructed efforts at rehabilitation or independent assessments of his wife’s true state,” continues Orient.

WorldNetDaily reports the family has been blocked by Michael Schiavo from visiting Terri at Morton Plant Hospital in Clearwater, Fla., where she was transferred. Their inability to verify she is being rehydrated per Bush’s order concerns them. As of yesterday morning, they reported she was awake and appeared alert, although shrunken.

Felos told reporters yesterday Terri was showing signs of massive organ failure and said the reinsertion of the feeding tube was just prolonging her death.

AAPS, a non-partisan, professional association of physicians dedicated to protecting the sanctity of the patient-physician relationship put out a warning to colleagues: “The ethical question for her nurses and physicians is whether they will cooperate in carrying out a death warrant.

“And the ethical question for all of us is whether we will allow the state to obstruct the efforts of people who want to provide medical care to a patient who wants to receive it,” said Orient. “If we go down that path, who’s to say what treatment the state will prevent you from getting?”

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Media ‘getting it wrong’ on Terri Schiavo story (WorldNetDaily, 031025)

Press erroneously report she’s ‘comatose,’ doctors also dispute vegetative-state ruling

Network news outlets across the board and national newspapers – from the New York Times and the Washington Post to the Miami Herald and the Atlanta Journal-Constitution – are misreporting the medical facts of the Terri Schindler-Schiavo story, say her family, doctors and the pro-family organization Focus on the Family.

“The media’s killing us, and they’re killing her, frankly,” said Terri’s father, Robert Schindler, at a press conference yesterday. The family and about a dozen people, including doctors and Terri’s caregivers, spent an hour trying to school reporters on the facts of the case.

Public opinion outside the courtroom matters in high-profile legal battles, as the 165,000 e-mails sent this week to Florida Gov. Jeb Bush’s office and the scores sent to state legislators exemplified. The community spoke and lawmakers heard them and responded with emergency legislation empowering Bush to defy Terri’s judge-ordered starvation by ordering the reinsertion of the 39-year-old brain-disabled woman’s feeding tube.

For the Schindlers, the first task at hand in setting the public record straight regards the erroneous use of the word “comatose” by newspapers and media outlets across the country in their coverage of the emotionally charged legal battle.

The Webster’s New World College Dictionary defines comatose as someone who is in a deep or prolonged state of unconsciousness. It is undisputed that Terri does not meet this definition. Even her husband, Michael Schiavo, who sought the court order to end her life does not call her “comatose.”

Yet, in a search of today’s coverage of the case using the Lexis-Nexis media search engine, WorldNetDaily found that national network news outlets across the board – ABC, CBS, CNN, MSNBC and NPR – refer to Terri as being “in a coma” or “comatose.” Prominent newspapers making the same error include the New York Times, Washington Post, Miami Herald, Atlanta Journal-Constitution, Baltimore Sun, Cincinnati Enquirer, Salt Lake City’s Deseret News, South Dakota’s Aberdeen American and even one local paper, the Bradenton Herald.

At the press conference, Terri’s family and several doctors also stressed it is debatable whether she is in a persistent vegetative state, or PVS, despite court rulings labeling her as such.

“You have to get it through your heads. This girl is not PVS,” Robert Schindler pleaded with reporters.

Dr. William Hammesfahr, a Clearwater, Fla., neurologist, told reporters Terri’s eyes fixate on her family and she tries to follow simple commands, such as when doctors ask her to pull against their arm.

WorldNetDaily has reported Terri sustained brain damage when she mysteriously collapsed in 1990 at the age of 26 and oxygen was cut to her brain for several minutes. Terri breathes and maintains a heart beat and blood pressure on her own. She can see and move her limbs. But she needs a feeding tube to sustain her life.

Six years after being awarded $1.2 million in medical malpractice suits on the basis that he intended to seek long-term medical care and therapy for his wife, Michael Schiavo hired right-to-die attorney George Felos and launched a court battle to terminate his wife’s life. Terri has no written directive on the matter. Michael Schiavo says he’s fulfilling his wife’s wishes.

At a press conference Thursday Felos insisted his client was acting out of love and respect for his wife’s desire to “die with dignity.”

“Who in God’s name would subject themselves to what he has gone through for any other reason?” he said. “He always deeply loved her.”

After hearing testimony from Michael Schiavo, his brother and sister-in-law that Terri had casually told them she would not want to be kept alive by artificial means, circuit court Judge George Greer ruled in 2000 and again in subsequent trials to remove the feeding tube.

Felos and Schiavo maintain Terri is PVS, which in Florida is defined by statute as a “permanent and irreversible condition of unconsciousness in which there is the absence of voluntary action or cognitive behavior of any kind [and] an inability to communicate or interact purposefully with the environment.”

Last year, Greer reaffirmed his ruling in favor of Felos and Schiavo on the basis of testimony from two physicians solicited by them and a third appointed by him. The PVS diagnosis is required by law for the removal of the feeding tube.

The Schindlers, who have been fighting with their son-in-law for 10 years argue Terri is alert, responsive and vocalizes, and given appropriate therapy can improve. WorldNetDaily has reported their opinion is buttressed by that of nearly a dozen physicians who signed sworn affidavits that she is not PVS – affidavits Greer rejected as evidence. The physicians offered their opinions after viewing videotape of Terri taken during a court-ordered evaluation. Some doctors have offered pro-bono treatment for her, which her husband declines.

In excerpts of the video shown in court, Terri smiles, laughs, vocalizes and tracks a balloon from one side of the room to the other. The Schindlers posted three audio clips and a series of videos clips of Terri on their website.

“You can see on the tapes how she has a big smile on her face as soon as she sees her mother, like she’s opening up a Christmas present,” her father remarked to WorldNetDaily. “That’s what’s so heartbreaking.”

Felos and two neurologists – one of them a right-to-die advocate – maintain Terri’s vocalizing and apparent expressions of happiness at seeing her mother or her tracking a balloon with her eyes are merely “involuntary reflexes” by a woman in a persistent vegetative state, whose cerebral cortex has been so irreparably damaged her condition cannot be improved by therapy or treatment.

“There is no cognition, no consciousness,” Felos told the Tampa Tribune.

WorldNetDaily has reported that in the first couple of years after her collapse Terri received rehabilitative therapy and progressed to the point of saying “no,” according to nurses’ notes. She would also say, “yes” and “stop that,” according to her parents. But in 1993, following the malpractice-suit awards, the therapy was discontinued and Terri was relocated by her husband to one nursing home and then another before ultimately being moved to a hospice in 2000 where she remains.

During a covert therapy session, Robert Schindler reports his daughter sat bolt upright and tried to get our of her chair when told by a therapist over the telephone she was sentenced to die.

“My daughter is not in a persistent vegetative state. She is not a ‘plastic plant’ as Mr. Felos says she is. She is extremely brain-damaged, and she’s a human being,” Mary Schindler, Terri’s mother said at yesterday’s press conference. “She responds to me every time I go in there.”

“This is a case about a judicial system making an error,” Hammesfahr said.

Focus on the Family believes the liberal-biased mainstream media is promoting and facilitating the judicial error by misreporting the medical facts of the case. The conservative, pro-family organization issued a fact sheet prepared by physician Walt Larimore and bioethics analyst Carrie Gordon Earll, to assist the family in correcting the misinformation, or disinformation.

Among the points the fact sheet makes is that Terri “is not comatose,” “is not dependent on life support,” and was not dying by natural causes prior to the removal of her feeding tube.

“Focus on the Family believes that there is a time to die (Ecclesiastes 3:2), and therefore there are situations when medical interventions should cease and a natural death be allowed. The question is not whether Terri should be allowed to die, however. The question is whether she has been given the opportunity to live,” reads the fact sheet.

“The sad case of Terri Schiavo is a poignant sign of the advance of the Culture of Death and the impact of its logic on the nation’s conscience,” concurs R. Albert Mohler Jr., president of Southern Baptist Theological Seminary, in commentary posted on Crosswalk.com. “The liberal elites have embraced the euthanasia movement and are ready to define life in terms of its perceived ‘meaningfulness.’”

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Schiavo Lawyers Challenge ‘Terri’s Law’ (Foxnews, 031030)

CLEARWATER, Fla. — The husband of a severely brain-damaged woman claimed in a court filing that a hastily passed state law empowering Gov. Jeb Bush to keep her alive violated the state constitution.

Lawyers for Michael Schiavo contended Wednesday that the law infringed on Terri Schiavo’s right to privacy and the separation of power provisions of the Florida Constitution.

The statute, dubbed “Terri’s Law” by Florida lawmakers, gave Bush the authority to order Terri Schiavo’s feeding tube be reinserted Oct. 21.

“It argues that her constitutional right to refuse medical treatment was, in essence, cast aside by a statute that allows the governor to do that under any whim and without any standards and without any review,” said George Felos, who represents Michael Schiavo, after filing the document.

Bush’s lawyers have a week to file a response. A hearing date has not yet been set.

“We will be responding in court,” said Bush spokesman Jacob DiPietre.

Michael Schiavo has been battling in court for years to carry out what he says is his wife’s wish to not be kept alive artificially.

His in-laws, Bob and Mary Schindler, have fought him, saying their daughter had no such wishes and is not in a permanent vegetative state, as a probate judge has declared. They say she is responsive and could improve with therapy.

Pat Anderson, lawyer for the Schindlers, hadn’t read the filing but contends that removing Terri Schiavo’s feeding tube and letting her die would be unconstitutional, violating the protections against discrimination based on physical disability and her right to enjoy life.

Terri Schiavo suffered severe brain damage in 1990 when her heart stopped. The legal battle over her fate is one of the nation’s longest and most contentious right-to-die cases.

She went without food and water for six days under a court order which allowed her husband to withdraw the tube. But within hours of the Legislature’s action last week, the tube was reinserted.

Florida courts have repeatedly affirmed Michael Schiavo’s legal right to remove his wife’s feeding tube. The state Supreme Court has twice refused to hear the case; the U.S. Supreme Court also refused to hear it.

President Bush said Tuesday that Gov. Bush, his younger brother, did the right thing in ordering the feeding tube reinserted.

The law passed by legislators also requires a guardian be appointed to represent Terri Schiavo’s interests in court. Deborah Bushnell, another lawyer for Michael Schiavo, asked Chief Circuit Judge David Demers Wednesday to delay the appointment until constitutional questions are settled.

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British Govt. Supports Euthanasia of Mentally Handicapped (LifeNews, 031117)

London, England (LifeNews.com) — While the current British government says it opposes euthanasia, it supports coming legislation that would legalize passive euthanasia, or euthanasia “by neglect” on mentally incapacitated adults.

A draft of the Mental Incapacity Bill is being prepared for presentation to Parliament. An attempt to clarify difficult medical and financial decisions for those unable to do so themselves as a result of illness or accident, it opens the door to starvation and dehydration of those suffering from dementia, stroke or traumatic brain injury, as well as other illnesses.

If passed, the Mental Incapacity Bill would be the first comprehensive law in the world to allow “euthanasia by neglect,” and could require the denial of treatment to patients not in danger of death, and would force doctors and other health professionals to assist in the starvation or negligent death of those in their care.

Because the legislation defines medical ‘treatment’ as “includ[ing] a diagnostic or other procedure,” decisions including tube-feeding, giving sedatives or pain-killers, and possibly spoon-feeding and turning immobile bed-bound patients, could be up to a government-appointed guardian, prior suicidal decisions by the patient, or anyone with “lasting powers of attorney.”

As the decision could be made by one’s spouse or government official it has the likelihood of creating situations like Terri Schiavo’s, in which her husband has been trying to have her feeding tube removed in order to starve her to death.

The legislation would also place the “wishes and feelings” of the patient, even suicidal ones, above their medical needs and best interests.

“On Nov. 26, the government might put the draft Mental Incapacity Bill in the Queen’s Speech, which announces what Bills the government plans for new legislation during the coming year,” said the Society for the Protection of Unborn Children (SPUC) in a statement to its members and supporters. “If the Bill is in the Queen’s Speech, legalized euthanasia by neglect is a step closer.”

Scottish and Northern Ireland MPs will be allowed to vote on the bill, although it will only apply to England and Wales.

The bill has been gathering opposition from lawyers, doctors, and human rights groups.

Richard Gordon, a leading human rights lawyer, has concluded that the bill is incompatible with the European Convention on Human Rights.

Dr. Philip Howard, a senior lecturer in medicine in London and consultant physician, has predicted that doctors and nurses will be criminalized or forced to leave their profession if they attempt to save the lives of suicidal patients.

“If the Mental Incapacity Bill becomes a new law it will be a very big step backwards for people with learning difficulties’ rights,” said People First, a learning disability group.

“The Bill will affect every single person in this country,” warned SPUC. “Everyone is vulnerable to accidents or illnesses that may cause mental incapacity.”

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Belgium Sees Over 200 Euthanasia Deaths During First Year Allowed (LifeNews, 031128)

Brussels, Belgium (LifeNews.com) — According to new figures from the Belgian government, there were 203 confirmed euthanasia deaths since the European country legalized the practice last year.

The Federal Ministry for Public Health released the figures on Tuesday and an official governmental report is expected early next year.

The data shows that significantly more, four to one, Flemish-speaking Belgians are seeking assisted suicide than French residents.

Brian Johnston, the author of “Death as a Salesman: What’s Wrong With Assisted Suicide” told LifeNews.com that the figure leads him to believe that “euthanasia is not being employed for medically indicated reasons but instead for culturally indicated reasons.”

The second revealing aspect has to do with the government’s monitoring and promotion of euthanasia, Johnston said. This summer the Belgian “Ministry of Euthanasia Control” had minimized the situation, suggesting there were far fewer actual acts of euthanasia.

Following the report, federal Health Minister Rudy Demotte said the government is looking at changes in the law to better check compliance with the regulations as well as make the application form simpler.

“The Belgian Medical Association quickly repudiated that suggestion, keeping the bureaucrats honest, thus requiring more transparency from the ‘controlling government authority,’” Johnston explained. “But now, rather than question the propriety and apparent imbalances in the use of euthanasia, the government is seeking to simplify and expand the practice, an ominous turn for the medically and emotionally vulnerable in Belgium.”

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Belgian Docs: Possibly More than 1,000 Euthanasia Deaths a Year (LifeNews, 031208)

Brussels, Belgium (LifeNews.com) — Doctors in Belgium over the weekend held a forum on euthanasia following the first year of legalized assisted suicide in the country. Though they admitted there could be as many as 1,000 deaths via euthanasia annually, a leading spokesman says the practice should be expanded to include teenagers and more disabled persons.

Several hundred doctors attended the national event, days after governmental figures showed just over 250 people died by euthanasia in the European country last year.

However, the doctors said that the number of deaths is severely underreported and there could be as many as 1,000 people who died last year from the grisly practice.

Surprisingly, the stark figure doesn’t have the country’s doctors up in arms. Instead, Wim Distelmans, chairman of the evaluation commission, wants to see euthanasia expanded to include teenagers and people suffering from degenerative diseases such as Alzheimer’s.

Distelmans also wants doctors who don’t believe in euthanasia to be required to refer patients to other doctors who will kill them.

Pro-life advocates say allowing teens to seek assisted suicide does them a disservice. Teen suicide rates are high in many country as teenagers battle depression as a result of academic and peer pressure and their first forays into relationships.

Brian Johnston is the author of “Death as a Salesman: What’s Wrong With Assisted Suicide.” He tells LifeNews.com that the doctors’ forum represents the “condescending, utilitarian view of humanity employed by euthanasia advocates.”

“‘Imperfect’ human beings are dismissed as objects that will do everyone, including themselves, a favor if they will just die,” Johnston explained.

Johnston was amazed that doctors would not only ignore the potential deaths of more than 1,000 people but work to expand the law.

“When physicians would not only ignore a thousand quiet, secret killings by doctors, but in fact demand more; when they would reprimand and force colleagues who hesitate to kill depressed patients based on the patient’s judgment and not their own; when an unalloyed zeal for medically implemented death sweeps a nation so quickly and savagely, the rest of the world is duty bound to give pause,” Johnston concluded.

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Disabling Assisted Suicide: Why a deadly movement hasn’t been contagious (NRO, 040119)

Just about year assisted-suicide advocacy groups insist that they are on the verge of their next big legalization breakthrough. In 1998 it was supposed to be in Michigan, via a voter initiative. Early polls showed the proposal leading by a wide margin. But when the smoke cleared, the measure lost by a whopping 71-29%.

Then, in 2000, a Maine initiative was going to prime the legalization pump and get the new assisted-suicide laws flowing. Polls showed strong public support for permitting doctors to prescribe death for their patients. Unlike in previous state referendums, supporters of assisted suicide were better financed than their opponents, making their success a likelihood. So urgent was their desire for victory that Oregon activists, where assisted suicide is legal, even sent missionaries to promote the measure — including then-Governor John A. Kitzhaber. Yet, when the votes were cast and counted, Maine had rejected assisted suicide by 51-49%.

The next big threat came in Hawaii in May 2002. Pushed energetically by then-Governor Ben Cayetano, an euthanasia enthusiast, the Hawaii house of representatives passed a legalization bill 30-20. It appeared stuck in a senate committee when, in an unexpected tactical maneuver, the bill reached the senate floor and passed on a snap vote, 14-11. But the measure needed a second affirmative vote to be sent to the governor’s desk. Opponents pressed the lobbying pedal to the metal, accelerating from zero-to-100 in less than 24 hours. The next day, the bill failed 13-12, and the legislative session ended. A disappointed Governor Cayetano left office and the danger ebbed.

In recent months, assisted-suicide advocates buzzed — and opponents worried — that Vermont was going to be “the place.” To prepare for the “Death with Dignity Act,” proponents lobbied the Vermont Medical Society to drop its opposition. They were almost successful. The group took a vote of its members and, essentially, decided not to advocate any law.

That could have helped promote passage. After all, the neutrality of the Oregon Medical Association was key in getting 51% of Oregon voters to approve assisted suicide in 1994. But it now appears that the early optimism of assisted-suicide advocates has, again, been dashed. The Rutland Herald reported earlier this month that the bill was dealt a “death blow” when “the heads of both the House and Senate Health and Welfare Committees said they won’t take up the measure.”

All of this begs a crucial question: Why have American euthanasia activists, who triumphed so spectacularly when Oregon voters legalized physician-assisted suicide, been so spectacularly unsuccessful ever since? The answer, I think, is found in the following Rutland Herald description of what led to the apparent downfall of the Vermont bill:

The move comes after the Vermont Coalition for Disability Rights, an advocacy group for the disabled, joined the Vermont Medical Society and Vermont Center for Independent Living [also closely affiliated with disability rights] in opposing the measure. It is also opposed by the Vermont Right to Life Committee and Burlington’s Catholic Diocese.

Note the prominence given to disability-rights activists; ten years ago, such a sentence would never have appeared in a media report. Then, opponents of assisted suicide were almost exclusively (if inaccurately) depicted as religiously motivated — even though medical, nursing, and hospice professional organizations also almost universally opposed legalization.

This misleading stereotype aided the assisted-suicide cause; it gave credence to euthanasia advocates’ political strategy of casting their opponents as religious fanatics seeking to impose sectarian beliefs upon secular society. Toward this end, Oregon euthanasia activists ran a distinctly anti-Catholic political campaign on behalf of Measure 16. One radio ad featured an angry Oregonian accusing the Catholic Church of “putting out garbage” about the measure and “trying to control my life.” Another falsely accused the church of imposing upon “every Oregonian” the religious belief that “suffering is redemptive and preserving physical life is always valued higher than relief of suffering.”

After Oregon’s law passed, both opponents and supporters of assisted suicide anticipated that this demagogic advocacy strategy would effectively break down what seemed to be weakening resistance among the public to the legalization of assisted suicide. But then, just when the situation seemed most bleak, disability-rights activists — who see disabled people as the prime targets of the euthanasia movement — powerfully entered the fray. And the tide began to turn.

In 1996 disability activists formed NOT DEAD YET after Jack Kevorkian was acquitted after assisting the suicides of two women with non-terminal disabilities. (The group takes its name from a scene in Monty Python and the Holy Grail.) NDY immediately made news by picketing Jack Kevorkian’s home and conducting a sit-in at the Hemlock Society’s Denver headquarters. (The Hemlock Society, like a leopard trying to change its spots, recently renamed itself “End of Life Choices.”) Since then, eleven other national disability-rights groups have joined NDY in opposing legalized assisted suicide, and chapters have protested and taken other political actions against the euthanasia agenda throughout much of the country.

The energetic commitment of the disabled-rights community, more than any other single factor, has thwarted the assisted-suicide movement. Because disability-rights activists are generally politically liberal, distinctly secular in outlook, and often supportive of abortion rights, the media can no longer caricature assisted-suicide opponents as religious busybodies. Moreover, people who would jump head first off a skyscraper if pro-lifers told them not to will listen to the opinions of disability-rights activists with open minds. As a result, some polls now show a sharp drop in the support for legalizing assisted suicide.

This “ecumenical” approach is now being applied to other issues that threaten the sanctity and equality of human life in the U.S. The disability-rights community has been deeply engaged in the struggle to save the life of Terri Schiavo, the Florida woman who a court determined should be dehydrated. They are also prime opponents of the neo-eugenics that permeate the bioethics movement. They have, for example, vocally opposed “futile-care theory,” which would permit doctors to unilaterally refuse a patient’s request for life-sustaining treatment, based on the perceived “quality” of that patient’s life.

Political conservatives and pro-life advocates will not always agree with the public-policy positions taken by the disability-rights community, and vice versa. But both realize that they have shared interests when it comes to some of the most important sanctity- and equality-of-life issues of our times. The political maturity exhibited by their willingness to work together on issues on which they agree — without demanding that deeply held convictions on other issues be sacrificed — is a winning political strategy. Just ask the assisted-suicide movement: It’s licking painful political wounds at the very time it expected to be enjoying electoral triumph.

— Author Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture.

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Ruling on Terri’s Life: Are courts encroaching on the right to live? (NRO, 040415)

The world has moved on since the case of Terri Schiavo, whose husband sought to remove the feeding tube that kept her alive, briefly grabbed public attention last fall. But Terri’s life remains at risk.

Michael Schaivo, her parents, the state of Florida, and advocacy groups continue to fight over her future. She keeps losing where it seems to matter most — in court.

Terri collapsed in 1990, leaving her profoundly cognitively disabled. Her husband won a $250,000 settlement and a $1.3 million malpractice judgment, including money awarded for Terri’s medical care.

He then refused to fund such treatment and in 2000 moved Terri into a hospice, designed to care for the dying, rather than the living. Along the way he moved in with a woman who he describes as his fiancé and with whom he has had two children. Six years ago he petitioned to remove the feeding tube that kept Terri alive.

Last October, Michael won court approval to let her die. Within a week after her feeding tube was removed, Florida’s legislature empowered Gov. Jeb Bush to order the tube reinserted, which he did.

With the support of the American Civil Liberties Union, Michael is seeking to invalidate that legislation. Moreover, backed by Florida Sixth Judicial Circuit Judge George W. Greer, who has managed the case for years, Michael continues to block family access to medical information about Terri’s care.

Terri Schiavo’s case is a tragedy, a vibrant life struck down so mysteriously when so young. But despite her disabilities, she remains very much alive.

The court-appointed guardian ad litem, Jay Wolfson, says that she has a “distinct presence,” responsive to her family, even if her responses are not consistent. Several doctors have argued that she is not unconscious, let alone in a “pervasive vegetative state.”

Killing Terri — or, more delicately, allowing her to die — surely should be allowed only if that is what she wants, or would have wanted. But we don’t know that.

Michael claims that she said she desired “no tubes.” Backing him are his brother and sister-in-law, who said that she made off-hand comments that she wouldn’t want to live under such circumstances.

Her family never heard her talk in such terms. And Michael apparently told a girlfriend that he and Terri never discussed the issue. Nor did he bother mentioning it until after winning the malpractice lawsuit over her injury.

But such comments by Terri, even if true, hardly offer the certainty necessary to let her die, especially since she is not comatose. Indeed, a number of doctors and other experts have

testified that rehabilitative therapy, barred by Michael, could improve her condition, wean her off of the feeding tube, and perhaps help her to speak. Moreover, reports attorney Wesley J. Smith of the Discovery Institute, “affidavits filed by nurses who cared for Terri claim that she has responded to them, can speak, and can even swallow food.”

More fundamentally, Michael’s own credibility is in doubt, to put it mildly. Normally a spouse is the best representative of a disabled patient. However, it is not clear that he is acting, or ever has acted, on her behalf.

Sadly, questions go back to her initial injury. A noted New York pathologist, Dr. Michael Baden, discounted the diagnosis of a heart attack induced by a potassium imbalance; after reviewing the report of a bone scan taken after her collapse he observed that Terri had “a history of trauma.”

Of course, Dr. Baden’s assessment does not prove that Michael is responsible for her condition, as her family believes. But nurses report hearing him make such comments as “When is that bitch going to die” in the mid-1990s. The circumstances raise important questions, which are now being investigated by Florida’s Advocacy Center for Persons with Disabilities.

Indeed, there is much to review when it comes to Terri’s treatment. The state of Florida requires annual reviews of guardianship plans, installation of a proper guardian, proper management of financial assets, provisions of “necessary services and rehabilitation,” and much more. Arguably all of these statutory rights have been violated.

In any case, Michael clearly would benefit from Terri’s death. Not only is he the legal guardian of the trust fund holding what remains (after hefty attorneys’ fees) of the malpractice judgment, but he cannot wed his fiance so long as Terri lives. Maybe such clear conflicts of interest have not influenced his decisions. But maybe they have.

He’s done nothing to dispel such suspicions through his treatment of the family. For instance, in 1996, Terri’s parents won a court order requiring Michael to furnish them with annual guardianship reports and to notify Terri’s caregivers that they could answer questions from Terri’s family.

However, Michael has repeatedly failed to write or turn over guardianship reports. Moreover, Terri’s parents explain that hospice staff have refused to consult with them, saying that Michael barred them from doing so. Robert and Mary Schindler say they were not even aware of two episodes of vomiting, which could have result in Terri’s death, in February.

The frustrated Schindlers filed suit to hold Michael in contempt. But in late March Florida Circuit Judge George W. Greer rejected their motion on the grounds that Mrs. Schindler’s testimony was based on hearsay. He ignored the missing guardian reports.

As Schindler attorney Pat Anderson has told Wesley J. Smith, most court decisions seem to follow “The Rule of Terri’s Case.” Explains Anderson: “If following a legal procedure will likely result in Terri dying, it will be adhered to. But if a procedure could make that outcome more difficult to attain, it will not be followed.”

Consider the Sixth Judicial Circuit’s Chief Judge David A. Demers. Guardian ad litem Wolfson recommended giving Terri a swallowing test — and maintaining the tube if she passed — which Judge Demers rejected. Judge Demers also failed to renew Wolfson’s guardianship.

The case took an even more bizarre turn when Michael’s attorney accused the family of trying to inject Terri with an unknown substance, perhaps to lay the groundwork for ending their visits. They rejected his claim; after all, they observe, they, not Michael, have been trying to care for her. They also noted the ubiquitous presence of medical and security personnel during their visits. A subsequent investigation found no evidence of injections.

Now everyone is waiting for the most important court decision, before Judge W. Douglas Baird, also of the Sixth Judicial Circuit, on the challenge to the constitutionality of the Florida law which enabled Gov. Bush to intervene. Judge Baird barred the Schindlers from intervening to help defend the law and prevented the state from deposing opposition witnesses. An appellate court ordered him to go back and follow proper procedures. Whether doing so will cause him to change his earlier rulings is yet to be seen.

If the legislation is voided, Michael certainly will move to again remove Terri’s feeding tube. And, given the operation of Terri’s Rule, it is hard to imagine any court intervening to save her.

Although the most important immediate concern is Terri’s life, much more is at stake. The “right to die” has become a political issue in such states as Hawaii, Michigan, and Oregon. More ominously, the “duty to die” seems to be advancing in America as well as Europe.

Village Voice columnist Nat Hentoff warns of a “growing conviction among American doctors, bioethicists, and hospital ethics committees that it is ‘futile’ to try to treat certain patients, and therefore, medical professionals should have the power to decide — even against the wishes of the family — when to allow these valueless lives to end.” Put bluntly: Why waste time, effort, and money on hopeless cases?

Wesley J. Smith cites the suit by Leslie Burke, a British man suffering from a terminal neurological disease, against the National Health Service demanding that it be ordered to treat him even after he requires a feeding tube to live. Amazingly, in a 1998 case British doctors complained that the parents of a seriously disabled 12-year-old resuscitated him after he suffered respiratory failure. Judges later ruled that the decisions on his life belonged to his doctors.

It is easy to look at Terri Schiavo and ask, who wants to live like that? But David Jayne, who lives only through use of a ventilator, says that “I’m very passionate about the Terri Schindler-Schiavo issue, because I live it.” He explains that before contracting ALS he couldn’t have imagined living under such circumstances, but that I “still find meaning in life.” He warns: “It is incredibly wrong for society to decide who lives or dies based on their opinions of what level of quality of life is worth living.”

What is Terri’s opinion? We may never know for sure. But we do know that we don’t know enough to assume that she would prefer to be dead. “Terri’s Rule” should presume that life is sacred and worth preserving. Nothing has been presented in Terri’s case to overcome that presumption of life.

— Doug Bandow is a senior fellow at the Cato Institute and a former special assistant to President Ronald Reagan.

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The Assault on Terri Schiavo Continues (WS, 040430)

Michael Schiavo won his fight to have his wife killed by dehydration. Now he won’t even allow her parents to sit by her side.

WHAT LITTLE Terri Schiavo has left in this life, is being cruelly stripped away. Not only has a judge ordered her to die slowly by dehydration via having her tube-supplied food and water removed, but now, her (estranged) husband and legal guardian Michael Schiavo has completely isolated her from her family. Ever since mysterious “puncture wounds” were supposedly detected on Terri’s arm, he has refused to allow Bob and Mary Schindler, Terri’s parents, to visit her.

For those who may not recall the controversy, Terri is the profoundly cognitively disabled woman who is the subject of a bitter right-to-live case in Clearwater, Florida. Michael remains in dictatorial charge of her care, even though he long ago abandoned his marriage by living with another woman and siring two children by her. He wants Terri dead (he says that is what she would want), while her parents only want to care for her properly for the rest of their lives.

Michael’s behavior toward Terri has been utterly despicable for the last decade. After she collapsed in 1990, he sued for medical malpractice on her behalf. During the trial, he presented himself to the jury as a dedicated and loving husband—even though he had been romancing other women since shortly after the time of Terri’s collapse and brain injury. He told the jury he would care for Terri for the rest of her life, which an expert testified would be a normal life span, and that as part of this loving devotion, he would provide

her with regular medical tests and appropriate rehabilitation with the money the jury awarded.

Terri received about $750,000 in early 1993, and Michael about $300,000 for loss of her companionship. As soon as Terri’s money was safely in the bank, Michael put her two cats to sleep. He then melted down her wedding and engagement rings to make a ring for himself. Medical records indicate that Terri went for years without having her teeth cleaned, as an apparent consequence of which, she recently had five teeth extracted.

And, he wanted his wife dead. Within a year of the verdict, he refused to allow doctors to treat her with antibiotics to treat a serious infection, claiming that Terri would not want to live in her disabled condition—a point he somehow forgot to mention to the malpractice jury. Not coincidentally, had she died, he would have inherited her $700,000. Terri’s parents sued to mandate care, and their relationship with Michael was forever poisoned.

Thereafter, medical records indicate, Terri had none of the medical testing Michael told the malpractice jury he would provide her, and apparently she received no rehabilitation. Indeed, nurses who cared for her in the mid-1990s filed sworn affidavits claiming that Michael repeatedly refused doctor recommendations that Terri be provided therapy.

As bad as Michael has been, in many ways, the performance of Judge George W. Greer of the Sixth Judicial Circuit, the jurist who oversees Terri’s case, has been even worse. Over the years Greer has repeatedly allowed Michael to shirk his legal mandate as guardian to file annual prospective “guardianship plans,” specifying his proposal for providing for Terri’s medical and social needs for the coming year.

The Florida legislature considered annual court approval of the guardianship plan so crucial to the proper protection of the incapacitated, that the law explicitly states that the “court must review” a new plan each year to ensure that it “meets the needs of the ward.” Moreover—and this is key—the law states, “the [court] approved report constitutes authority for the guardian to act in the forthcoming year. The powers of the guardian are limited by the terms of the report.” [emphasis added] In other words, without an approved plan, the guardian is without legal power to act on behalf of the ward.

Yet there has been no court-approved plan for Terri’s care in effect since July 1, 2001. Under the law, Greer should have hauled Michael into court to explain why he has failed to file a plan for court approval. Instead, Greer granted each of Michael’s repeated (and often tardy) requests for extra time to file his plans. Meaning Judge Greer has permitted Michael to act as guardian of Terri for nearly three years without a guardianship plan in effect, even though under Florida law, this means that Michael has no legal authority over her.

The Schindler’s attorney, Pat Anderson, frustrated by the many legal irregularities in the case, has now filed a crucial motion challenging Michael’s authority to isolate Terri from her parents, based on his lack of legal authority in light of the absence of a court approved guardianship plan. This should be a slam-dunk. Unfortunately, Greer—the very judge who has

repeatedly permitted Michael to shirk his legal duty—will decide the matter. It is hard to believe he will sanction Michael for failing to take legally mandatory actions that he gave permission to skip.

Judge Greer’s performance has been so deficient that he should be removed from the case forthwith, if not impeached. Michael Schiavo should be given a size-14 boot out as Terri’s legal guardian. And, since no one has any current legal authority to make decisions for Terri under Florida law, Governor Jeb Bush should direct Florida’s protective services to step in, take custody, and sort the entire mess out.

This entire travesty must come to an end. Not only is the life of a helpless human being at stake, but so too are the rule of law and the application of ordered justice.

Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture.

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Latimer questions top court ruling (National Post, 040510)

Sentence based on ‘fabricated assumptions’

OTTAWA — Robert Latimer blames “fabricated assumptions” for his 10-year prison term and says he wants to clarify a top-court judgment rather than apply for clemency — the legal route he’s been told is the best hope for shortening his sentence.

The Saskatchewan farmer has now served more than three years for the murder of his severely disabled daughter.

Latimer still questions how seven Supreme Court of Canada judges could unanimously conclude he had other medical options for easing Tracy’s pain.

“If these people are so proud of their decision, why can’t they explain it?” he asked in a rare interview from the minimum-security William Head Institution in B.C.

The high court ruled in 2001 that he would have to serve the minimum mandatory 10-year penalty for second-degree murder. The punishment was not grossly disproportionate to the crime, the judges said.

That decision came despite the wishes of Latimer’s trial jury that he spend one year in jail and another under house arrest at his farm near Wilkie, Sask.

The Supreme Court judgment also cited undefined “more effective” medication that Latimer could have given Tracy. He has never understood the reference, and he believes it leaves an impression that would undercut any application for clemency.

Latimer still says killing Tracy “was the right thing to do.” He wrapped her tiny frame in a blanket on Oct. 24, 1993, put her in the cab of his pickup truck and filled it with exhaust fumes.

It was the best decision because she faced unbearable suffering from planned surgery, he says.

At trial, Tracy’s pediatric orthopedic surgeon testified that the little girl, contorted by cerebral palsy, would likely face “incredible” pain after surgery to ease a permanently dislocated hip. The procedure involved removing part of her upper leg to create a “flail limb” that would no longer be connected by bone.

Both the surgeon and a family doctor had told the Latimers that Tylenol was the only thing Tracy could have once released from hospital. Anything stronger could have shut down her fragile respiratory system, Latimer said.

“She wouldn’t be able to breathe.”

Tracy would inevitably need the same surgery on her other hip, the family was told. She could not talk or feed herself, but enjoyed listening to music on good days, the trial court heard.

Escalating discomfort had erased such joys in the weeks leading up to Tracy’s death, Latimer says.

The 2001 Supreme Court judgment suggests the family could have used more effective drugs.

“It’s a fabrication,” Latimer said, his voice soft and measured even as he described his fruitless quest for details. “It’s certainly contrary to everything I’ve ever understood.”

The high court denied Latimer’s application for a re-hearing in 2002, deeming the case closed. “I guess they’ve swung their mighty hammer and that’s as far as it goes,” he says now.

Not that the married father of three other children is giving up. He plans to write again to the Justice Department, now headed by minister Irwin Cotler. All he wants, he says, are “honest answers from people who claim to be honest people.”

He insisted that until the matter is clarified there’s little point in heeding calls that he apply for clemency.

He is not eligible for day parole until Dec. 8, 2007.

More than three years behind bars hasn’t tempered Latimer’s belief that he ended his daughter’s life out of love. And his case is still a powerful catalyst for passionate debate.

To his detractors, he’s a murderer who must serve his full sentence to ensure protection for the disabled. “They believe that we had to keep mutilating and torturing her,” Latimer says.

Supporters assail his prison term as an unjust legal failure to reflect heart-breaking circumstances.

The Canadian Civil Liberties Association says Latimer has suffered enough. It’s urging Ottawa to “do the right thing” and release him, but the Justice Department says the Criminal Code provides that Latimer must apply first.

“We just cannot accept the fact that this man continues to languish in prison,” says Alan Borovoy, general counsel of the association. “We plan to renew the call for clemency in his case.”

Latimer says he appreciates such efforts but has no plans to file a clemency application.

For now, he’s completing an electrical course in prison where he shares a two-storey duplex with a small group of inmates. He walks the beachfront compound just west of Victoria and plays tennis for exercise.

Latimer runs his grain farm from behind bars with hired help and still gets letters and donations of support.

His wife and youngest son visited last Christmas. In a way, the distance is a blessing, he said.

“It’s important to be somewhat removed to try and let them carry on.”

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Now They Want to Euthanize Children (Weekly Standard, 040913)

In the Netherlands, 31% of pediatricians have killed infants. A fifth of these killings were done without the “consent” of parents. Going Dutch has never been so horrible.

by Wesley J. Smith

FIRST, Dutch euthanasia advocates said that patient killing will be limited to the competent, terminally ill who ask for it. Then, when doctors began euthanizing patients who clearly were not terminally ill, sweat not, they soothed: medicalized killing will be limited to competent people with incurable illnesses or disabilities. Then, when doctors began killing patients who were depressed but not physically ill, not to worry, they told us: only competent depressed people whose desire to commit suicide is “rational” will have their deaths facilitated. Then, when doctors began killing incompetent people, such as those with Alzheimer’s, it’s all under control, they crooned: non-voluntary killing will be limited to patients who would have asked for it if they were competent.

And now they want to euthanize children.

In the Netherlands, Groningen University Hospital has decided its doctors will euthanize children under the age of 12, if doctors believe their suffering is intolerable or if they have an incurable illness. But what does that mean? In many cases, as occurs now with adults, it will become an excuse not to provide proper pain control for children who are dying of potentially agonizing maladies such as cancer, and doing away with them instead. As for those deemed “incurable”—this term is merely a euphemism for killing babies and children who are seriously disabled.

For anyone paying attention to the continuing collapse of medical ethics in the Netherlands, this isn’t at all shocking. Dutch doctors have been surreptitiously engaging in eugenic euthanasia of disabled babies for years, although it technically is illegal, since infants can’t consent to be killed. Indeed, a disturbing 1997 study published in the British medical journal, the Lancet, revealed how deeply pediatric euthanasia has already metastasized into Dutch neo natal medical practice: According to the report, doctors were killing approximately 8% of all infants who died each year in the Netherlands. That amounts to approximately 80-90 per year. Of these, one-third would have lived more than a month. At least 10-15 of these killings involved infants who did not require life-sustaining treatment to stay alive. The study found that a shocking 45% of neo-natologists and 31% of pediatricians who responded to questionnaires had killed infants.

It took the Dutch almost 30 years for their medical practices to fall to the point that Dutch doctors are able to engage in the kind of euthanasia activities that got some German doctors hanged after Nuremberg. For those who object to this assertion by claiming that German doctors killed disabled babies during World War II without consent of parents, so too do many Dutch doctors: Approximately 21% of the infant euthanasia deaths occurred without request or consent of parents. Moreover, since when did parents attain the moral right to have their children killed?

Euthanasia consciousness is catching. The Netherlands’ neighbor Belgium decided to jump off the same cliff as the Dutch only two years ago. But already, they have caught up with the Dutch in their freefall into the moral abyss. The very first Belgian euthanasia of a person with multiple sclerosis violated the law; and just as occurs routinely in the Netherlands, the doctor involved faced no consequences. Now Belgium is set to legalize neo-pediatric euthanasia. Two Belgian legislators justify their plan to permit children to ask for their own mercy killing on the basis that young people “have as much right to choose” euthanasia as anyone else. Yet, these same children who are supposedly mature enough to decide to die would be ineligible to obtain a driver’s license.

Why does accepting euthanasia as a remedy for suffering in very limited circumstances inevitably lead to never-ending expansion of the killing license? Blame the radically altered mindset that results when killing is redefined from a moral wrong into a beneficent and legal act. If killing is right for, say the adult cancer patient, why shouldn’t it be just as right for the disabled quadriplegic, the suicidal mother whose children have been killed in an accident, or the infant born with profound mental retardation? At that point, laws and regulations erected to protect the vulnerable against abuse come to be seen as obstructions that must be surmounted. From there, it is only a hop, skip, and a jump to deciding that killing is the preferable option.

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Ottawa to revisit right to die debate (National Post, 041118)

It’s time to renew debate on assisted suicide: Minister

OTTAWA - Canada’s Justice Minister says the time has come to reopen the debate on whether assisted suicide should be legal.

Acknowledging that times have changed in the decade since Parliament last looked at the divisive issue, Irwin Cotler said politicians should debate whether Canada’s Criminal Code ban is outdated.

“This is a serious question, but a difficult and complex one on a moral level, a philosophical level, and a legal and medical level,” Mr. Cotler told the House of Commons justice committee last night.

“There are people who believe this is a matter of personal choice and the right to die in dignity, others who feel we’ve got to protect the rights of the disabled,” he said.

Mr. Cotler said he decided it is time to go back to the drawing board in light of recent high-profile assisted suicides in Quebec and British Columbia that have revived public debate.

Criminal charges were recently laid against Montrealer Marielle Houle for allegedly helping her 36-year-old son, Charles Fariala, commit suicide as relief from multiple sclerosis. In Victoria, 78-year-old Evelyn Martens, executive director of the Right to Die Network of Canada, was cleared this month on charges of aiding in the suicides of two women.

The assisted suicides have sparked numerous articles and commentary from medical and legal experts.

Bloc Quebecois MP Richard Marceau raised the issue at the justice committee, telling Mr. Cotler that a majority of Canadians now favour assisted suicide.

A recent national survey indicated that 76% believe people should have the right to die rather than endure the full course of a terminal illness.

Mr. Cotler told Mr. Marceau that the matter has been on his mind, and the Justice Minister suggested there should be a “take note debate” in Parliament, where politicians gather for an evening discussion that does not end in a vote.

The debate could be a starting point on whether it’s time to change the Criminal Code, Mr. Cotler said.

“I think it may be appropriate to offer the opportunity for this discussion,” he said.

“I don’t think there should be a rush to judgment until we say we are as properly informed as we deserve to be to make the most appropriate principled judgment in this regard.”

The last time Parliament looked at the issue was in 1995, when the Senate conducted a study and recommended that assisted suicide should remain illegal.

The Supreme Court of Canada reached the same conclusion in a monumental 1993 ruling involving Sue Rodriguez, a 42-year-old British Columbia woman suffering from debilitating Lou Gehrig’s disease who killed herself in 1994.

Retired Supreme Court justice Claire L’Heureux-Dube, a dissenter in the 5-4 ruling, recently wrote an opinion piece in the Quebec City newspaper Le Soleil calling for a change to the law.

Mr. Cotler said he has spoken to Ms. L’Heureux-Dube as well as other experts.

Evelyn Martens, a right-to-die activist charged with helping two people kill themselves, was acquitted earlier this month in Duncan, B.C.

The jury, which spent a day deliberating about the case, decided that the 73-year-old grandmother from Langford, B.C., was not guilty of aiding and abetting the suicides of former nun Monique Charest and teacher Leyanne Burchell.

The trial raised emotions, even among the jurors who heard the case.

One juror leaned over the box and whispered “thank-you, thank-you, thank-you,” as Ms. Martens trembled with relief in the verdict’s aftermath.

Ms. Martens said she helped the women end their lives out of compassion.

“I feel justified,” the former teacher said.

Charles Fariala, 36, was the multiple sclerosis sufferer found dead in his Montreal apartment Sept. 26. His mother, Marielle Houle, 58, has been charged with assisting his suicide.

He had planned his suicide for months, finding a recipe for a lethal cocktail mix on the Internet and having his loving mother at his side.

A four-member panel of experts brought together in the wake of Mr. Fariala’s death in October in Calgary was evenly split over whether to legalize assisted suicide.

“I think we should leave the law as it is,” said Margaret Somerville, professor of law and medicine at McGill University, speaking on the Global Sunday current-affairs talk show.

“We’re not a product in a supermarket — as one politician who advocated euthanasia said — to be checked out as quickly, cheaply and efficiently as possible.

“Particularly with an ageing population (and) scarce health-care resources, add to that euthanasia and you’ve really got a lethal societal cocktail. It’s extremely important that we keep the value of respect for life.”

But University of Calgary philosophy professor John Baker argued that was out of step with where the majority of the population sits on the issue.

A 2001 Leger Marketing poll found 75.5 per cent of Canadians are in favour of assisted suicide.

“One of the interesting statistics is that the citizenry are more frightened of being forced to stay alive than they are of prematurely having their lives ended in a hospital situation,” Mr. Baker said.

“I give talks on this all over the place and the almost uniform reaction of people when I give the talk is, ‘I’m afraid of someone forcing me to suffer and not giving me the appropriate release when the time comes.’ “

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Dutch Hospital Euthanizing Gravely Ill Babies (Foxnews, 041130)

AMSTERDAM, Netherlands — A hospital in the Netherlands — the first nation to permit euthanasia — recently proposed guidelines for mercy killings of terminally ill newborns, and then made a startling revelation: It has already begun carrying out such procedures, which include administering a lethal dose of sedatives.

The announcement by the Groningen Academic Hospital came amid a growing discussion in Holland on whether to legalize euthanasia on people incapable of deciding for themselves whether they want to end their lives — a prospect viewed with horror by euthanasia opponents and as a natural evolution by advocates.

In August, the main Dutch doctors’ association KNMG urged the Health Ministry to create an independent board to review euthanasia cases for terminally ill people “with no free will,” including children, the severely mentally retarded and people left in an irreversible coma after an accident.

The Health Ministry is preparing its response, which could come as soon as December, a spokesman said.

Three years ago, the Dutch parliament made it legal for doctors to inject a sedative and a lethal dose of muscle relaxant at the request of adult patients suffering great pain with no hope of relief.

The Groningen Protocol, as the hospital’s guidelines have come to be known, would create a legal framework for permitting doctors to actively end the life of newborns deemed to be in similar pain from incurable disease or extreme deformities.

The guideline says euthanasia is acceptable when the child’s medical team and independent doctors agree the pain cannot be eased and there is no prospect for improvement, and when parents think it’s best.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions; and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida and epidermosis bullosa, a rare blistering illness.

The hospital revealed last month it carried out four such mercy killings in 2003, and reported all cases to government prosecutors. There have been no legal proceedings against the hospital or the doctors.

Roman Catholic organizations and the Vatican have reacted with outrage to the announcement, and U.S. euthanasia opponents contend the proposal shows the Dutch have lost their moral compass.

“The slippery slope in the Netherlands has descended already into a vertical cliff,” said Wesley J. Smith, a prominent California-based critic, in an e-mail to The Associated Press.

Child euthanasia remains illegal everywhere. Experts say doctors outside Holland do not report cases for fear of prosecution.

“As things are, people are doing this secretly and that’s wrong,” said Eduard Verhagen, head of Groningen’s children’s clinic. “In the Netherlands we want to expose everything, to let everything be subjected to vetting.”

According to the Justice Ministry, four cases of child euthanasia were reported to prosecutors in 2003. Two were reported in 2002, seven in 2001 and five in 2000. All the cases in 2003 were reported by Groningen, but some of the cases in other years were from other hospitals.

Groningen estimated the protocol would be applicable in about 10 cases per year in the Netherlands, a country of 16 million people.

Since the introduction of the Dutch law, Belgium has also legalized euthanasia, while in France, legislation to allow doctor-assisted suicide is currently under debate. In the United States, the state of Oregon is alone in allowing physician-assisted suicide, but this is under constant legal challenge.

However, experts acknowledge that doctors euthanize routinely in the United States and elsewhere, but that the practice is hidden.

“Measures that might marginally extend a child’s life by minutes or hours or days or weeks are stopped. This happens routinely, namely, every day,” said Lance Stell, professor of medical ethics at Davidson College in Davidson, N.C., and staff ethicist at Carolinas Medical Center in Charlotte, N.C. “Everybody knows that it happens, but there’s a lot of hypocrisy. Instead, people talk about things they’re not going to do.”

More than half of all deaths occur under medical supervision, so it’s really about management and method of death, Stell said.

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Death by Committee (Weekly Standard, 041202)

What the Groningen Protocol says about our world, and where it might lead next.

WHEN NEWS of the Groningen Protocol surfaced in October, it was reported in the Grand Forks Herald,though I didn’t read of it, nor apparently did many others. The Groningen Protocol could have been the stuff of a fine presidential debate question, or a series of questions, but I doubt if any of the debate moderators or either of the presidential candidates had heard of it either. It is an intriguing title, but it should enter the history books as shorthand for an appalling brutality, so appalling in fact, that “The Groningen Protocol” could have been an entry on the agenda at the Wannsee Conference.

The Groningen Protocol is the proposal of doctors in the Netherlands for the establishment of an “independent committee” charged with selecting babies and other severely handicapped or disabled people for euthanasia. The original article provides some of the key details:

Under the Groningen protocol, if doctors at the hospital think a child is suffering unbearably from a terminal condition, they have the authority to end the child’s life. The protocol is likely to be used primarily for newborns, but it covers any child up to age 12.

The hospital, beyond confirming the protocol in general terms, refused to discuss its details.

“It is for very sad cases,” said a hospital spokesman, who declined to be identified. “After years of discussions, we made our own protocol to cover the small number of infants born with such severe disabilities that doctors can see they have extreme pain and no hope for life. Our estimate is that it will not be used but 10 to 15 times a year.”

A parent’s role is limited under the protocol. While experts and critics familiar with the policy said a parent’s wishes to let a child live or die naturally most likely would be considered, they note that the decision must be professional, so rests with doctors.

On Tuesday the AP carried a second story, and Drudge broadcast the news to the cyber world: The protocol was already in effect, and at least four babies had been deemed disposable, and killed.

This is either a low point, or a point of no return. The establishment of “independent committees” to dispatch non-consenting humans is nothing but a death penalty committee for innocents. Once begun, it is impossible—simply impossible—to limit the concept with any bright line. Abortion, of course, has always been limited by the physical act of birth, and once out of the womb, only the most extreme “reproductive rights” advocates have argued that the baby’s natural right to live can be compromised by the mother. But now the Netherlands has gone farther—much, much farther. If the “severely retarded” may be killed upon appropriate motion, second, debate, and majority vote, why not the moderately retarded? Why not the mildly retarded? Why not, in fact, anyone the “independent committee” deems as usefully dispatched.

Incredibly, the nation’s elite media has turned a collective blind eye to this story, though the Los Angeles Times did, on the day following the Drudge headline, find time to put on the paper’s front page, above the fold, the story that Salmon and Steelhead May Lose Protection, but not a column inch of ink for a radical leap past Kevorkian land into the regions of Mengele.

LAST WEEK I marveled at the casual manner with which the Target Corporation announced that the Salvation Army could no longer place its kettles and ring its bells outside the giant retailer’s 1,500+ stores. It was a callous and Scrooge-like act, one that I and thousands of others found sufficiently appalling as to oblige us not to shop at the store this season. I noted the irony of a retailer grown fat on Christmas gift sales tossing the charity most closely aligned with the public’s image of Christmas spirit.

How foolish to imagine that actions such as Target’s would offend greatly when protocol’s such as Groningen’s pass without comment before the eyes of editorialists and talking heads. Four years into the new century, and one can only guess where it will end. I do not think it is safe to bet that these next 96 years will be less bloody than the years 1905 to 1999.

Hugh Hewitt is the host of a nationally syndicated radio show, and author most recently of If It’s Not Close, They Can’t Cheat: Crushing the Democrats in Every Election and Why Your Life Depends Upon It. His daily blog can be found at HughHewitt.com.

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In Service to Inhumanity (American Spectator, 041203)

What is the difference between aborting a baby and euthanizing it? Nothing except the timing of the killing. In the Netherlands, a country that never hesitates to unfold the logic of liberalism to its farthest points, doctors have devised a program to euthanize babies deemed defective. They euthanized four babies last year, according to press reports earlier in the week. Now they are calling upon the Dutch government to pursue a more ambitious program that would let doctors euthanize undesirables with “no free will,” meaning minors.

C.S. Lewis wrote that evil is done “in clean, carpeted, warmed and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voices.” Lewis could have added that they don’t even need to raise their voices when they go on public radio to explain their evil. On Wednesday, National Public Radio politely interviewed one of the Dutch doctors overseeing the euthanasia-for-children program, Eduard Verhagen, clinical director of the Pediatric Clinic of the University Hospital at Groningen. This white-coated doctor with neatly trimmed fingernails didn’t need to raise his voice when asked by NPR quite casually, “How was it decided that they should die?” The children had medical conditions like “spina bifida,” responded Verhagen. The babies were born “with incurable conditions,” so “we felt that in these children the most humane course of action would be to allow the child to die, and even actively assist them in their death.”

Assist them in their death. Had the toddlers scrawled out a consent form? No, they lack “free will,” so pediatricians made the decision for them. Asked if what his hospital had done was legal, Verhagen blithely said, “No, it’s not legal,” but implied the Dutch government would tidy up that decision later. “It’s a very delicate and very important decision that one needs to make,” he said. “And if such a decision is made, we prefer to have it tested or assessed by a committee of experts, just to make sure that we have taken into account all the requirements and that we are really doing something that is correct.”

Would parents be able to veto the decision on which children get to live or die according to the committee? Apparently not. When Verhagen was asked, “Is it just up to the parents?” he said, “No.” But he quickly caught himself and magnanimously allowed that parents are “always very much involved.” Ultimately, however, who lives or dies is the culture’s decision, he said. “Let’s see how society thinks of it,” he offered. “What we would like to happen here in Holland is that we put the spotlight on such decisions because they need to be extremely secure. And instead of taking these decisions in a kind of gray area, we want them to be in the spotlight…The culture in Holland is a culture where euthanasia for adults has been legalized in 2002 by the Parliament.”

Verhagen concluded on the thought that “the best way to protect life is to sometimes assist a little bit in death.” This contradicted what he had said earlier when he stressed that “we are actually talking about children that are already in a dying process.” No, they were not dying. If they were dying, they would have died without euthanasia. It is precisely because they were not dying that the Dutch doctors euthanized them.

Euthanasia isn’t letting a patient die but killing a patient who isn’t dying. It is an act of annoyance at a patient who isn’t dying on the timetable those who want the patient to die would prefer. In the Terri Schiavo case, for example, her impatient husband demanded that she be deprived of food and water because she wasn’t dying with sufficient speed. “Has she died yet?” a nurse heard him say. “When is that bitch going to die?” Euthanasia, it was said, would allow Schiavo to “die in peace.” Die in peace? No, it would guarantee that she die violently. Starvation is not a peaceful act.

In clean, well-lighted hospitals, Verhagen and doctors like him are committing barbaric acts no different from pagans of old leaving inconvenient children on hilltops. Whenever a doctor uses the word “humane,” it is clear that he has already performed the inhuman.

George Neumayr is executive editor of The American Spectator.

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Court Refuses to Reopen Terry Schiavo’s Case (Christian Post, 041231)

Florida’s Second District Court of Appeal Dec. 29 affirmed a lower court’s decision not to re-open a case involving the religious liberty of a woman in a vegetative state, Terri Schiavo. Terri Schiavo has been in what doctors consider a persistent vegetative state since 1990 when she collapsed in her home.

Florida Supreme Court determined that once any court has issued a decree regarding the care of an incompetent person, neither the legislature nor the executive branch can take independent steps on behalf of the incompetent person’s welfare, according to BPNews.

Bob and Mary Schindler, Terri’s parents, filed the appeal on first amendment grounds, arguing that the removal of the woman’s feeding and hydration tube would violate her religious rights. The Schindlers are allowed to file a motion within 15 days asking the court to re-hear their appeal, but will not be permitted to appeal the court’s decision to the Florida Supreme Court. However, the case will be appealed to the Supreme Court.

Her parents argue that even if Terri had previously indicated she would wish to die in such circumstances, as a Roman Catholic, Terri would very likely have changed her mind after Pope John Paul II’s statement last year that removing a feeding tube would constitute “euthanasia by omission.”

Circuit Court Judge George Greer in October denied the religious liberty argument and refused to re-open the case based on what Schindler attorneys said. The stay on removing Terri’s feeding tube will expire when the Second District Court of Appeals issues their final decision within 15 days.

Her husband and legal guardian, Michael Schiavo, has sought the removal of his wife’s feeding tube for nearly a decade, saying it is what she would have wanted. The Schindlers maintain that their daughter has not received the rehabilitation and care she requires.

Schiavo’s feeding tube was removed in October 2003, but the Florida legislature passed a law giving Bush the authority to order the re-insertion of the tube. He did so, and Michael Schiavo challenged the constitutionality of the law, and it was ruled unconstitutional by the Florida Supreme Court in September 2004.

Bob Schindler told the Florida Baptist Witness he is angered and frustrated by the court of appeal ruling, which may clear the way for Michael Schiavo to have his wife’s feeding tube removed.

Lawyers from Gibbs Law Firm, who are representing the Schindlers, are planning to file about 4-5 other legal motions related to the case in the next few weeks.

Meanwhile, Florida’s Gov. Jeb Bush asked the U.S. Supreme Court to hear the case.

“This is a case that certainly deserves consideration by the Supreme Court and we are supporting the Governor’s office in its effort to have the high court take this critically important case,” Sekulow, a lawyer said.

The U.S. Supreme Court is expected to give a decision by early January on whether or not they will accept the case.

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Supreme Court Clears Way to Pull Schiavo’s Feeding Tube (Foxnews, 050124)

WASHINGTON — The Supreme Court refused Monday to reinstate a Florida law passed to keep a severely brain-damaged woman hooked to a feeding tube, clearing the way for it to be removed. How soon that would happen, however, was unclear.

The Florida Supreme Court had struck down the law last fall, and the justices were the last hope for state leaders who defended the law in a bitter long running dispute over the fate of Terri Schiavo.

Her husband, Michael Schiavo, contends she never wanted to be kept alive artificially. But her parents told justices in a filing that their son-in-law is trying to rush her death so he can inherit her estate and be free to marry another woman.

The Supreme Court did not comment in rejecting an appeal from Gov. Jeb Bush, who argued that the state had the authority to step in and pass the 2003 law that ordered Terri Schiavo’s feeding tube reinserted six days after her husband had it removed.

Florida judges will now decide, after the Supreme Court’s action, what happens next in the case.

“It’s judicial homicide. They want to murder her,” her father, Robert Schindler, said Monday. “I have no idea what the next step will be. We’re going to fight for her as much as we can fight for her. She deserves a chance.”

The case was one of two right-to-die appeals pending at the high court. Justices are expected to decide in the next month whether to consider a Bush administration request to block the nation’s only law allowing doctors to help terminally ill patients die more quickly. Oregon voters passed that law in 1998.

At issue Monday was “Terri’s Law,” which the Florida Supreme Court ruled unanimously was an unconstitutional effort to override court rulings.

The 41-year-old Schiavo suffered brain damage in 1990 when her heart temporarily stopped beating because of an eating disorder. In 2001, her parents lost an emergency Supreme Court appeal seeking to keep her feeding tube in place, but more appeals followed.

Terri Schiavo has lived in nursing homes. She can breathe on her own but depends on a feeding tube to stay alive because she cannot swallow on her own. She left no written directive.

Issues in dispute are whether she is in a persistent vegetative state with no chance of recovery, and if she had said before her illness that she did not want to be kept alive by machines.

Washington attorney Robert Destro, representing Florida, told justices to consider “the most vulnerable of our citizens who cannot speak for themselves.”

Michael Schiavo did not file any arguments with the court, but his attorney had accused Florida leaders of engaging in delaying tactics to prevent Terri Schiavo from carrying out her right to die.

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Terri Shiavo’s Right to Life Case Returns to Supreme Court (Christian Post, 050210)

The critical right-to-life case of Terri Shiavo, a disabled woman who has been in a “persistent vegetative state” for fifteen years, will be presented to the U.S. Supreme Court in what may be the last chance for her to remain alive.

Terri’s story began when she collapsed at her home in 1990. Since then, she has been in what some doctors consider a “persistent vegetative state,” and have been connected to a feeding tube to maintain her life. Only five years after her condition, Michael Shiavo, Terri’s husband and legal guardian, began seeking ways to remove her tube, claiming she did not want to be kept alive artificially. According to reports, Michael, who fathered two children with his live-in girlfriend, never mentioned his wife’s wishes until after the couple was awarded more than $1 million in medical malpractice claims.

Michael Schiavo succeeded in removing her tube in October 2003, but the Florida legislature passed a law giving Governor Jeb Bush the authority to re-insert the tube. Michael challenged the law and the Florida Supreme Court ruled “Terri’s Law” unconstitutional in September 2004.

Terri’s parents then filed an appeal, explaining that even if her daughter had requested to die, as a Roman Catholic she would’ve changed her mind. The appeals court however let stand the Florida Supreme Court decision on December 29.

Most recently, Terri’s parents, Bob and Mary Schindler, were dealt a loss when the U.S. Supreme Court Feb. 4 refused to reinstated Terri’s law.

The ruling leaves the Schindlers without many options in Florida, but offers a way for their attorney to take the case to the U.S. Supreme Court under the disabled person’s religious liberty rights clause.

The Schindlers’ lawyers plan to argue that even if their daughter had said before that she would not want to be kept a live artificially, she would’ve changed her mind as a Roman Catholic after hearing Pope John Paul II say that removing a feeding tube from a patient such as herself would be “euthanasia by omission”.

According to the Florida Baptist Witness, an attorney with the Gibbs Law Firm which represents the Schindlers, said Terri’s parents are doing “amazingly well” in light of the district court’s ruling. The attorneys plan to press for Terri’s religious and due process rights in filing the lawsuit.

“We have been all along planning to do that,” Barbara Weller, to the Witness. “We’re just very disappointed that [the court] chose not to deal with such an important issue of the free exercise of religion, which is one of the most important foundations of our American government.”

Weller also said Michael Schiavo’s attorney, George Felos, is incorrect in statements he made to the press that healthcare workers will be able to begin starving her in February 22.

“We still have other avenues of appeal,” Weller said, explaining that since several courts are involved, her firm cannot request a stay in anticipation of another stay’s expiration.

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Supreme Court to Hear Assisted-Suicide Challenge (Foxnews, 050222)

WASHINGTON — The Supreme Court on Tuesday said it will hear a challenge to the nation’s only assisted suicide law, taking up a case embracing the Bush administration’s appeal to stop doctors from helping terminally ill patients die more quickly.

Justices will review a lower court ruling that said the U.S. government cannot sanction or hold doctors criminally liable for prescribing overdoses under Oregon’s voter-approved Death With Dignity Act. Since 1998, more than 170 people — most with cancer — have used the law to end their lives.

Arguments will be heard in the court’s next term, which begins in October.

Former Attorney General John Ashcroft filed the appeal last November, on the day his resignation was announced by the White House, arguing that physician-assisted suicide is not a “legitimate medical purpose” and that doctors take an oath to heal patients, not help them die.

Oregon countered by saying that regulation of doctors generally has been the sole responsibility of the states. Ashcroft has no authority under the federal Controlled Substances Act to punish doctors because Congress intended the law only to prevent illegal drug trafficking, the state argued.

The San Francisco-based 9th U.S. Circuit Court of Appeals sided with Oregon last May.

“The attorney general’s unilateral attempt to regulate general medical practices historically entrusted to state lawmakers interferes with the democratic debate about physician-assisted suicide,” wrote Judge Richard Tallman in the 2-1 opinion.

In 1997, the Supreme Court unanimously ruled that individuals had no constitutional right to die, upholding state bans on physician-assisted suicide. In an opinion by Chief Justice William H. Rehnquist, the court suggested it was up to the individual states to decide whether to permit or ban the practice.

The issue now before the high court is whether Congress could step in to prohibit assisted suicide if a state chose to allow it, and, if so, whether the federal Controlled Substances Act authorizes the Justice Department to do so.

Oregon voters approved the law in 1994 and overwhelmingly affirmed it three years later when it was returned to the ballot following a failed legal challenge that stalled its implementation.

The law allows terminally ill patients with less than six months to live to request a lethal dose of drugs. Two doctors must confirm the diagnosis and determine the patient to be mentally competent to make the request.

The Oregon challenge is the second right-to-die case to come before the Supreme Court this year. Last month, justices rejected Florida Gov. Jeb Bush’s appeal to keep Terri Schiavo, who is severely brain-damaged, on life support over the objections of her husband.

Schiavo, whose legal fight is continuing, was scheduled to be taken off life support as early as Tuesday.

In 1990, the Supreme Court ruled that terminally ill people may refuse treatment that would otherwise keep them alive, but declined in the 1997 case to extend that constitutional right to obtaining medication that would put them to death.

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Church of England Reaffirms Disapproval of Euthanasia (Christian Post, 050120)

The highest senior member of the 77-million member Anglican Communion re-iterated his disapproval of euthanasia, in light of the final evidence session of the House of Lords select committee on the Assisted Dying for the Terminally Ill Bill, Thursday, Jan. 20, 2005.

In a January 20 op-ed to the Times in London, the Archbishop of Canterbury explained that if euthanasia – also known as assisted suicide - is recognized legally, it would place a responsibility on others to kill.

“Rights create responsibilities, we often like to say. Does the recognition of a legal right to assisted dying entail a responsibility on others to kill? This is not an academic question,” said Canterbury. “What legal implications could arise about the deliberate frustration of someone’s legally secured rights, if relatives or physicians refused to act?”

Canterbury also appealed to the belief in the intrinsic value of human life as a reason to halt the euthanasia bill from becoming law.

“The appeal to our sense of compassion in order to justify a change in our legal practice is wholly understandable,” wrote Canterbury, stating the oft-used argument in favor of assisted suicide. “But could it end up undermining just that broad sense of unconditional human worth and value in which compassion itself is grounded?”

Canterbury also said that for someone with religious beliefs to say they wanted to die was for them to feel their life had no value.

“That would be, in the eyes of most traditional believers, Christian or otherwise, an admission that faith had failed,” he said.

Additionally, allowing non-believers to support assisted suicide would be harmful to the society as a whole, said Williams.

Allowing non-believers to take a different view through assisted suicide would be harmful for society as a whole, Williams added.

“What anyone’s life means is not exclusively his own affair. He lives in relation — to others and to a society,” explained Williams. “At the simplest level, what often most shocks and grieves people who have been close to a suicide is the feeling that someone who has killed himself did not know what he really meant to his friends or family, did not know that he was loved and value”

Williams’ statement comes only one week after a British judge freed a retired policeman who killed his terminally-ill wife out of “compassion.”

The man, Brian Blackburn, 62, plead guilty to the manslaughter of his wife, Margaret. Brian, who made a suicide pact with his wife, slit Margaret’s wrist and then held her for the 20 minutes until she died, according to reports. He then tried to cut his own wrist, but he failed to sever an artery and soon ended up in the hospital.

Earlier this week, Blackburn was released without a prison sentence, after being described a “loving husband.”

In a separate case, Graham Lawson, a man who “comforted” his terminally ill sister during her 26-hour suicide, was not charged with a crime. Lawson faced the possibility of 14 years’ imprisonment because he watched as his sister repeatedly tried to suffocate herself with a plastic bag; she was successful on her eight time.

According to the BBC, the House of Lords select committee on the Assisted Dying for the Terminally Ill Bill holds it’s final evidence session on Thursday. The Select Committee was set up to consider a Private Member’s Bill calling for legalized euthanasia introduced by Lord Joffe.

The Church of England House of Bishops and the Roman Catholic Bishops’ Conference of England and Wales last year sent in a joint submission to the House of Lords Select Committee, where they described the Bill as “misguided” and “unnecessary.”

In its conclusion, the bishops’ joint submission says: “It is deeply misguided to propose a law by which it would be legal for terminally ill people to be killed or assisted in suicide by those caring for them, even if there are safeguards to ensure it is only the terminally ill who would qualify.

“To take this step would fundamentally undermine the basis of law and medicine and undermine the duty of the state to care for vulnerable people. It would risk a gradual erosion of values in which over time the cold calculation of costs of caring properly for the ill and the old would loom large. As a result many who are ill or dying would feel a burden to others. The right to die would become the duty to die.”

It adds: “The Bill is unnecessary. When death is imminent or inevitable there is at present no legal or moral obligation to give medical treatment that is futile or burdensome. It is both moral and legal now for necessary pain relief to be given even if it is likely that death will be hastened as a result. But that is not murder or assisted suicide.

“What terminally ill people need is to be cared for, not to be killed. They need excellent palliative care including proper and effective regimes for pain relief. They need to be treated with the compassion and respect that this Bill would put gravely at risk.”

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Euthanasia: Who Needs It? (Christian Post, 050131)

Sharon A. Falkenheimer, M.A., M.D., M.P.H., is President of Bioethics & Medicine, Inc. and a Fellow of The Center for Bioethics and Human Dignity.

Do people really want doctors to help them end their lives in times of pain and illness? To listen to the media or read the press, you certainly would think so. Advocates of euthanasia argue that if people are given a choice between dying in agonizing pain or undergoing euthanasia/physician assisted suicide (PAS), the preferred choice would be euthanasia/PAS. Indeed, few people would choose to die in agony, except possibly Jesus, as the recent movie The Passion of the Christ has so graphically re-enacted.

However, the presentation of only these two extreme alternatives is deeply biased. Agonizing pain and euthanasia/PAS are not the only ways people die. A wide range of choices and experiences exist between these extremes including adequate treatment of pain and other bothersome symptoms (so-called “palliative care”), hospice care at home or in a medical facility, and even sedation to the point of complete anesthesia and unconsciousness (known as “terminal sedation”). Questions, like this one, frequently are meant to be misleading. One choice is set up to be so unpalatable (i.e., dying in agony) that it makes the other option (euthanasia/PAS) seem acceptable in comparison. However, when considered separately, a physician’s assistance in death would be judged unacceptable. Fear of the dreaded alternative may motivate a respondent to make an immoral choice. Posing questions in this way is an old trick that is easily anticipated when only polar alternatives are presented.

Regardless of whether euthanasia/PAS is desired by most people or even viewed as moral, it has been legalized in the Netherlands, Belgium, and the U.S. State of Oregon. The irony of the Netherlands being the first nation to legalize the practice is lost on many who are unfamiliar with the history of medical practice in that nation. In the Nazi era, 98% of Dutch physicians refused to conform or participate when ordered by the Germans to become members of its Nazi-led, anti-Semitic medical society and thereby lost their authority to practice medicine. Now it is their medical heirs who are the leading the world in the acceptance and practice of PAS!

Many predicted abuses of PAS have come to pass and are increasingly well documented. These include physicians failing to follow one or more of the mandated regulations for administering PAS. The requirements are that (1) the patient is in “unbearable suffering,” (2) no other effective alternative treatment is available, (3) two physicians agree that PAS is indicated, (4) the patient requesting PAS is competent, not depressed, and not pressured by others, and (5) that all cases of PAS are reported to the authorities. Most alarmingly, some physicians have decided to administer PAS when neither the patient nor family has requested it.

However, recent trends indicate a shift in the practice. A recent survey of 1,500 physicians in the Netherlands by a professor at Nijmegen University reported that euthanasia/PAS is waning in their country. Due to improvements in palliative care and pain relief, it is increasingly rare for Dutch physicians to see medical indications for euthanasia or PAS. This should not be a surprise. Over 2,000 years ago, Hippocrates recognized the importance of ensuring that physicians gave exclusive attention to patients’ needs and did not participate in harming them in any way. Attending to patients’ needs certainly does not include helping to kill them.

This “Hippocratic” form of medicine initially was a minority practice at a time when both medical and spiritual care were often under a single individual, such as a shaman, who might bless or curse a person seeking assistance. Hippocratic medicine was entered into by swearing an oath that proscribed, among other things, giving poison to a patient (a form of PAS). This oath has, of course, become known as the Hippocratic Oath, and though originally sworn to Greek deities, has been adopted in a slightly modified form by Jewish, Christian, and Muslim medical practitioners. Though increasingly watered down to conform to current societal mores, the Hippocratic Oath is foundational to Western medicine. It recognizes what Dr. William Osler later more succinctly put into words: “The secret of caring for the patient is caring for the patient.” Studies have shown that it is not euthanasia/PAS that patients want, but optimum pain relief, end of life care, and the assurance that their physician will not abandon them.

The push for legalized euthanasia/PAS is, to a great extent, the result of a failure of medical training and practice. Only recently have the relief of pain, optimum palliative care, and the availability of hospice services become a high priorities. Medical societies, such as the American Medical Association, are working to ensure that all physicians are trained adequately in pain relief and end of life care. Bemoaning past failures to provide this type of care will do little to help our current patients. Even the most active proponents increasingly recognize that the legalization of euthanasia and PAS is more reflective of a failure than a solution. One can only hope that the increasing rejection of physician participation in euthanasia and PAS will spread and initiate a recognition of and return to the wisdom of Hippocratic values in patient care.

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Accident Victim Speaks After 20-Year Silence (Foxnews, 050213)

HUTCHINSON, Kan. — For 20 years, Sarah Scantlin has been mostly oblivious to the world around her — the victim of a drunken driver who struck her down as she walked to her car. Today, after a remarkable recovery, she can talk again.

Scantlin’s father knows she will never fully recover, but her newfound ability to speak and her returning memories have given him his daughter back. For years, she could only blink her eyes — one blink for “no,” two blinks for “yes” — to respond to questions that no one knew for sure she understood.

“I am astonished how primal communication is. It is a key element of humanity,” Jim Scantlin said, blinking back tears.

Sarah Scantlin was an 18-year-old college freshman on Sept. 22, 1984, when she was hit by a drunk driver as she walked to her car after celebrating with friends at a teen club. That week, she had been hired at an upscale clothing store and won a spot on the drill team at Hutchinson Community College.

After two decades of silence, she began talking last month. Doctors are not sure why. On Saturday, Scantlin’s parents hosted an open house at her nursing home to introduce her to friends, family members and reporters.

A week ago, her parents got a call from Jennifer Trammell, a licensed nurse at the Golden Plains Health Care Center. She asked Betsy Scantlin if she was sitting down, told her someone wanted to talk to her and switched the phone to speaker mode:

“Hi, Mom.”

“Sarah, is that you?” her mother asked.

“Yes,” came the throaty reply.

“How are you doing?”

“Fine.”

“Do you need anything?,” her mother asked her later.

“More makeup.”

“Did she just say more makeup?” the mother asked the nurse.

Scantlin still suffers constantly from the effects of the accident. She habitually crosses her arms across her chest, her fists clenched under her chin. Her legs constantly spasm and thrash. Her right foot is so twisted it is almost reversed. Her neck muscles are so constricted she cannot swallow to eat.

The driver who struck Scantlin served six months in jail for driving under the influence and leaving the scene of an accident.

Scantlin started talking in mid-January but asked staff members not to tell her parents until Valentine’s Day to surprise them, Trammell said. But last week she could not wait any longer to talk to them.

“I didn’t think it would ever happen, it had been so long,” Betsy Scantlin said.

Scantlin’s doctor, Bradley Scheel, said physicians are not sure why she suddenly began talking but believe critical pathways in the brain may have regenerated.

“It is extremely unusual to see something like this happen,” Scheel said.

The breakthrough came when the nursing home’s activity director, Pat Rincon, was working with Scantlin and a small group of other patients, trying to get them to speak.

Rincon had her back to Scantlin while she worked with another resident. She had just gotten that resident to reply “OK,” when she suddenly heard Sarah behind her also repeat the words: “OK. OK.”

Staff members brought in a speech therapist and intensified their work with Sarah. They did not want to get her parents’ hopes up until they were sure Sarah would not relapse, Trammell said.

On Saturday, Scantlin seemed at times overwhelmed by the attention. Dressed in a blue warm-up suit, she spoke little, mostly answering questions in a single word.

Is she happy she can talk? “Yeah,” she replied.

What does she tell her parents when they leave? “I love you,” she said.

Family members say Scantlin’s understanding of the outside world comes mostly from news and soap operas that played on the television in her room.

On Saturday, her brother asked whether she knew what a CD was. Sarah said she did, and she knew it had music on it.

But when he asked her how old she was, Sarah guessed she was 22. When her brother gently told her she was 38 years old now, she just stared silently back at him. The nurses say she thinks it is still the 1980s.

Her father, Jim Scantlin, understands that Sarah will probably never leave the health care center, but he is grateful for her improvement.

“This place is her home ... They have given me my daughter back,” he said.

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Judge Greer orders Terri’s starvation (WorldNetDaily, 050225)

Parents of disabled Florida woman granted 3 weeks to appeal ruling

A Florida judge today ordered that Terri Schiavo’s life-sustaining feeding tube be removed March 18 at 1 p.m.

Pinellas Circuit Court Judge George Greer denied a motion for an indefinite stay filed by parents Robert and Mary Schindler, who wanted more time to pursue medical tests that might prove their severely brain-damaged daughter could benefit from physical therapy.

Greer could have ordered the tube be removed immediately. The extra three weeks gives the Schindlers time to appeal the decision.

In today’s order [pdf file], Greer reasoned that five years had passed since the February 2000 order to remove the feeding tube and the court, “therefore, is no longer comfortable in continuing to grant stays ... .”

The judge said the court is “persuaded that no further hearing need be required but that a date and time certain should be established so that last rites and other similar matters can be addressed in an orderly manner.”

Schindler family spokesman Gary McCullough, who is at the St. Petersburg-area hospice where Terri lives, told WorldNetDaily he’s encouraged there still is time to act, noting the Florida legislature will be in session 10 days before the deadline.

The Department of Children and Families also seeks intervention in the case, asking for a 60-day stay to probe allegations of abuse.

In addition, the Schindlers filed a motion to remove their son-in-law Michael Schiavo as Terri’s guardian, arguing he is her husband in name only and consistently has sought to withhold care and therapy.

Schiavo has been living with fiance Jodi Centonze, with whom he has two children, for 10 years. Schiavo has said he plans to marry Centonze upon Terri’s death.

Today’s decision came exactly 15 years after Terri Schiavo collapsed under disputed circumstances and suffered brain damage when her heart stopped momentarily.

She breathes on her own and appears to be responsive to people and her surroundings in photographs and videos released by the family. But early in the legal process, the Schindlers agreed with Michael Schiavo’s attorneys to stipulate Terri is in a “persistant vegetative state” — a decision the parents now regret. Michael claims his wife had told him she would never want to be kept alive in such a condition, although she left no written directive.

The Schindlers assert their daughter never would have seriously expressed such a wish and point out Schiavo made his claim only after he won a $1.3 million malpractice suit on Terri’s behalf and began seeing Centonze.

The Schindler family says there is evidence Terri’s sudden brain injury was caused by Michael Schiavo himself, alleging a pattern of abusive behavior, medical records indicating trauma, and his motion filed with Judge Greer to ensure Terri is cremated immediately upon death.

Schiavo claims Terri collapsed due to a potassium imbalance triggered by bulimia that caused her to suffer cardiac arrest.

In the 1992 malpractice trial, Schiavo argued he needed the money for long-term care for his wife, based on a life expectancy of another 50 years. But seven months after receiving the cash, the Schindlers argue, he began to withhold care and therapy, first ordering nurses to not give Terri antibiotics for a urinary tract infection, which could have resulted in her death.

Bobby Schindler told WND his family never has believed Terri would want to die, contending Michael Schiavo’s actions indicate the “wishes” are fabricated.

“Which Michael are we to believe?” he asked. “The one who promised he would take care of his wife for rest of his life, or the who who says these were Terri’s death wishes.”

Florida probes abuse

Noted “right-to-die” attorney George Felos, who is representing Michael Schiavo, argued in court Wednesday that the question of guardianship was irrelevant, because regardless of who had that role, the court has ruled Terri’s wishes were that she not live in her current condition.

At the Wednesday hearing, the Department of Children and Family services submitted a petition to Greer asking for 60 days to conduct an investigation of alleged abuse.

DCF spokesman Bill Spann said confidentiality laws prevent his discussion of the details of the case, but Florida law “provides for the investigation of allegations of abuse of elders, the disabled and other vulnerable adults.”

Greer said he would not consider the petition, but added, “The department can do whatever the department thinks the department needs to do.”

Felos said the petition “reeks of the intervention of politics in this case.”

The Schindlers’ lawyer, David Gibbs, replied: “I object to any characterization of our government, in good faith, coming to this court ... seeking to intervene when there’s serious allegations of abuse.”

Gov. Jeb Bush said Wednesday he was exploring options to block removal of the feeding tube and would do “whatever I can within the means, within the laws, of our state to protect this woman’s life. I won’t go beyond that.”

Terri Schiavo has had her feeding tube remove twice since Greer ruled in February 2000 that artificial feeding must be stopped. The order finally was carried out in April 2001, after more than a year of litigation, but a series of hearings led to restoration of feeding after two-and-a-half days of starvation and dehydration.

In October 2003, Terri went without food or water for six days before a new state law allowed Gov. Bush to order the tube reinserted. “Terri’s Law” later was struck down by the the Florida Supreme Court as unconstitutional.

‘Another wife’

Bobby Schindler told WND he’s astonished Schiavo has been allowed to remain as Terri’s guardian while having, de facto, another wife.

“Michael claims he loves Terri, and he has said it on numerous occasions, but he treats her in a way I don’t think most of us would treat our own pets,” Schindler said.

Among the family’s complaints are that Michael Schiavo:

* Has not allowed therapy or rehabilitation since 1992, despite medical records indicating Terri is responsive.

* Has prevented swallowing tests or swallowing therapy since 1993, despite medical testimony Terri can be taught to eat.

* Ordered caretakers not to clean Terri’s teeth since 1995, resulting in removal of five teeth in April 2004.

* Placed Terri in hospice in 2000, despite the fact she is not terminally ill.

* Refuses to allow Terri to leave her room. She has not been outside since 2000.

* Has refused to fix her wheelchair since 2000.

* Refuses to allow Terri to practice her Catholic faith by attending weekly mass.

* Ordered Terri’s shades down at all times.

* Ordered doctors not to treat Terri when she had a life threatening infection in 1993 and 1995.

* Removes family pictures from Terri’s room, denies flowers from family and friends, denies certain CDs to be played for Terri, and refuses to allow her to listen to music with headphones.

* Refuses to release medical information to parents since 1993 despite court order requiring him to do so.

* Has limited the visitors list, requiring they must first be approved by him and removes visitors at own discretion. Schiavo removed the Schindlers from the visitors list a total of eight months between 2001 and 2004.

* Denies all requests for Terri to attend nursing home functions and refuses to allow therapeutic animals to visit with her, knowing that she is an animal lover.

Joni Eareckson Tada, a well-known Christian advocate for the disabled, issued a statement after Greer’s decision Wednesday to extend the stay, urging that the requested medical tests be run.

Regardless of the test results, Tada said, Terri Schiavo’s feeding tube still should not be removed.

“If it is removed, it will inaugurate a dangerous social policy concerning a severely disabled person’s right to live, a policy founded on irrational fears of disability,” she said.

Tada said the “individual liberties of severely disabled Americans — especially their right to life — would be inextricably tied to the whims of a guardian who may not have their best interest at heart.”

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Vatican warns of consequences in Schiavo case (WorldNetDaily, 050225)

Allowing Florida woman’s death ‘grave step’ toward euthanasia in U.S.

As a Florida judge considers the fate of brain-damaged Terri Schiavo, a top Vatican official is appealing to save her life, warning of broader consequences if estranged husband Michael Schiavo is allowed to have her feeding tube removed.

“If Mr. Schiavo succeeds legally in causing the death of his wife, this not only would be tragic in itself, but would be a grave step toward the legal approval of euthanasia in the United States,” Cardinal Renato Martino, president of the Pontifical Council for Justice and Peace, told Vatican Radio.

On Wednesday, Pinellas County Circuit Judge George Greer extended an emergency stay to 5 p.m. Eastern time today, saying said he needed time to consider legal challenges raised by Terri Schiavo’s parents, Robert and Mary Schindler.

The stay held off a court order to remove the feeding tube.

The Schindlers believe Michael Schiavo, who lives with another woman with whom he has two children, is unfit to be their daughter’s guardian. The parents also want medical tests to determine if Terri Schiavo could benefit from physical therapy and possibly be be taught to swallow.

Separately, Florida’s Department of Children and Families filed a motion with Judge Greer to be granted a 60-day stay in order to investigate allegations of abuse, presumably by Michael Schiavo.

In the Vatican Radio interview, Martino referred to a statement by Pope John Paul II.

“I would like to remind everyone in this connection, about all that the Holy Father has said in past days to the Pontifical Academy for Life, confirming that the quality of life is not interpreted as economic success, beauty and physical pleasure, but consists in the supreme dignity of the creature made in the image and likeness of God,” Martino said.

“No one can be the arbiter of life except God himself.”

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Euthanasia for Newborns—Killing in the Netherlands (Christian Post, 050314)

Advocates for euthanasia routinely chide opponents that “slippery slope” arguments are fallacious and irrelevant. A decision to allow euthanasia in some cases, they say, does not in fact open the door for the killing of yet others. Tragically, however, the “slippery slope” argument is neither fallacious nor irrelevant, as recent developments in the Netherlands have made graphically clear. Once doctors are allowed to choose death over life, the resulting Culture of Death will inevitably discount human life in other contexts as well.

The latest proof of this comes in a March 10, 2005 article published in the New England Journal of Medicine. In “The Groningen Protocol—Euthanasia in Severely Ill Newborns,” Dutch doctors Eduard Verhagen and Pieter J. J. Sauer defend the policy they established for euthanizing newborns in the Netherlands.

The infamous “Groningen Protocol” was released last year, leading to a wave of moral outrage and revulsion. Doctors Verhagen and Sauer, affiliated with the University Medical Center in Groningen, developed guidelines for euthanizing newborns. In the face of international outrage, the doctors decided to defend their policy in the prestigious New England Journal of Medicine. That journal’s publication of this article marks a critical milestone in America’s medical debate, and sets a chilling precedent for even more ominous developments in the future. “Of the 200,000 children born in the Netherlands every year, about 1,000 die during the first year of life,” the doctors report. “For approximately 600 of these infants, death is preceded by a medical decision regarding the end of life. Discussions about the initiation and continuation of treatment in newborns with serious medical conditions are one of the most difficult aspects of pediatric practice.”

Thus, the authors argue that when “a medical decision regarding the end of life” is necessary with respect to newborns, policies should be in place that would allow doctors to choose euthanasia—the willful killing of a newborn baby—as a medically accepted practice, at least under certain circumstances.

“Suffering is a subjective feeling that cannot be measured objectively, whether in adults or in infants,” the doctors admit. “But we accept that adults can indicate when their suffering is unbearable. Infants cannot express their feelings through speech, but they do so through different types of crying, movements, and reactions to feeding.” This debatable clinical observation sets the stage for Verhagen and Sauer to argue that infants should have a “right” to euthanasia if they are likely to experience extreme pain and discomfort, and if they face a poor prognosis and “a poor quality of life.”

The doctors advise that, in the Netherlands, “euthanasia for competent persons older than 16 years of age has been legally accepted since 1985.” That observation is true, though the Dutch began experiments with illegal euthanasia long before 1985. The so-called “Dutch Cure” has become a standard feature of medical practice in the Netherlands. “Voluntary” euthanasia is now considered a legal “right” for all those 16 years of age and older. Recently, Dutch physicians have been arguing for the age of consent to be reduced to age 12. Beyond this, what has been described as “voluntary” euthanasia has, by some reports, led to involuntary forms of euthanasia as well. The legal notion of “consent” is a thin legal principle, easily manipulated in actual practice.

Verhagen and Sauer pose the central question of their policy with clarity: “The question under consideration now is whether deliberate life-ending procedures are also acceptable for newborns and infants, despite the fact that these patients cannot express their own will. Or must infants with disorders associated with severe and sustained suffering be kept alive when their suffering cannot be adequately reduced?”

Of course, the way a question is posed largely determines the shape of the answer. The Dutch doctors frame their question with the assumption that infant suffering can, in some cases, be beyond medical alleviation or treatment.

“In the Netherlands, as in all other countries, ending someone’s life, except in extreme conditions, is considered murder.” They go on to argue, “A life of suffering that cannot be alleviated by any means might be considered one of those extreme conditions.” The “might” in that sentence is critical, for this is not a universally held belief.

The “Groningen Protocol” was developed in order to protect physicians who induce the death of infants from interrogation, investigation, and possible prosecution by police. Admitting that infants and newborns are being euthanized in the Netherlands, Verhagen and Sauer developed their policy, “To provide all the information needed for assessment and to prevent interrogations by police officers.”

The revulsion and reaction to the release of the “Groningen Protocol” apparently surprised the Dutch physicians, who described media reports of their policy as “blood-chilling accounts and misunderstandings concerning this protocol.” But, if these doctors hoped that publishing their argument in the New England Journal of Medicine would help, they are likely to be severely disappointed.

The doctors divide seriously ill newborns and infants into three different categories. The first are almost certain to die, given unquestionably terminal diseases or conditions. Infants in the second category “have a very poor prognosis and are dependent on intensive care.” Verhagen and Sauer argue that these babies “may survive after a period of intensive treatment, but expectations regarding their future condition are very grim.” They describe these infants as characterized by “an extremely poor prognosis and a poor quality of life.”

The third category of infants are those “who experience what parents and medical experts deem to be unbearable suffering.” The doctors admit that this group of infants “is difficult to define in the abstract,” but would include “patients who are not dependent on intensive medical treatment but for whom a very poor quality of life, associated with sustained suffering, is predicted.” They offer as an example a child “with the most serious form of spina bifida.”

Note carefully that the doctors define infants in the second and third groups as those who face a poor “quality of life.” This concept is the fuse that detonates the movement for euthanasia. Doctors, and other medical professionals, presume to be able to determine and define an adequate quality of life for human existence. Once doctors become the quality control engineers for the human race, they can define whatever category they choose as constituting those with an inadequate quality of life, who can then be denied medical treatment or, in some cases, see their lives terminated.

“Neonatologists in the Netherlands and the majority of neonatologists in Europe are convinced that intensive care treatment is not a goal in itself,” the doctors claim. “Its aim is not only survival of the infant, but also an acceptable quality of life.” For the second category of infants, the doctors argue that forgoing or not initiating life-sustaining treatment is acceptable “if both the medical team and the parents are convinced that treatment is not in the best interest of the child because the outlook is extremely poor.”

The explicit shift to active euthanasia comes in the cases of infants in the doctors’ third category. “All possible measures must be taken to alleviate severe pain and discomfort,” the doctors argue. “There are, however, circumstances in which, despite all measures taken, suffering cannot be relieved and no improvement can be expected. When both the parents and the physicians are convinced that there is an extremely poor prognosis, they may concur that death would be more humane than continued life.” That is a breathtaking assertion. These doctors argue that, if parents and physicians agree, they may choose death for an infant believed to be suffering “severe pain and discomfort.”

All this would be sufficiently frightening, but reports out of the Netherlands indicate that some doctors are killing newborns without the knowledge or consent of parents.

Even in the Netherlands, parents are not allowed to request euthanasia for their newborns, acting as representatives of their child. This poses a problem for doctors who would wish to euthanize infants. Since newborns “cannot ask for euthanasia,” and since their parents are unable to act as legal representatives to indicate consent, this poses a legal challenge. “Does this mean that euthanasia in a newborn is always prohibited?” The Dutch doctors think not.

“We are convinced that life-ending measures can be acceptable in these cases under very strict conditions; the parents must agree fully, on the basis of a thorough explanation of the condition and prognosis; a team of physicians, including at least one who is not directly involved in the care of the patient, must agree; and the condition and prognosis must be very well defined. After the decision has been made and the child has died, an outside legal body should determine whether the decision was justified and all necessary procedures have been followed.”

All this amounts to a bureaucratic rationalization for killing newborn babies. There can be no doubt that the practice of killing newborns is already a reality of Dutch medical culture. Verhagen and Sauer report that “there are 15 to 20 cases of euthanasia in newborn infants” each year in the Netherlands. Two Dutch court cases, both decided in the 1990s, ruled that physicians had met “the requirements for good medical practice” in ending the lives of infants, even though the practice is apparently illegal. Here again, the “slippery slope” is aided and abetted by courts that will not prosecute doctors who are violating the very laws intended to protect individuals from euthanasia—much less involuntary euthanasia. In the aftermath of the two court cases, physicians requested additional guidance and guidelines. Verhagen and Sauer report that the Dutch government has failed to provide these guidelines, “despite having promised repeatedly, since 1997, to do so.”

Over the last several years, 22 cases of euthanasia in newborns were reported to Dutch district attorneys’ offices. Verhagen and Sauer reviewed the cases, reporting that all of them “involved infants with very severe forms of spina bifida.”

The reluctance of Dutch courts to evaluate doctors—even in matters of life and death—is made apparent when Verhagen and Sauer report on these cases. “The decisions were always made in collaboration with, and were fully approved by, both parents. The prosecutor used four criteria to assess each case: the presence of hopeless and unbearable suffering and a very poor quality of life, parental consent, consultation with an independent physician and his or her agreement with the treating physicians, and the carrying out of the procedures in accordance with the accepted medical standard. The conclusion in all 22 cases was that the requirements of careful practice were fulfilled. None of the physicians were prosecuted.”

Finally, the doctors argue that “all cases must be reported if the country is to prevent uncontrolled and unjustified euthanasia and if we are to discuss the issue publicly and thus further develop norms regarding euthanasia in newborns.” This is a clear assertion that the euthanizing of newborns should be standard medical procedure, so long as such physician-directed deaths are neither “uncontrolled” nor “unjustified.” Of course, these doctors presume that euthanasia itself is justifiable and that they possess the moral wisdom to decide when euthanasia would be “unjustified.”

Verhagen and Sauer provide two tables of data that accompany their article. In the first table, the doctors indicate that all 22 cases of newborn euthanasia considered in their study involved an “extremely poor quality of life.” Stunningly, their report also indicates that, in the case of at least 18 of these infants, a “predicted inability to communicate” was a factor in making the decision for death.

Their article also raises another frightening question. If Dutch citizens age 16 and older can request euthanasia, and if doctors and parents can agree that newborns and infants can be euthanized under certain circumstances, what about children beyond infancy but under age 16? This is not a hypothetical question, for children are also being euthanized in Dutch clinics and hospitals. Should we expect yet another “Groningen Protocol” for older children?

Verhagen and Sauer recognize that the “Dutch Cure” is considered murder by many outside the Netherlands. “This approach suits our legal and social culture,” the doctors allow, “but it is unclear to what extent it would be transferable to other countries.”

Verhagen and Sauer may be unclear about the transferability of their protocol to other cultures, but the Culture of Death is not found only in the Netherlands. Here in the United States, the logic behind the “Groningen Protocol” is gaining traction. The “Dutch Cure” now seems to be a contagious Dutch disease.

________________________________________________

R. Albert Mohler, Jr. is president of The Southern Baptist Theological Seminary in Louisville, Kentucky.

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House Passes Bill to Delay Schiavo Case (Foxnews, 050317)

WASHINGTON — The House passed legislation late Wednesday intended to delay the removal of the feeding tube keeping alive a brain-damaged woman whose husband has been given permission by a state court to allow her to die.

Earlier in the day, a Florida appeals court refused to block the removal of Terri Schiavo’s feeding tube. For years her husband has battled her parents over his efforts to allow her to die, which he contends she would prefer rather than live in a vegetative state.

The House bill, passed on a voice vote, would move such a case to federal court. Federal judges have twice turned down efforts by the parents, Bob and Mary Schindler, to move the case out of Florida courts, citing a lack of jurisdiction.

Senate Republicans are introducing a separate bill to give Schiavo and her family standing in federal court, and they hope it can be debated on Thursday, a GOP aide said.

Under the House legislation, a federal judge would decide whether withholding or withdrawing food, fluids or medical treatment from an incapacitated person violates the Constitution or U.S. law. It would apply only to incapacitated people who had not left directives dealing with being kept alive artificially and for whom a state judge had authorized the withholding of food or medical treatment.

Schiavo, 41, suffered severe brain damage in 1990 when her heart stopped temporarily, and court-appointed doctors say she is in a persistent vegetative state. Her husband, Michael Schiavo, says she told him she would not want to be kept alive artificially. Her parents disagree that was her wish and say she could improve with proper treatment.

Florida Circuit Judge George Greer has granted Michael Schiavo permission to remove the feeding tube, a ruling a state appellate court upheld Wednesday. Without the feeding tube, which the state court allowed to be removed as early as Friday, Terri Schiavo would likely die in one to two weeks.

“What’s going on in Florida regarding Terri Schiavo is nothing short of inhumane,” said House Judiciary Chairman James Sensenbrenner, R-Wis., who introduced the bill with Rep. Dave Weldon, R-Fla.

Some House members criticized the bill, which Rep. Jerrold Nadler, D-N.Y., called “a dangerously reckless way to deal with some serious issues.”

“It does not deal just with feeding tubes. It would allow intervention in any decision affecting any kind of medical care. Read the bill,” Nadler said.

The Florida appeals court said in Wednesday’s ruling that the issues the Schindlers’ raised were not new ones and had been dealt with previously by numerous courts.

“Not only has Mrs. Schiavo’s case been given due process, but few, if any similar cases have ever been afforded this heightened level of process,” Chief Judge Chris Altenbernd wrote.

The court also rejected the Department of Children & Families’ request for a 60-day stay while that agency investigates allegations that Terri Schiavo has been abused.

The Schindler’s planned to ask the Supreme Court to consider whether their daughter’s religious freedom and due process rights have been violated. Federal courts have declined to become involved the case.

In Tallahassee, the House and Senate were considering competing proposals to prevent the removal of Terri Schiavo’s feeding tube.

The bills would block the removal of feeding tubes from patients in a persistent vegetative state who didn’t leave specific verbal or written instructions otherwise. But the Senate plan would only affect cases where families disagreed.

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Starving for a Fair Diagnosis: Terri Schiavo is not out of medical options. But that’s the “fact” her husband wants you to believe (National Review Online, 050316)

Terri Schiavo lies in a Florida hospice, subject to a judge’s order that will cause her to die of starvation and dehydration commencing this Friday, March 18, at 1:00 P.M. Her parents, Bob and Mary Schindler, have fought for over a decade to prevent her death. They have repeatedly gone to court in their efforts to stop Terri’s husband, Michael, from removing the tube that provides her with food and water.

The court battle has gone largely against the Schindlers. Last week, Pinellas County Circuit Court judge George Greer issued a steady stream of rulings denying almost every motion the Schindlers raised. He denied some of them summarily, without hearing arguments or evidence. Among the motions Judge Greer denied was a request for new testing and examination of Terri by independent and qualified specialists. David Gibbs, attorney for the Schindlers, submitted 33 affidavits from doctors and other medical professionals contending that Terri’s condition should be reevaluated. About 15 of these affidavits are from board-certified neurologists. Some of these doctors also say that Terri could benefit from therapy. Judge Greer was unmoved.

Many people believe that Terri Schiavo has had “the best of care,” and that everything has been tried by way of rehabilitation. This belief is false. In fact, Terri has had no attempts at therapy or rehabilitation since 1992, and very little had been done up to that point. Terri has not even had the physical therapy most doctors would regard as normative for someone in her condition. The result is that Terri suffers from severe muscle contractures, which have caused her body to become contorted. Physical therapy could remedy this, but husband Michael has refused to provide it.

Terri has also suffered from what many professionals would regard as neglect. She had to have several teeth extracted last year because of severe decay. This decay was caused by a lack of basic dental hygiene, such as tooth-brushing. She also developed decubitus (skin) ulcers on her buttocks and thighs. These ulcers can be prevented by a simple regimen of regular turning: a basic nursing task that any certified nurse’s aide can perform. The presence of these easily preventable ulcers is a classic sign of neglect. Bob and Mary Schindler have repeatedly complained of Terri’s neglect, and have sought to remove Michael as guardian on that basis. Judge Greer was unmoved by those complaints as well.

BAD MEDICINE

And, quite apart from the question of Terri’s therapy and care, it is entirely likely that Terri has never been properly diagnosed. Terri is usually described as being in a Persistent Vegetative State (PVS), and indeed Judge Greer ruled as a finding of fact that she is PVS; but this diagnosis and finding were arrived at in a way that has many neurologists expressing surprise and dismay.

I have spent the past ten days recruiting and interviewing neurologists who are willing to come forward and offer affidavits or declarations concerning new testing and examinations for Terri. In addition to the 15 neurologists’ affidavits Gibbs had in time to present in court, I have commitments from over 30 others who are willing to testify that Terri should have new and additional testing, and new examinations by unbiased neurologists. Almost 50 neurologists all say the same thing: Terri should be reevaluated, Terri should be reexamined, and there are grave doubts as to the accuracy of Terri’s diagnosis of PVS. All of these neurologists are board-certified; a number of them are fellows of the prestigious American Academy of Neurology; several are professors of neurology at major medical schools.

So how can Judge Greer ignore the opinions of so many qualified neurologists, some of whom are leaders in the field? The answer is that Michael Schiavo, his attorney George Felos, and Judge Greer already have the diagnosis they want.

Terri’s diagnosis was arrived at without the benefit of testing that most neurologists would consider standard for diagnosing PVS. One such test is MRI (Magnetic Resonance Imaging). MRI is widely used today, even for ailments as simple as knee injuries — but Terri has never had one. Michael has repeatedly refused to consent to one. The neurologists I have spoken to have reacted with shock upon learning this fact. One such neurologist is Dr. Peter Morin. He is a researcher specializing in degenerative brain diseases, and has both an M.D. and a Ph.D. in biochemistry from Boston University.

In the course of my conversation with Dr. Morin, he made reference to the standard use of MRI and PET (Positron Emission Tomography) scans to diagnose the extent of brain injuries. He seemed to assume that these had been done for Terri. I stopped him and told him that these tests have never been done for her; that Michael had refused them.

There was a moment of dead silence.

“That’s criminal,” he said, and then asked, in a tone of utter incredulity: “How can he continue as guardian? People are deliberating over this woman’s life and death and there’s been no MRI or PET?” He drew a reasonable conclusion: “These people [Michael Schiavo, George Felos, and Judge Greer] don’t want the information.”

Dr. Morin explained that he would feel obligated to obtain the information in these tests before making a diagnosis with life and death consequences. I told him that CT (Computer-Aided Tomography) scans had been done, and were partly the basis for the finding of PVS. The doctor retorted, “Spare no expense, eh?” I asked him to explain the comment; he said that a CT scan is a much less expensive test than an MRI, but it “only gives you a tenth of the information an MRI does.” He added, “A CT scan is useful only in pretty severe cases, such as trauma, and also during the few days after an anoxic (lack of oxygen) brain injury. It’s useful in an emergency-room setting. But if the question is ischemic injury [brain damage caused by lack of blood/oxygen to part of the brain] you want an MRI and PET. For subsequent evaluation of brain injury, the CT is pretty useless unless there has been a massive stroke.”

Other neurologists have concurred with Dr. Morin’s opinion. Dr. Thomas Zabiega, who trained at the University of Chicago, said, “Any neurologist who is objective would say ‘Yes’” to the question, “Should Terri be given an MRI?”

But in spite of the lack of advanced testing, such as an MRI, attorney George Felos has claimed that Terri’s cerebral cortex has “liquefied,” and doctors for Michael Schiavo have claimed, on the basis of the CT scans, that parts of Terri’s cerebral cortex “have been replaced by fluid.” The problem with such contentions is that the available evidence can’t support them. Dr. Zabiega explained that “a CT scan can’t resolve the kind of detail needed” to make such a pronouncement: “A CT scan is like a blurry photograph.” Dr. William Bell, a professor of neurology at Wake Forest University Medical School, agrees: “A CT scan doesn’t give much detail. In order to see it on a CT, you have to have massive damage.” Is it possible that Terri has that sort of “massive” brain damage? According to Dr. Bell, that isn’t likely. Sometimes, he said, even patients who are PVS have a “normal or near normal” MRI.

So why hasn’t an MRI been done for Terri? That question has never been satisfactorily answered. George Felos has argued that an MRI can’t be done because of thalamic implants that were placed in Terri’s skull during the last attempt at therapy, dating back to 1992. But Felos’s contention ignores the fact that these implants could be removed. Indeed, the doctor who put them in instructed Michael to have them removed. Michael has never done so.

The most obvious possible explanation for what would otherwise be inexplicable behavior is that Michael Schiavo, George Felos, and Judge Greer don’t want to admit any information that would upset the diagnosis they already have. Dr. Morin, when told that Michael had refused an MRI, and that Judge Greer had confirmed the decision, said: “He refused a non-invasive test? People trying to do the right thing want the best and most complete information available. We don’t have that in Terri’s case.” Dr. Bell agreed with this assessment, saying, “It seems as though they’re fearful of any additional information.”

THE CRANFORD DIAGNOSIS

Doctors for Michael Schiavo have said that an MRI and PET are not necessary for Terri because PVS is primarily a “clinical” diagnosis, that is, one arrived at on the basis of examination of the patient, rather than by relying on tests. And the neurologists I have spoken to agree on the clinical nature of the diagnosis, while insisting that advanced tests nonetheless are a necessary part of it. But the star medical witness for Michael Schiavo, Dr. Ronald Cranford of the University of Minnesota, has repeatedly dismissed calls for MRI testing, and his opinion has prevailed.

Dr. Cranford was the principal medical witness brought in by Schiavo and Felos to support their position that Terri was PVS. Judge Greer was obviously impressed by Cranford’s résumé: Cranford travels throughout the country testifying in cases involving PVS and brain impairment. He is widely recognized by courts as an expert in these issues, and in some circles is considered “the” expert on PVS. His clinical judgment has carried the day in many cases, so it is relevant to examine the manner in which he arrived at his judgment in Terri’s case. But before that, one needs to know a little about Cranford’s background and perspective: Dr. Ronald Cranford is one of the most outspoken advocates of the “right to die” movement and of physician-assisted suicide in the U.S. today.

In published articles, including a 1997 op-ed in the Minneapolis–St. Paul Star Tribune, he has advocated the starvation of Alzheimer’s patients. He has described PVS patients as indistinguishable from other forms of animal life. He has said that PVS patients and others with brain impairment lack personhood and should have no constitutional rights. Perusing the case literature and articles surrounding the “right to die” and PVS, one will see Dr. Cranford’s name surface again and again. In almost every case, he is the one claiming PVS, and advocating the cessation of nutrition and hydration.

In the cases of Paul Brophy, Nancy Jobes, Nancy Cruzan, and Christine Busalucci, Cranford was the doctor behind the efforts to end their lives. Each of these people was brain-damaged but not dying; nonetheless, he advocated death for all, by dehydration and starvation. Nancy Cruzan did not even require a feeding tube: She could be spoon-fed. But Cranford advocated denying even that, saying that even spoon-feeding constituted “medical treatment” that could be licitly withdrawn.

In cases where other doctors don’t see it, Dr. Cranford seems to have a knack for finding PVS. Cranford also diagnosed Robert Wendland as PVS. He did so in spite of the fact that Wendland could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request. He did so in spite of the fact that Wendland could operate and maneuver an ordinary wheelchair with his left hand and foot, and an electric wheelchair with a joystick, of the kind that many disabled persons (most famously Dr. Stephen Hawking) use. Dr. Cranford dismissed these abilities as meaningless. Fortunately for Wendland, the California supreme court was not persuaded by Cranford’s assessment.

Expert witnesses in court are supposed to be unbiased: disinterested in the outcome of the case. Part of the procedure in qualifying expert witnesses is establishing that they are objective and unbiased. But given Dr. Cranford’s history of advocacy in the “right to die” and euthanasia movements, and given his track record of almost always coming down on the side of PVS and removal of nutrition and hydration, one might question his objectivity. Indeed, the Schindlers’ attorneys attempted to do so in the 2002 evidentiary hearing at which Cranford testified, but went unheard. Organizations such as the International Task Force on Euthanasia and Assisted Suicide submitted amicus curiae (friend of the court) briefs in the appellate proceedings in Terri’s case, demonstrating Cranford’s bias in detail. But these arguments also seemed to fall on deaf ears.

Some neurologists who also consult in legal cases were not surprised at the handling of Dr. Cranford’s expert testimony. In theory, they said, the expert witness is supposed to be objective, but, as Dr. Bell explained, “the way it really works is that an attorney carefully selects an expert that will give him the outcome he desires.” He related that he has been asked by attorneys to serve as an expert. “I have looked over medical records,” he said, “and told attorneys what I thought.” But on occasion, he said, his opinion was “obviously not what they wanted to hear” and “they moved on to another expert.” Bell acknowledged that Cranford is “a highly accomplished and experienced speaker,” but said that in him the court “likely found a highly prejudiced expert.”

Neurologists who are familiar with diagnosing and treating PVS and other brain injuries have told me that PVS is a notoriously difficult diagnosis to make. It requires a great deal of time spent with the patient over several days or weeks. The reason for this, as Dr. Bell explained, is that brain-injured patients have severely disrupted sleep/wake cycles. Dr. Mack Jones, a neurologist in Ft. Walton Beach, Fla., added that patients with severe brain injury will have greatly varying levels of alertness: “Two independent examiners may get an entirely different impression depending on when and how long he/she has spent performing the examination. For example, one examiner may unknowingly attempt to evaluate the patient during a stage of sleep. Another examiner, by chance, may find a more responsive patient simply because [the patient is] now more aroused.” Dr. Morin concurred, saying that in his experience “the attention of brain-injured patients is very erratic,” and that because of this he has “seen inadequate assessments even by experienced neurologists.” Because of these difficulties, the American Academy of Neurology has made it clear that it can take months for a physician to establish with confidence the diagnosis of PVS. A 1996 British Medical Journal study, conducted at England’s Royal Hospital for Neurodisability, concluded that there was a 43-percent error rate in the diagnosis of PVS. Inadequate time spent by specialists evaluating patients was listed as a contributing factor for the high incidence of errors.

So, did Dr. Cranford, or any of the doctors testifying for Michael Schiavo, spend months evaluating Terri? No. To be fair, none of the doctors appearing for the Schindlers spent months with Terri either. But it is hardly coincidental that the doctors who spent the most time with Terri came to the conclusion that she is not PVS. The doctors brought in by the Schindlers spent approximately 14 hours examining Terri over more than two weeks; their conclusion was that Terri is not PVS, and that she may benefit from therapy.

In marked contrast, Dr. Cranford examined Terri on one occasion, for approximately 45 minutes. Another doctor for Michael Schiavo, Dr. Peter Bambikidis of the Cleveland Clinic Foundation in Ohio, examined Terri for about half an hour. When Dr. Bell learned of the cursory nature of these exams, he said: “You can’t do this. To make a diagnosis of PVS based on one examination is fallacious.” In Cranford’s examination, described by one witness as “brutal,” he discounted evidence under his own eyes of Terri’s responsiveness. At one point, Dr. Cranford struck Terri very hard on the forehead between her eyes. Terri recoiled and moaned, seemingly in pain. In his court testimony, Cranford dismissed the reaction and moan as a “reflex.”

“I asked Dr. Bell if he thought a moan uttered after a painful blow could be a reflex. “It’s highly unlikely,” he replied. He qualified his answer by noting that he had not actually seen the video of the exam, but he believes that the description of Terri’s reaction is not consistent with a reflex. “A moan is not a reflex,” Bell said. “A wince or grimace is not a reflex.” “

By the very definition of Persistent Vegetative State, the patient must exhibit no “evidence of awareness of self or environment” or “ability to interact with others.” As one neurologist put it, if a patient shows “any response to the outside world, the patient isn’t in a PVS.” All it takes, according to Dr. Jones, is “only one examiner to discover the presence of higher brain function and the naysayers’ opinions are, by the very definition of PVS, null and void.”

TERRI’S FUTURE — AND THE ISSUE OF TRUTH

Given the difficulty of diagnosing PVS, the high rate of error, the obvious bias of the doctor whose judgment forms the basis of the judge’s ruling that Terri is PVS, and the growing outcry from the neurological community, how is it that Judge Greer’s ruling has been sustained? The answer is that in our legal system, once a judge has ruled on a matter of fact, it is very difficult to revisit such a ruling. The lawyers’ rule of thumb is that trial courts hear and rule on questions of fact, and appellate courts rule on questions of law; it’s unusual for an appellate court to overturn a lower court’s ruling because of an issue of fact.

That’s why, at every turn in this case, the Schindlers have had to try to undo the faulty rulings of fact previously issued by Judge Greer. They’ve had to go back before Judge Greer himself and try to convince him that he was wrong, and should undo his own rulings. Judge Greer has proven unwilling to do so. The higher courts, unwilling to overturn a trial judge’s rulings of fact, have no interest in granting new hearings. Michael Schiavo and George Felos have no interest in revisiting Terri’s diagnosis, as that ruling provides the whole legal basis of their ability to end her life. Dr. Cranford has no interest in seeing his own diagnosis called into question. Dr. Bell lamented that at this point, “medical realities are no longer governing this case.” He added that it seemed to him that medical issues concerning the care of the patient had been subsumed by legal issues. In our courts, he added, “once a decision is made they don’t want additional information.”

The whole history of Terri’s case over the past few years can be summed up as the efforts of the Schindlers, and those who value Terri’s life, to try to introduce additional information before the courts and other authorities. Some of this information consists of facts and arguments that were ignored or dismissed without adequate consideration; some has been the result of advances in the diagnosis and treatment of brain injuries over the last five years. On the side of Michael Schiavo, George Felos, and Judge Greer, their efforts have consisted almost entirely in trying to prevent any new information from being presented or considered.

The legal system’s willful blindness to facts cannot succeed forever. The truth has a way of coming out. But will it do so in time to save Terri Schiavo? Dr. Morin said to me, towards the end of our conversation, that “the law can find a way to do the right thing if it wants to.” The problem so far is that those who have the power to do the right thing seem to have no desire or inclination to do so.

— Rev. Robert Johansen is a Catholic priest of the Diocese of Kalamazoo, Michigan.

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Legal Refuge: Congress aims to protect Terri Schiavo (National Review Online, 050316)

This Friday, after a long and protracted legal struggle, a Florida woman named Terri Schiavo will be starved to death by court order.

In 1990, at the age of 27, Terri Schiavo collapsed, resulting in brain damage from a lack of oxygen. A feeding tube was inserted by doctors at that time to provide nutrition and hydration to keep her alive.

Over the last 15 years, there has been a protracted legal fight between Terri’s parents, who insist that Teri wants to live and want guardianship of their daughter, and Terri’s husband, who insists Terri wants to die and currently has guardianship. It has without a doubt been an emotional and drawn-out legal battle over what Terri’s wishes truly were and whether or not her feeding tube should be removed.

Terri is severely brain-damaged — of that there is no question. However, many media reports have indicated that she is in a persistent vegetative state. There is evidence to the contrary.

She is not on a respirator or other 24-hour-a-day medical equipment. She responds to voices, touch, and the presence of people. She can smile, cry, and establish eye contact. She can make facial expressions. And several of Terri’s caregivers and outside medical professionals feel that, with proper therapy, she may even be able to learn to eat without a feeding tube.

For years, this legal battle between Terri’s parents and her husband has made its way through Florida’s courts, Florida’s legislature and Florida’s governor’s office. All legal options available in the state of Florida have been exhausted and the Schiavo case has culminated with a final court-ordered removal of the feeding tube and cessation of nutrition and hydration on March 18 — this Friday.

Last week, I introduced my first piece of legislation in the Senate: The Incapacitated Person’s Legal Protection Act of 2005. This bill would ensure that incapacitated individuals — like Terri Schiavo — would have their due-process rights of habeas corpus when a court orders their death by removal of nutrition, hydration and medical treatment. My colleague from Florida, Congressman Dave Weldon has introduced identical legislation in the House of Representatives.

“Habeas Corpus” refers to the legal rights available under the 14th Amendment of the Constitution that “No State…shall deprive any person of life…without due process of law…nor to deny any person within its jurisdiction equal protections of the laws.”

In essence, this legislation would give incapacitated individuals like Terri, who have been given what amounts to a death sentence by the courts, federal habeas corpus protections to ensure that she receives the same due process protections as convicted murderers given the death penalty.

This bill is very narrowly written and a balanced approach to acknowledging the rights of individuals to refuse consent to medical treatment with the right to consent to treatment to preserve life. The Incapacitated Person’s Legal Protection Act would only apply when the following criteria are met:

There is a contested judicial proceeding because of a dispute about the expressed previous wishes or best interest of a person currently incapable of making a choice about lifesaving treatment;

There is no valid prior written directive on wishes from the now-incapacitated individual; and

There is a court order authorizing or directing the withholding of food, fluids, or medical treatment to sustain the individual’s life.

This is not a right-to-life or right-to-die issue — it is about proper legal representation for individuals with no voice for themselves. It’s about giving a last avenue of legal refuge to disabled individuals when their lives hang in the balance.

This is a narrowly tailored, compassionate piece of legislation to ensure that Terri Schiavo has all legal due process available to her before following through on a court order that, in all seriousness, is a death sentence.

Before you click onto another screen or go back to work, please contact your senators and contact your congressman to let them know that you support this bill — that Terri Schiavo deserves the same rights as criminals to equal protection under the law.

— Mel Martinez is a freshman Republican senator from Florida.

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Too Vigorously Assisted Suicide: Congress and Terri Schiavo (National Review Online, 050321)

Editors

Opponents of assisted suicide have good reasons for persisting in efforts to save Terri Schiavo’s life. But supporters of assisted suicide may have even better ones.

The opponents have always asserted that allowing assisted suicide at all, while bad in itself, would lead to further evils: that we would start by allowing people who want to die to kill themselves, but end up allowing the killing of people who do not want to die. If we were supporters of assisted suicide, we would want to disprove these predictions. We would want to make sure that safeguards are in place to prevent such abuse.

The facts of this case suggest that existing safeguards are dangerously inadequate. The evidence that Mrs. Schiavo would have wanted the removal of the tube that brings her food and water appears sketchy at best. Even if we granted that she said both that she did not want to be on life support and that she would not want to be in a coma, it would not establish that she would not even want food and water when she is not in a coma.

Terri Schiavo has had no MRI or PET scan. Only a CT scan has led some neurologists to conclude that her cerebral cortex has liquefied; other neurologists dispute the possibility of reliably making that inference from CT scans. Many of the initial determinations of fact under Judge Greer relied on the testimony of Dr. Ronald Cranford. He is certainly a medical expert; but he is also a right-to-die zealot who advocates the removal of feeding tubes for patients with Alzheimer’s dementia.

“The facts of this case

suggest that existing safeguards

are dangerously inadequate.”

While several courts have been involved in litigation surrounding that case, the other courts have deferred to Judge Greer’s questionable factual findings. The legal findings built on those factual findings do not inspire great confidence, either. It is hard to see how Mrs. Schiavo could be found to be in a “persistent vegetative state” when Florida law defines that term as including “the absence of voluntary action or cognitive behavior of any kind.” (Some of the doctors the judge consulted did not believe that she was in a persistent vegetative state.)

The dispute between Schiavo’s husband, who wants her to die, and her parents and siblings, who want to keep her alive, has perhaps inevitably led to ugly allegations all around. Some of those who have fought to keep Schiavo alive, including some congressmen, have speculated rather too freely about Mr. Schiavo’s perfidy. But it is not necessary to believe the worst about him to think that it is madness to accept his word about his wife’s wishes. He has fathered two children with another woman, to whom he has gotten engaged. It is not necessary to judge that behavior harshly to think that his desire to move on, however understandable, compromises his ability to represent his wife fairly.

Republicans and Democrats in Congress concluded that the situation required their intervention. After some embarrassingly un-coordinated attempts to pass a bill, a House committee issued a subpoena that would have had the effect of keeping Schiavo’s tube from being disconnected (and could, in theory, have led to a clarification of some of the factual disputes in the case). Whatever one thinks of the merits of that use of the subpoena power, it seems remarkably high-handed of Judge Greer to flout it. Congressional subpoenas have not heretofore been considered to be subject to the review of state courts — a point which was lost on all the commentators who confidently opined that it was the congressmen who were threatening the separation of powers.

Next Congress, having come back into session on an emergency basis, passed a law authorizing a federal court to review whether Mrs. Schiavo’s constitutional rights were being violated. Opponents of the bill were put in an impossible argumentative position. On the one hand, they had to believe that courts never simply make up the law as they go along: Judge Greer was, for their purposes, infallible. But then what was the harm of a review by a federal court? If a constitutional claim existed, they could hardly oppose its enforcement; and if one did not, the federal court would have to be trusted not to recognize one.

So opponents of the bill were left with various complaints of hypocrisy. The conservatives who wanted to save Mrs. Schiavo were said to be trampling on their traditional beliefs in federalism and the sanctity of marriage. The complaint about federalism would have more force if we had reason to think that the people of Florida, acting through their legislature, had prospectively blessed the decisions of Judge Greer. But Judge Greer has twisted the state’s law; and the legislature has enacted a law designed to save Schiavo’s life, which the states’ courts set aside. The sanctity of marriage, meanwhile, has never been held to be so absolute that authorities could not take action to prevent someone from killing a spouse.

It is hard, again, to believe that most citizens who approve of assisted suicide meant to create laws that would allow it in a case of this type. We applaud Congress for having taken corrective action last night, and we hope this case brings attention to the cavalier manner in which the law too often allows the killing of the sick.

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Lingering Questions: The Schiavo bill passes, but much is still in doubt (National Review Online, 050321)

Well, the bottom line today is: Let’s be thankful the Schiavo bill was finally done, since it at least gives time for sanity to prevail and for responsible actors — whether law-enforcement authorities or the federal courts — to say that to torture of a live, defenseless person by starvation/dehydration is illegal, barbaric, and must never be permitted. So today is a day for guarded hope. Yet, a few troubling observations are in order.

First, the path to the cultural crossroad at which we find ourselves was blazed by judicial proceedings aimed at deciding whose life has value. How ironic is it, then, that these circumstances have actually reduced us to asking for Terri to be placed at the mercy of...yet another judicial proceeding?

The fact that the case will now be reviewed by a jurist who happens to be a federal judge hardly means the outcome here will necessarily be different than it was in the state courts. Now that the dust has settled, it’s probably worth asking about the composition — as in the general judicial philosophies — of the judges sitting on the federal bench in the Middle District of Florida. The “right to die” is yet another pet cause of the “progressive” vanguard. As we have come to know all too well, such movements tend to have more fellow travelers among legal elites (including the federal judiciary) than among the general population.

Second, in an age where more and more people get their news from television, and in the most fleeting of snatches, the language battle is more important than ever. It also remains the one thing the mainstream media still dominates. After watching the coverage over the weekend and the House debate last night, we should be very troubled by terms like life support, brain dead, and recover.

Life support came into our lay lexicon understood as a respirator of some kind for someone whose brain had ceased all but the barest minimum of function and who could not breathe on his own. In much of the public mind, however, it is now coming to include a feeding tube or intravenous hydration for someone who is very much alive and responsive to stimuli. Brain dead, meanwhile, is being sedulously broadened to include brain damaged, even though the two concepts are manifestly worlds apart — in truth, as different as dead and alive.

Recover, moreover, is now cavalierly tossed about in public discussions with a connotation critically different from its prior meaning. It used to be said of an authentically brain-dead person that he would never recover, and this, sensibly, meant would never actually be alive again. It is now said of the brain damaged, like Terri, that they will never recover — as in will never be whole and enjoy all of their mental faculties again. The latter kind of lack of recovery is tragic, but it is not effective death, and thus is not a justification for society to take affirmative measures to bring death about. Even if the brain damaged cannot recover, they are still alive and a good many of them can improve.

Finally, the bill passed early Monday morning is a strange reflection of our times. It basically says: You have to stop starving and dehydrating Terri Schiavo until we can figure out whether any federal rights have been violated. That’s a bit like saying: You need to stop clubbing me until I can figure out whether my head hurts.

Right-to-die folks will use the bill’s internal logic to their advantage. They will say that, notwithstanding the Fifth and Fourteenth Amendments, whatever the U.S. constitutional “right to life” may be, it does not include the right not to be tortured by slow starvation/dehydration. After all, they will rationally argue, if those amendments did include such a right, there would have been no reason for Congress to refer the matter to a federal court — Congress could simply have said that the state is not permitted to starve and dehydrate a person who is not clinically dead.

That is to say, the bill does not communicate any sense of the Congress that torture by starvation/dehydration is itself a constitutional violation. Since no one disputes that Terri was being starved/dehydrated, the right to die people will say: Surely Congress did not refer the case to a federal judge to determine whether starvation/hydration was ongoing, and surely if Congress thought starvation/dehydration violated the constitution it would have said so. Thus, so the argument will conclude, what Congress must have meant is that the federal court is limited to analyzing the state court proceedings themselves to weigh whether some federal law violation has occurred. If that is the route the federal court takes — essentially, that it is limited to deciding whether the state proceedings satisfied minimal threshold of constitutional due process, which tends not to be rigorous — it will be much more difficult to reverse the Florida outcome.

The question still lingers: Regardless of what one thinks of the evidence developed and the procedures followed in the Florida courts, how is a judge empowered, ever, to order or license torture? Let’s hope the federal court asks.

— Andrew C. McCarthy, who led the 1995 terrorism prosecution against Sheik Omar Abdel Rahman and eleven others, is a senior fellow at the Foundation for the Defense of Democracies.

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Is Prosecution the Solution? Terri Schiavo is being tortured, torture is a crime, therefore... (National Review Online, 050321)

The U.S. Congress and the Florida state legislature are struggling to overcome impasses in their efforts to enact laws that might save Terri Schiavo’s life, or at least have her case reviewed by federal courts. But is there a more straightforward solution? Excruciatingly slow starvation and dehydration is clearly a form of torture. Torture is a crime. So why don’t the state law-enforcement authorities in Florida prosecute Michael Schiavo and any person who is aiding and abetting him in carrying it out?

After the feeding tube that sustains Terri Schiavo was removed on Friday afternoon, National Review’s John Miller asked a question (on NRO’s weblog, The Corner) which was penetrating in its trenchant simplicity: “If somebody put a pistol to [Terri] Schiavo’s head and pulled the trigger — you know, to give the “dying process” a little nudge — would the shooter be guilty of murder under Florida law?” Well, given that we’ve had no small amount of propaganda from right-to-die activists about the purported humaneness of letting Terri wither and die, why doesn’t someone just shoot her — or at least administer the procedure employed to execute in capital cases. It would, after all, be quicker and thus more humane, right?

It is not being done because its crude blatancy would too obviously spotlight that what’s happening here is cold-blooded murder. Terri is not a person who is brain dead or a corpse being sustained by artificial means. She is alive and merely needs nutrition, like any child or incapacitated adult needs food and water. She will not be dead unless someone actually takes action to kill her. Yet, killing her efficiently, and with a comparative minimum of suffering, would interrupt the happy fiction the right-to-die people are selling: that the state is not really killing her, she’s just slowly dying on her own. Of course, she is not dying on her own. Because she is incapacitated, someone has to be responsible for her; and because she is alive that someone has to do something affirmative to end her life.

That it is being done by torture rather than a gunshot simply changes the amount of time the killing will take and the degree of suffering Terri will have to endure. That Michael Schiavo is carrying this affirmative act out over, say, two weeks rather than two seconds does not change the legal reality: If it would be the crime of murder for him to pull the trigger, it is the crime of torture, and murder, for him to drag the process out to accomplish the exact same end.

The starvation and dehydration process will cause Terri extreme, sustained physical and perhaps even mental suffering. Throughout the months of Abu Ghraib fanfare, the mainstream media, the American Civil Liberties Union, and some congressional Democrats — while contending that a Justice Department memorandum had shamed the United States by purportedly authorizing the use of torture against terrorists — repeatedly reminded us that the legal definition of torture, at least under federal law, is “an act committed by a person acting under the color of law specifically intended to inflict severe physical or mental pain or suffering (other than pain or suffering incidental to lawful sanctions) upon another person within his custody or physical control.” (18 U.S.C. Sec. 2340(1).)

That is plainly what Michael Schiavo and his helpers are committing. They have her in their custody, they are preventing anyone from providing her assistance, and though she is alive and in their care, they are denying her nutrition, which will gradually cause her immense discomfort and distress. They will putter, naturally, that it’s not their intention to inflict pain but to effectuate Terri’s purported “choice” to kill herself. But even if we accept this claim at face value, it speaks to motive not intent.

Legally, the two are critically different. The bank robber doesn’t get out from under by claiming: “I needed the money to pay for mom’s surgery.” His crime is intentionally stealing the money from the bank — that he purports to have had a noble reason for the robbery is irrelevant to the issue of whether he is guilty of the robbery. Similarly, people who withhold needed nutrition knowing it will cause severe pain and eventual death obviously intend the consequences of their actions. It is not a defense to a charge of torture or murder to say the victim would have wanted it that way — even in the highly unlikely event that the victim really would have wanted it that way.

Federal torture laws apply only outside the U.S. Domestic torture is generally a state matter. Not surprisingly, Florida has an anti-torture law — not to mention murder and murder-conspiracy laws — directly applicable to Terri’s situation. And it is much more expansive than the federal provision.

The law, aptly, is called “Abuse, Neglect, and Exploitation of Elderly Persons and Disabled Adults” (Florida Penal Section 825.102) [see here]. Under it, for example, it is a serious felony to cause the “[a]ggravated abuse of [a] ... disabled adult” by, among other things, “[w]illfull tortur[e].” Under the same statute, moreover, it is a serious felony if one responsible for an incapacitated adult “willfully or by culpable negligence neglects [a]...disabled adult and in so doing causes great bodily harm, permanent disability, or permanent disfigurement[.]” And the law regards as a somewhat less serious offense, but still a felony, a responsible caregiver’s “failure or omission to provide [a]...disabled adult with the care, supervision, and services necessary to maintain the...disabled adult’s physical and mental health, including, but not limited to, food, nutrition, clothing, shelter, supervision, medicine, and medical services that a prudent person would consider essential for the well-being of the...disabled adult.”

But wait a minute, you say. The torture in this case (euphemistically referred to in the media as “the removal of the feeding tube,” lest we be so impolite as to call it what it actually is) was authorized by a court. Doesn’t that mean it’s legal? Well, that all depends on whether the judge was directing something it was within his power to direct. A judge has no more legitimate power to order that torture take place than he does to order the moon to come up in the morning.

Let us go back to John Miller’s hypothetical. Is there anyone who thinks it would have been legal for Pinellas Circuit Court Judge George Greer to order Terri Schiavo to be shot at sunrise? Of course not. He’d be indicted in a heartbeat if he tried such a thing, and the old “I was just following orders” defense wouldn’t work any better for the hands-on executioner. So the question is: Is a judge any more empowered to order (or at least authorize) a torture — or any other felony abuse or neglect of a disabled person — than he would be to direct a shooting? Is it any more legally justifiable for Michael Schiavo and the hospice to rely on the judge’s say-so to carry out a torture than it would be for them to murder her by more swift means?

I don’t think so. Yes, most jurisdictions recognize what is known as a “public authority defense,” which essentially comes down to saying a person acted without criminal intent because he thought his conduct was excused by directions from a public official. (For example, a federal informant who, at the direction of DEA agents conducting a legitimate investigation, buys drugs from a narcotics dealer so the agents can gather evidence on the dealer is not guilty of a crime because the agents properly authorized him to commit the act.) But generally speaking, the public official in question must have the legitimate power to permit the otherwise unlawful act — or at the very least it must have been reasonable under the circumstances for the actor to believe the public official had such power. (In our example, the informant who bought the drugs would actually be guilty of narcotics trafficking if he tried to claim that he believed he had permission from, say, an IRS agent who had nothing to do with drug investigations; indeed, if the IRS agent actually did give such instructions, he’d likely be guilty of the drug crime too — his authority to probe tax crimes gives him no legitimate power to cause the commission of narcotics transactions for investigative purposes.)

If a person is brain dead — meaning, in layman’s terms (which are the only terms on which I understand the concept), for all intents and purposes dead but still respirating by artificial means — there would seem to be little doubt that a judge is empowered to discontinue the artificial means. In such an instance, the judge (and whoever pulls the plug) is not intentionally causing death or pain. Instead, death has already occurred, and it is merely the artificially supported functions that are being terminated. But, as noted above, that is not the Terri Schiavo case. She is alive; someone has to do something affirmative and intentional to snuff out that life and cause her death. That affirmative act began Friday afternoon.

But by what right? Where does it say, under Florida law, that a judge has the power to authorize the commission of felony violations of the law? A judge manifestly had no power to tell Michael Schiavo and the hospice that they could feel free to shoot or hang or over-medicate Terri to death. Why in the world to we think he had the cognate power to permit a torture?

If a federal judge told the CIA: You should feel to starve and dehydrate Khalid Sheikh Mohammed until he tells you everything he knows about the 9/11 plot, would anyone contend that that was a lawful order? Would anyone claim that the judge had the authority to override U.S. anti-torture laws? Of course not — the streets would be rife with angry protesters and the editorial pages with stinging condemnation. So why are we acting as if we must simply abide a similar order from a state judge in Florida that has no purpose other than to cause enduring pain and eventual death?

Prosecution, furthermore, is an executive function, not a judicial function. If criminal laws are being violated, the state authorities charged with enforcing the law have the power to bring charges. Why shouldn’t that be done here? Why shouldn’t Florida Governor Jeb Bush, among others, be using his bully pulpit to demand that it be done? We know this woman is being tortured and abused. Even if you want to pretend that this was what Terri wanted, “she asked for it” is not a defense to a charge of murder or torture. Even the people saying that it is Terri’s “choice to die” do not have the temerity to claim openly that it was her choice to be tortured.

A court has no power to order torture. If we start thinking about what is going on in Florida as what it is, a crime, rather than as the execution of a lawful order, law-enforcement authorities should be able to halt it forthwith. Indeed, they have a duty to do so. They should be able to issue grand-jury subpoenas, including a subpoena demanding production and preservation of Terri’s body for evidentiary purposes. And they should have the discretion to charge anyone responsible for violations of the criminal law — including the judge if he blatantly exceeded his authority.

The torture debate has gone on with great theater in this country for over a year. What has most offended humanitarian-law activists, so they tell us, is what they frame as the Justice Department’s suggestion that the president may have the constitutional authority to ignore U.S. anti-torture laws if he deems it necessary to American national security. Is it such a reach to say that if the president of the United States does not have such authority in the middle of a war, neither does a state judge sitting in Florida at any time?

It is time to ask: What is the legal rationale for the judicial allowance of torture in Terri Schiavo’s case? If there isn’t one: (a) Why is it happening, and (b) Why isn’t someone in handcuffs?

— Andrew C. McCarthy, who led the 1995 terrorism prosecution against Sheik Omar Abdel Rahman and eleven others, is a senior fellow at the Foundation for the Defense of Democracies.

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Facts First: Motives matter little, it’s the facts of the Terri Schiavo case which dictate that Congress was right to get involved (Weekly Standard, 050321)

FOR ALL THE QUESTIONING of motives in the Terri Schiavo case, it’s three simple facts that make it both wise and morally necessary to have allowed the federal courts to examine the issue. And these facts suggest that Schiavo, brain damaged since a heart attack 15 years ago, should have her feeding tube restored so she won’t starve to death.

Congress acted early today to let Schiavo’s parents take her case out of the sole jurisdiction of a Florida judge and have it considered by the federal courts. The Florida judge has repeatedly ruled, at the request of Terri’s husband Michael, that her feeding tube should be removed. Florida appeals courts have upheld that decision. The feeding tube was removed on Friday.

Here are the three facts which undermine that decision:

* Terri Schiavo is brain damaged but not brain dead. She is not on life support. She breathes on her own. She occasionally laughs. She reacts to stimuli. She responds at times to her parents. She is not dying, though she needs a feeding tube. A doctor diagnosed her as being in a “permanent vegetative state” but other doctors have disputed that view. Indeed there are legitimate questions about her initial diagnosis.

* Schiavo’s parents have offered to take full responsibility for her care, relieving her husband of any obligations whatsoever. They are willing to pay the expenses of her hospitalization and any rehabilitation program.

* Senate majority leader Bill Frist, himself a doctor, has talked to a neurologist who examined Schiavo. The neurologist told him that with proper care of a type she hasn’t received there is a good chance that Schiavo’s condition will improve markedly.

These facts alone warrant a second look at Schiavo’s fate. And the only way to achieve that was by giving her parents the right—or “standing”—to pursue the matter before a federal judge. Florida law denies parents the right to intervene, leaving the life-or-death decision entirely in the hands of a spouse.

True, there is an arguable federalism issue: whether taking the issue out of a state’s jurisdiction is constitutional. But it pales in comparison with the moral issue. Without the action of Congress to involve the federal courts, Schiavo would die. Of course, she may die anyway if the federal courts refuse to overturn the ruling of the Florida judge. But at least the case will have been reviewed.

But the facts alone are sufficient to justify saving Schiavo’s life. The motives of the players are merely interesting. Does it really matter if Republicans such as Frist are out for political gain? Not much. Should Michael Schiavo have lost his right to decide his wife’s fate since he now has a girlfriend (and two children by her)? Maybe. But motives don’t need to be taken into account in this case. Facts do.

Fred Barnes is executive editor of The Weekly Standard.

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Pushing Infanticide: From Holland to New Jersey (National Review Online, 050322)

Bureaucracy has trumped morality in the Netherlands. How else can one explain a country where, when doctors admit publicly that they commit eugenic infanticide, the leaders’ response is not to prosecute them for murder, but instead to urge that guidelines be created under which future baby killings can openly take place?

The “Groningen Protocol” — named after a pediatric hospital which admittedly permits doctors to end the lives of babies born with disabilities or terminal conditions — seeks to normalize infanticide by bringing the practice out of the shadows and into the light of day. Under this thinking, it isn’t the killing that is wrong, but the secrecy.

Secrecy? What secrecy? It has been widely known for years that Dutch doctors kill disabled and dying babies. As far back as 1992, the Dutch Royal Society of Medicine published guidelines to be used in deciding whether to kill a baby, including whether the child would ever be able to live independently, experience “self realization” (being able to hear, read, write, labor) and have meaningful interpersonal relations.

By 1993, as documented in PBS’s Choosing Death, three out of eight neonatal intensive care unites in the Netherlands had specific policies, endorsed by the Dutch Pediatric Society, that permitted infanticide by lethal injection. Rita Marker’s breakthrough book Deadly Compassion (Marker leads the International Task Force on Euthanasia and Assisted Suicide), raised the warning flag about Dutch infanticide in 1993. In 1996, the Lancet published a study finding that 8% of all Dutch infant deaths each year — between 80 and 100 — result from lethal injections, many without parental consent. I wrote about the matter extensively in my 1997 book Forced Exit.

No, the publishing of the Groningen Protocol isn’t designed to end the secret that is not a secret. It is intended to legitimize eugenic infanticide and move it from a crime tolerated by the, oh, so tolerant Dutch, to outright legality. In other words, the last vestige of protection left in the Netherlands against infanticide — that is, the technical illegality of killing babies in the Netherlands — is to be stripped away, including the protection against the killing of disabled infants not dependent on intensive care for survival.

Murdering babies because they are disabled or dying is a profound violation of their human rights. At least, it used to be. After all, German doctors who killed disabled infants during World War II faced the business side of the hangman’s noose for their crimes.

This belief appears to be changing, at least among elites. As a consequence, an effort appears to be under way to spread the Dutch cancer to our own shores. The New England Journal of Medicine, for example, recently provided a forum for two Dutch doctors to explain dispassionately how the Groningen Protocol seeks “to develop norms” for infanticide. This was merely the most recent in a series of euthanasia/assisted suicide-promoting articles that have been published in that once august journal in recent years. (Perhaps the NEJM should change its name to The New Euthanasia Journal of Medicine.)

Meanwhile, rather than writing scathing editorials against infanticide, the New York Times instead published “A Crusade Born of a Suffering Infant’s Cry,” a puff profile of one of the leaders of the Dutch infanticide movement, Dr. Eduard Verhagen, “a father of three who spent years tending to sick children in underdeveloped countries.” The article laments, “For his efforts to end what he calls their unbearable and incurable suffering, Dr. Verhagen has been called Dr. Death, a second Hitler and worse — mostly by American opponents of euthanasia.” Poor baby.

Meanwhile, the Los Angeles Times published an apologia for infanticide by Princeton’s notorious Peter Singer, which its subheadline described as “an ethics expert,” in which the world’s most famous proponent of infanticide — he once explicitly compared the killing of a baby to the catching of a mackerel — attempts to conflate removing intensive care and other life support from a dying baby with active killing based on quality of life considerations: “The dispute is no longer about whether it is justifiable to end an infant’s life if it won’t be worth living,” Singer wrote, “but whether that end may be brought about by active means....”

Not mentioned by Singer or the Los Angeles Times is that the “ethics expert” believes that babies who could unquestionably lead happy lives, such as those with Down syndrome and hemophilia, indeed, any infant — not just the dying or disabled — can be killed if their deaths would serve the interests of their families. Indeed, Singer does not consider infants to be “persons,” and hence under his thinking, no infant has the right to life.

The Dutch have fallen into a moral abyss of utter relativism where even the lives of helpless babies are not sacrosanct. But this isn’t a foreign problem: Many of our own molders of professional and public attitudes apparently want to drag us over the same precipice. Whatever the New Euthanasia Journal of Medicine is trying to cell, when it comes to infant euthanasia, this is a time for repulsion not acceptance.

— Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture. He is the author most recently of Consumer’s Guide to a Brave New World.

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‘Cruel and unusual’ (townhall.com, 050322)

Thomas Sowell

If the tragic case of Terri Schiavo shows nothing else, it shows how easily “the right to die” can become the right to kill. It is hard to believe that anyone, regardless of their position on euthanasia, would have chosen the agony of starvation and dehydration as the way to end someone’s life.

A New York Times headline on March 20th tried to assure us: “Experts Say Ending Feeding Can Lead to a Gentle Death” but you can find experts to say anything. In a December 2, 2002 story in the same New York Times, people starving in India were reported as dying, “often clutching pained stomachs.”

No murderer would be allowed to be killed this way, which would almost certainly be declared “cruel and unusual punishment,” in violation of the Constitution, by virtually any court.

Terri Schiavo’s only crime is that she has become an inconvenience — and is caught in the merciless machinery of the law. Those who think law is the answer to our problems need to face the reality that law is a crude and blunt instrument.

Make no mistake about it, Terri Schiavo is being killed. She is not being “allowed to die.”

She is not like someone whose breathing, blood circulation, kidney function, or other vital work of the body is being performed by machines. What she is getting by machine is what all of us get otherwise every day — food and water. Depriving any of us of food and water would kill us just as surely, and just as agonizingly, as it is killing Terri Schiavo.

Would I want to be kept alive in Terri Schiavo’s condition? No. Would I want to be killed so slowly and painfully? No. Would anyone? I doubt it.

Every member of Terri Schiavo’s family wants her kept alive — except the one person who has a vested interest in her death, her husband. Her death will allow him to marry the woman he has been living with, and having children by, for years.

Legally, he is Terri’s guardian and that legal technicality is all that gives him the right to starve her to death. Courts cannot remove guardians without serious reasons. But neither should they refuse to remove guardians with a clear conflict of interest.

There are no good solutions to this wrenching situation. It is the tragedy of the human condition in its most stark form.

The extraordinary session of Congress, calling members back from around the country, with the President flying back from his home in Texas in order to be ready to sign legislation dealing with Terri Schiavo, are things that do us credit as a nation.

Even if critics who claim that this is being done for political or ideological reasons are partially or even wholly correct, they still miss the point. It is the public’s sense of concern — in some cases, outrage — that is reflected by their elected representatives.

What can Congress do — and what effect will it have? We do not know and Congress does not know. Those who are pushing for legislation to save Terri Schiavo are obviously trying to avoid setting a precedent or upsetting the Constitutional balance.

It is an old truism that hard cases make bad law. No one wants all such cases to end up in either Congress or the federal courts. But neither do decent people want an innocent woman killed because she was inconvenient and a court refused to recognize the conflict of interests in her legal guardian.

The fervor of those who want to save Terri Schiavo’s life is understandable and should be respected, even by those who disagree. What is harder to understand is the fervor and even venom of those liberals who have gone ballistic — ostensibly over state’s rights, over the Constitutional separation of powers, and even over the sanctity of family decisions.

These are not things that liberals have any track record of caring about. Is what really bothers them the idea of the sanctity of life and what that implies for their abortion issue? Or do they hate any challenge to the supremacy of judges — on which the whole liberal agenda depends — a supremacy that the Constitution never gave the judiciary?

If nothing else comes out of all this, there needs to be a national discussion of some humane way to end life in those cases when it has to be ended — and this may not be one of those cases.

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“Mercy”! Infant euthanasia creeps into acceptability (National Review Online, 050330)

Kathryn Jean Lopez

“Killing a defective infant is not morally equivalent to killing a person. Sometimes it is not wrong at all.”

Peter Singer, a bioethics professor at Princeton University, penned this chillingly cold line in his book Practical Ethics.

In case you’re not freezing yet: Singer explains that, “Newborn human babies have no sense of their own existence over time.” Hence, they’re disposable.

Infant euthanasia (Have you ever imagined seeing those two words together?) is the practice Singer is discussing. And don’t confuse it with abortion. We’re talking out-of-the-womb, mom-has-delivered, right-here-with-you-and-me babies. Where’s it happening? In Europe and the Netherlands, specifically — although word of it is slowly spreading. In Holland, the Associated Press reports that “at least five newborn mercy killings occur for every one reported.”

“Mercy” is the keyword. Learning that your newborn has a fatal or potentially fatal illness must be an indescribably painful experience for a parent. But consider the added anguish of a doctor talking you into being “merciful” by ending your child’s life.

And what determines merciful, anyway? That term is a bit vague in this context, as is most of the language advocating infant euthanasia.

Writing in The New England Journal of Medicine, two doctors from the University Medical Center Groningen in the Netherlands confessed that “it is difficult to define” who, among infants, can or should be eliminated. Babies, obviously, can’t tell you their pain is unbearable, so it becomes incumbent on “parents and medical experts” to determine what “hopeless” means.

“Hopeless” is another term for the infant-euthanasia glossary.

At the moment, the “mercy killing” of infants isn’t officially legal — even in the Netherlands. It’s just happening. But the Groningen doctors seem to believe that if they can present guidelines by which doctors can break the law uniformly — the presumption being that they be professional about their killing — that a law allowing such killing will follow.

The larger framework is already there in Holland: “Adult” euthanasia is legal in the Netherlands, including for some teenagers without parental consent. Voluntary euthanasia there is not restricted to the terminally ill; if your desire to die is “rational,” you’ve got a green light. (It’s not an attitude confined to the Dutch: In a 2001 interview, right-to-die activist Philip Nitschke told me that suicide facilitation should be available “to anyone who wants it, including the depressed, the elderly bereaved, (and) the troubled teen.”)

Just think about that. Life can seem pretty hopeless in high school pretty darn often when you’re struggling in French and the captain of the football team doesn’t know you exist. If the United States had a law like the one in the Netherlands, lines of the pimple-faced dejected would wrap around the killing clinics.

The Dutch way is a clear example of a slippery slope at work. First “adult” euthanasia is embraced (which was decriminalized in a pattern clearly familiar to the Groningen doctors are outlining), then infant euthanasia.

Christine Rosen, the author of Preaching Eugenics, a book on America’s experience with euthanasia, says that, “The Netherlands’ embrace of euthanasia has been a gradual process aided by the growing acceptance (in a much more secular Europe) that some life is ‘unworthy of life.’” Indeed, Europe is doing just that. According to the Associated Press, 73% of French doctors have admitted to using drugs to end an infant’s life, with between 2 and 4% of doctors in the United Kingdom, Italy, Spain, Germany and Sweden confessing the same.

Here in the United States, infant euthanasia remains under the radar. But it’s no new thing. There was the case of the Bollinger Baby in 1915, when a Chicago doctor permitted an infant, who could have lived with surgery, to die. According to Rosen, Dr. Harry J. Haiselden “later admitted that he had allowed the death of many other ‘defective’ babies.” He even made a propaganda film, The Black Stork, to promote euthanasia and infant euthanasia.

Could Peter Singer be, or be grooming, the next Harry Haiselden? Wesley Smith, author of A Consumer’s Guide to a Brave New World, points out that Singer is a tenured professor at one of our most prestigious universities “because of his advocacy” — school administrators knew exactly who they were hiring at the time. And there he is, “preparing the intellectual ground” for infant euthanasia right in New Jersey. Smith warns, “If we invite the vampire of euthanasia into our midst, we will fall off of the same vertical cliff as has Holland.”

Mercifully, we’re still a good way from vampires and cliffs on the issue of infant euthanasia. But a few more winks and nods at the “mercy killing” of newborns and it will be time to watch our necks and look out below.

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Dutch Gov’t Considers Euthanasia Questions (WorldNetDaily, 050330)

AMSTERDAM, Netherlands (AP) - The Dutch government, the first to legalize euthanasia for some terminally ill people, will tackle an even thornier ethical dilemma: what to do when doctors say it is best to end the lives of infants, the mentally handicapped or the demented.

Euthanasia opponents view the idea with horror, but The Royal Dutch Medical Association believes guidelines and a panel of experts should be created to vet such cases.

Health Secretary Clemence Ross, who has opposed expanding the current euthanasia rules, will send an opinion to Parliament in three or four weeks, said her spokesman, Richard Lancee.

If Ross approves, doctors acting with the families’ permission would not be punished for administering lethal sedatives to “people with no free will,” in cases that pass review.

Under current law, euthanasia is restricted to terminal patients suffering unbearable pain with no hope of improvement, and who request to die when they are of sound mind. Each case is reviewed by a panel of medical experts.

The new proposal calls for a similar panel for patients who cannot express themselves, with the addition of a judge or court official, giving a legal veneer to a practice that technically would remain illegal.

For advocates, the issue is one of transparency: Past studies have shown that doctors already carry out a handful of such euthanasia cases each year.

In the best known example, the Groningen Medical Center announced last year it euthanized four severely ill newborns in 2004, under guidelines known as “the Groningen Protocol” - a list of standards for performing and reporting euthanasia of newborns with serious, incurable deformities.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions, and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida.

Euthanasia opponents say formalizing such practice would be another step in the Netherlands’ slide down an ethical slope. Bert P. Dorenbos, director of Cry for Life, said the move would be a preliminary step to legalizing involuntary euthanasia.

“This is the most important moment, when we can still fight it,” he said.

A similar proposal was stricken from the euthanasia bill that was passed in 2001 and took effect in 2002, making the Netherlands the first country to legalize a practice it says is common but unstated in most Western countries.

Since then, Belgium has also legalized euthanasia, while in France, legislation to allow doctor-assisted suicide is currently under debate. In the United States, the state of Oregon is alone in allowing physician-assisted suicide, but its law is under constant challenge.

The Terri Schiavo case would not fall under Dutch euthanasia law, because courts have held that withdrawing life support or a feeding tube is a decision left up to doctors.

Peter Holland, the director of the Royal Dutch Medical Association, said doctors support the creation of a vetting panel for “extreme cases.” The Dutch Society for Voluntary Euthanasia has no official position on the latest proposal, but Chief Executive Rob Jonquiere said the organization generally supports it.

“The best argument for the review boards is the success of the existing system” in the Netherlands, he said.

There were 1,815 euthanasia cases reported to regional review boards in 2003, a slight decline from previous years. In eight cases, doctors were deemed not to have followed the rules properly and were referred to prosecutors.

According to a study published in the Netherlands Journal of Medicine in January, 22 cases of newborns being euthanized were reported to prosecutors since 1997. Prosecutors found that the Groningen guidelines were followed in all of them, so they recommended to superiors the cases not be pursued further though they were technically murder.

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Activists for disabled fear public perception (Washington Times, 050331)

CHICAGO (AP) — Grabbing attention with a brief, dramatic demonstration, disabled activists have been raising their voices throughout the final stages of the Terri Schiavo drama to send a message that Mrs. Schiavo, too, is a disabled person who is worthy of living.

“There is a perception that death is better than living with a disability,” said Mary Lou Breslin, a senior policy analyst with the Disability Rights Education & Defense Fund in California.

And that, she said, should not be the case.

Disabled activists went to great lengths over the weekend to make their point, a few of them laying on the ground outside Mrs. Schiavo’s Florida hospice next to their wheelchairs.

“They’re saying, ‘This is who I am. This device here allows me to get around — but this is who I am,’” said Stephen Drake, a spokesman for Not Dead Yet, a group that focuses on end-of-life issues for disabled people.

Mr. Drake’s group is one of many disabled-advocacy groups that — though divided within their own ranks — have taken a public stand in the Schiavo case.

Among other things, they’re asking Congress to consider requiring a federal court review in disputed cases where the wishes of an incapacitated person are not in writing and when family members disagree on care.

The federal review that Congress allowed as a special circumstance in the Schiavo case caused a backlash from many Americans uncomfortable with the government intervening in a family matter. But activists say such reviews are necessary to safeguard the incapacitated person’s rights.

“We obviously want people’s private life to be private. But to say there should be no review is not practical,” said Harriet McBryde Johnson, a disability-rights lawyer in Charleston, S.C., who’s been physically disabled since childhood.

She said that, because Mrs. Schiavo was not suffering from an illness or condition that threatened her life, removing her feeding tube was a decision to kill her.

Taking such a stance has placed disabled activists alongside religious conservatives, who have pegged the Schiavo case as a right-to-life issue.

But Marvin Wasserman said the terminology he’s heard disabled activists using in the Schiavo debate — calling removing the feeding tube “murder” and referring to Michael Schiavo as Mrs. Schiavo’s “so-called husband” — has angered him and others.

Mr. Wasserman, a New Yorker whose quadriplegic wife told him of her wish to die after she got cancer, said it’s wrong for people to second-guess Michael Schiavo and his push to have her feeding tube removed.

“I have a very strong feeling that he probably knew her better than anybody else and that he knew what her wishes were,” said Mr. Wasserman, whose wife was removed from life support after she was declared brain-dead.

“We should be more concerned about fighting for retaining and improving the quality of life for people who are conscious of their physical state,” Mr. Wasserman said.

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House to Issue Subpoenas in Schiavo Case (Foxnews, 050318)

WASHINGTON — Working against the clock, House lawmakers tried to prevent doctors in Florida from removing the feeding tube Friday from a severely brain-damaged woman.

In a two-pronged approach, a House committee was issuing congressional subpoenas to stop doctors from disconnecting the tube, while an attorney for the parents of the woman, Terri Schiavo, said he would ask a federal judge in Tampa to block the removal and review the actions of state courts.

Such habeas corpus appeals seek to require the government to justify its actions.

“We are going to ask him to issue a stay because in this case, state action would be used to end the life of an innocent, disabled woman,” the attorney, David Gibbs said.

Police in Pinellas Park, Fla., meanwhile, readied for the hundreds of protesters expected to show up outside Schiavo’s hospice as the hours slipped away before the scheduled 1 p.m. removal of her feeding tube.

The Florida House on Thursday passed a bill 78-37 to block the withholding of food and water from patients in a persistent vegetative state who did not leave specific instructions regarding their care. But hours later, the Senate defeated a different measure 21-16, and one of the nine Republicans voting against indicated that any further votes would be futile.

In a last-ditch attempt to stop the court-ordered removal, a House committee on Capitol Hill here decided early Friday morning to start an investigation into Schiavo’s case and issue subpoenas ordering doctors and hospice administrators not to remove her feeding tubes and to keep her alive until that investigation was complete.

The effort by the House Government Reform Committee came after lawmakers in both Washington and Tallahassee failed in attempts to pass legislation to keep her husband, Michael Schiavo, from having the tube pulled despite heavy lobbying by Schiavo’s parents.

“This inquiry should give hope to Terri, her parents and friends and the millions of people throughout the world who are praying for her safety,” House Speaker Dennis Hastert, Majority Leader Tom DeLay and Government Reform chairman Tom Davis said in a joint statement. “This fight is not over.”

It was not immediately known when the subpoenas would be delivered to Schiavo’s hospice and doctors, or whether the Florida health care providers would recognize them. A possible penalty for not recognizing the subpoena is to be held in contempt of Congress, a GOP leadership aide said.

“Everything is a longshot,” said Gibbs, attorney for Schiavo’s parents, Bob and Mary Schindler.

But several last-minute legal avenues were being tried, such as the habeas corpus appeal, which is commonly used in death penalty cases.

The Florida attorney general’s office usually defends the state against habeas filings. A call to the office late Thursday for comment was not immediately returned.

As part of the last-minute flurry of activity, the Florida judge who approved the withdrawal of food and water from Schiavo denied a request from the state to keep her alive. The state appealed that decision to the Florida Supreme Court, which promptly dismissed it. The U.S. Supreme Court also denied another appeal.

At the White House, President Bush left little doubt where he stands.

“The case of Terri Schiavo raises complex issues,” he said in a statement. “Yet in instances like this one, where there are serious questions and substantial doubts, our society, our laws and our courts should have a presumption in favor of life. Those who live at the mercy of others deserve our special care and concern.”

His brother, Gov. Jeb Bush, long has supported the parents’ efforts and urged lawmakers to act before it was too late.

Schiavo suffered severe brain damage in 1990 when her heart stopped because of a chemical imbalance, and court-appointed doctors say she is in a persistent vegetative state. Her husband, Michael Schiavo, says she told him she would not want to be kept alive artificially. Her parents dispute that, and say she could get better.

The court found that it was Terri Schiavo’s wish not to kept alive in her current state and issued an order to remove the feeding tube Friday. Michael Schiavo’s attorney, George Felos, wouldn’t comment on when and how the removal will take place or whether Michael Schiavo would visit his wife before it happened.

Doctors have said it could take a week or two for Terri Schiavo to die once the tube that delivers water and nutrients is removed.

==============================

Debate Renews Divide Over ‘Values’ (Foxnews, 050320)

WASHINGTON — The Terri Schiavo case has been catapulted from a drawn-out medical and legal battle into a fast-paced political drama with Congress, the White House and the courts playing leading roles.

Republicans see a vote for prolonging the life of the brain-damaged Florida woman as an opportunity to strengthen their support among religious conservatives, a vital constituency group, ahead of next year’s congressional elections.

For the most part, minority-party Democrats are asserting that congressional involvement in such a heart-wrenching private matter is unwarranted and unwise. But they are treading carefully, not wanting again to get clobbered on the “values” issue that hurt them in last year’s elections.

Schiavo and members of her family have “become political pawns to larger political issues,” Rep. Jim Moran, D-Va., said Sunday. “This is an issue that should be left to the state courts.”

But Moran raised a distinction not lost on Democrats in other parts of the country: “I can’t say necessarily that I’m speaking for my constituents.”

So many parts of the drama were in motion over the weekend after Schiavo’s feeding tube was removed on Friday at the direction of a Florida judge.

President Bush rushed back from spring break vacation at his Texas ranch to be on hand to sign legislation that supporters said would allow a federal judge to order the feeing tube reinserted.

Lawmakers were returning to the Capitol to try to pass a last-minute compromise. As GOP leaders scrambled to get enough members for a quorum, Schiavo’s parents notified her hospice to prepare to have the tube reinserted.

Not since the case of 6-year-old Cuban refugee Elian Gonzalez in 2000 have national leaders so involved themselves in such a personal issue.

Gonzalez survived a shipwreck that killed his mother and 10 others who were fleeing Cuba. His Miami relatives balked at returning him to his father in Cuba, but the Clinton administration did just that after court appeals and GOP-led efforts to declare the boy a U.S. citizen failed.

Republicans were quick to embrace legislation to prolong the life of Schiavo, who suffered brain damage in a heart attack 15 years ago. Her husband and parents have been in a long legal battle.

Senate Majority Leader Bill Frist, R-Tenn., a physician, urged the Senate to side with the parents and “give Terri Schiavo one last chance at life.”

An unsigned one-page memo, distributed to Republican senators, called it “an important moral issue and the pro-life base will be excited that the Senate is debating this important issue.”

The memo, reported first by ABC News and the Washington Post and later obtained by The Associated Press, added that “this is a tough issue for Democrats.”

It was not known who originated the memo or initially put it into circulation.

“It’s a very complicated case, but it can be boiled down to simple human values. It’s a story people can rally around,” said University of Virginia political scientist Larry Sabato. “This is the ‘values’ issue writ large again. And the divide couldn’t be clearer between the two parties.”

The issue has a dramatic impact because of video tapes that show Schiavo in her hospice bed with her mother and because of her parents’ dogged campaign to keep their daughter alive.

“She is responsive. She does try to vocalize. She emotes. ... And, at least according to the family, she is still in that kind of condition where she responds,” said Rep. Dave Weldon, R-Fla. He is a sponsor of the legislation to order her feeding tube reinserted until a federal judge reviews the case.

Critics of congressional intervention cite doctors who say the 41-year-old woman is in a persistent vegetative state.

Schiavo could linger for one or two weeks if the tube is not reinserted — as has happened twice before.

“Hours do matter at this point,” White House spokesman Scott McClellan told reporters as Bush rushed back to town.

McClellan shrugged off suggestions of a political component to Bush’s response. But the issue has mobilized religious conservatives and has become a dominant topic on conservative talk radio.

It has also provided House Majority Leader Tom DeLay, R-Texas, a role that helps deflect heat on him for alleged fund-raising improprieties and possible violation of House travel rules.

Critics suggest it is hypocrisy for a Congress that espouses federalism to get involved in case that has exhausted appeals in Florida courts.

“It is particularly hypocritical when you have people who say they advocate on behalf of the defense of marriage who now insert themselves between a husband and his wife,” said Rep. Debbie Wasserman Schultz, D-Fla.

“It is not Congress’ place to say yes or no” on the feeding tube issue, she said.

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Fast Facts: Schiavo Case Timeline (Foxnews, 050320)

The status of legal action surrounding Terri Schiavo, a severely brain-damaged woman at the center of a heated right-to-die battle:

U.S. CONGRESS:

— The Senate passed a bill aimed at prolonging Terri Schiavo’s life by giving federal courts jurisdiction in the case.

— House leaders scrambled to bring enough lawmakers back to the Capitol for an emergency vote early Monday, after Democrats thwarted their plans to approve the bill on a voice vote Sunday.

— President Bush returned to Washington from his Texas ranch for a chance to sign the measure when it was approved.

— House and Senate committees issued subpoenas last week seeking to force the continuation of treatment, but that move was rejected by a Florida court.

FEDERAL COURTS:

— Judges in the federal district court based in Tampa were standing by for an emergency hearing overnight in case Congress passed a bill that gave the federal court jurisdiction.

— The 11th Circuit Court of Appeals was considering an appeal on whether Terri Schiavo’s right to due process was violated. The court asked for additional briefs explaining how the law under consideration in Congress would affect that appeal. A brief was delivered Sunday morning.

— Other federal courts have previously declined to get involved in the case, citing lack of jurisdiction.

FLORIDA LEGISLATURE:

— The House passed legislation last week that would block doctors from withholding nutrition and water from people in persistent vegetative states, except in cases with living wills or other specific instructions.

— Identical legislation in the Senate has not been voted on because sponsors said it did not have enough support to pass. A different, and more popular, version of the bill was defeated in the Senate.

— Gov. Jeb Bush said he was urging senators to act.

FLORIDA COURTS:

— Judge George W. Greer approved Michael Schiavo’s request to have Terri’s feeding tube removed. It was taken out Friday afternoon.

— Greer also rejected the request from House lawyers to delay the tube’s removal because of the subpoenas.

==============================

Schiavo Case: Faith Against Science (Foxnews, 050320)

NEW YORK — Ten years ago, Christian Dwyer was in a car accident and doctors predicted he would spend the rest of his life in a persistent vegetative state — the same condition some doctors believe Terri Schiavo to be in.

Today, Dwyer is alive and well. Although confined to a wheelchair and afflicted with some permanent physical damage, he speaks clearly about his experience and his opposition to what is happening to Schiavo.

Doctors say that Schiavo, the 41-year-old woman who’s feeding tube was removed Friday, is in a persistent vegetative state, from which no one has ever recovered.

Others, such as Terri’s parents and a group of 30 doctors and nurses who have signed affidavits testifying as much, say she is not in such a state, and that there is a chance for recovery.

Dwyer has good reason to think Schiavo has a chance.

After five weeks in a “life-and-death situation” and three months in a coma, his doctors predicted that if he did survive, it would be as a vegetable.

His parents, despite their will for him to live, made the necessary arrangements.

“Even though that’s not what we wanted, we believed that it was possible that he could die, and we signed off for his organs to be donated,” his mother, Linda Dwyer, told FOX News’ “Dayside With Linda Vester.”

“Obviously, I got better,” Christian said on the program. “It was the supernatural powers of God that saved my life.”

Schiavo, however, has been in the same state since her accident 15-years-ago. And some medical professionals do not think she will live long without medical support.

Dr. Sean Morrison, professor of geriatrics and internal medicine at Mt. Sinai School of Medicine in New York, is one of them. He described the physical process her body will go through without medical assistance.

“She doesn’t starve. She loses fluid from her body. She enters into a peaceful coma, and she gradually passes away. She dehydrates as a result of the medical intervention being stopped,” Dr. Morrison told FOX News.

And because she is in hospice care, she will be made comfortable with artificial saliva spray and lip balm during the dehydration.

The process typically takes two weeks before the patient dies, Morrison said.

The Dwyers, however, thinks Schiavo’s rights are being violated with the removal of the tube.

“You don’t have to prove that you’re a human being to be treated as such. We don’t starve dogs to death, criminals to death and we don’t stave terrorists to death,” Linda Dwyer said. “This is incomprehensible that this would come to this.”

However, Morrison argues that because Schiavo had expressed not wanting to be kept alive with medical assistance before she entered her current state, she has the right to die.

“We are not causing Terri Schiavo’s death. We are removing a medical intervention, just as if you were attached to a breathing machine or a ventilator and I say, ‘You know what? I don’t want this anymore. Please stop it.’ The courts have said that you have that right,” Morrison said.

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Bush signs bill to save Terri (WorldNetDaily, 050321)

House votes overwhelmingly to make Schiavo case federal

WASHINGTON – The House of Representatives this morning passed a bill that could save Terri Schiavo’s life by sending it to a federal court for review to determine whether her feeding tube should be reinserted.

President Bush signed it into law moments later.

“In cases like this one, where there are serious questions and substantial doubts, our society, our laws and our courts should have a presumption in favor of life,” Bush said in a statement.

The emergency House vote of 203-58 came at 12:30 a.m. following a voice vote in the U.S. Senate. House Democrats stalled the vote forcing lawmakers into an emergency late-night session.

The president rushed back from his Texas ranch to sign the measure that could trigger a federal court review and a quick restoration of feeding tubes needed to keep the brain-injured Florida woman alive.

“We are very very thankful to have crossed this bridge,” Suzanne Vitadamo, Terri’s sister, told reporters following the vote. “We are hopeful, we are very hopeful, that the federal courts will follow the will of Congress and save my sister’s life.”

Republican supporters said the “Palm Sunday Compromise” would protect the constitutional rights of a disabled person, and denied suggestions that they viewed the case as an opportunity to shore up support among religious conservatives ahead of next year’s elections.

But Rep. Jim Davis, D-Fla., said the congressional action was “a clear threat to our democracy.” Congress, he said, was ignoring the constitutional separation of power and “is on the verge of telling states, courts, judges and juries that their opinions, deliberations and decisions do not matter.”

“We ought to err on the side of life in a case like this,” said White House spokesman Scott McClellan. Asked about a bill that would cover a single person, he said, “I think most people recognize that this case involves some extraordinary circumstances.”

House Majority Leader Tom DeLay, R-Texas, said the federal district court in Florida, which is open 24 hours a day, had already been informed that a petition would be filed as soon as the president signs the measure - with the presumption a judge will order that the tube be replaced.

“Time is not on Terri Schiavo’s side,” DeLay said. “The few remaining objecting House Democrats have so far cost Mrs. Schiavo two meals already today.”

Even though the legislation would pave an avenue for federal jurisdiction in the legal case, there was no way to determine in advance how or when a judge would rule — or even which judge would be assigned the case by lottery.

Lawmakers who left Washington Friday for the two-week Easter recess had to make abrupt changes in plans, backtracking for a dramatic and politically contentious vote.

In a special session Sunday afternoon, Democrats refused to allow the bill to be passed without a roll-call vote.

The delay on Capitol Hill was blasted by Schiavo’s parents, who spoke with reporters outside their daughter’s hospice in Pinellas Park, Fla. “There are some congressmen that are trying to stop this bill,” said Terri’s mother, Mary Schindler. “Please don’t use my daughter’s suffering for your own personal agenda.”

Among those in Congress fighting against restoration of the feeding tube is Rep. Bob Wexler, D-Florida. “It is not the place of Congress, at the 11th hour, in the most effusive fashion, to undermine the Florida court system, particularly given the fact that it has been seven years and 19 judges who have participated,” Wexler said.

“We are seeing, sadly, the manifestation of a constitutional crisis,” said Rep. Barney Frank, D-Mass. “You will have hundreds of members of Congress making a medical decision about which we know nothing.”

Schiavo, 41, collapsed under disputed circumstances Feb. 25, 1990, suffering severe brain damage when her heart stopped momentarily. Her husband, Michael Schiavo, attributes the collapse to an eating disorder, but the Schindlers strongly suspect he tried to strangle her.

The Schindlers have pleaded with Michael Schiavo to divorce their daughter, pointing out his live-in relationship with another woman, with whom he has two children.

“It’s not about me, it’s not about Congress, it’s about Terri,” Michael Schiavo said Friday on CNN’s “Larry King Live” program.

“I want you all to think about going through a judicial process to have your own wishes granted and then the Congress and the government walking in on that because of their personal views. That’s absurd.”

Michael Schiavo has maintained Terri had no desire to live under her current medical conditions, though there was no written corroboration of that.

“As millions of Americans observe the beginning of Holy Week this Palm Sunday we are reminded that every life has purpose and none is without meaning,” said House Judiciary Committee Chairman James Sensenbrenner, R-Wis., a leader in crafting the bill.

The House has 232 Republicans, 202 Democrats and one independent.

The legislation would give Schiavo’s parents the right to file suit in federal court over the withdrawal of food and medical treatment needed to sustain the life of their daughter.

It says the court, after determining the merits of the suit, “shall issue such declaratory and injunctive relief as may be necessary to protect the rights” of the woman. Injunctive relief in this case could mean the reinserting of feeding tubes.

“It gives Terri Schiavo another chance,” Senate Majority Leader Bill Frist, R-Tenn., said after the late-afternoon voice vote in a near-empty Senate chamber. “It guarantees a process to help Terri, but does not guarantee a particular outcome.”

Frist also noted that the bill, responding to some Democratic objections, does not affect state assisted suicide laws or serve as a precedent for future legislation.

The White House made arrangements for Bush to sign the measure at any hour, although without fanfare.

Rep. Chris Smith, R-N.J., said members scattered across the globe were being summoned back to Washington by aides to House Majority Whip Roy Blunt, R-Mo.

The Democratic whip, Rep. Steny Hoyer, D-Md., said his office was informing members of the vote and not discouraging them from returning to the capital. But he said the party was not counting votes and was telling members to vote their conscience on the issue.

House and Senate committees at the end of the week issued subpoenas seeking to force the continuation of treatment, but that move was rejected by a Florida court.

Republicans distanced themselves from a memo suggesting GOP lawmakers could use the case to appeal to Christian conservative voters and to force Democrats into a difficult vote. DeLay said he and other GOP leaders hadn’t seen the memo and that he would fire any staffer who wrote such a document.

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Majority of Americans Oppose Forced Starvation, Poll Finds (Christian Post, 050407)

The majority of Americans are not in favor of denying food and water to terminally ill patients with no written directive, according to a poll taken after Terri Schiavo’s death.

The poll, conducted by Zogby International on behalf of the Christian Defense Coalition, found that 80% of likely voters believe a disabled person who is not terminally ill or in a coma, has no written directive, and is not dependent on life support, should not be denied food and water.

The same poll also found that a majority of Americans believe Schiavo’s husband Michael should have “turned legal guardianship for the severely-disabled woman over to her parents based on his decision to have a long-term serious relationship with another woman,” according to Zogby.

The results from the March 30 to April 2 poll stand in contrast from what several unofficial polls found last month while the battle over Terri Schiavo’s fate was at its height.

Meanwhile, likely voters in the survey were closely divided on a number of other critical issues pertaining to the Schiavo battle.

When asked if it is proper for federal officials to intervene when disabled people are denied food and water by a state court judge, respondents were deadlocked, with 44% favoring such intervention, and 43% opposed.

Zogby International conducted interviews of 1019 likely voters nationwide from their headquarters in Utica, N.Y. The margin of error is +/-3.2%age points, according to the group. Slight weights were added to region, party, age, race, religion, and gender to more accurately reflect the voting population. Margins of error are higher in sub-groups.

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Schiavo-like woman speaks after 2½ years (WorldNetDaily, 050513)

Doctor: ‘I have never seen this happen in my career’

A Kansas woman severely brain-injured after an accident in 2002 has begun speaking – to the amazement of her doctor.

On Sept. 3, 2002, Tracy Gaskill suffered critical internal and head injuries when her pickup overturned. Doctors told her relatives that night that she probably would die by noon the next day, her grandfather, Don Gaskill, told the Ark City Traveler.

“That accident scared us to death,” Gaskill said. Both Gaskill and his granddaughter hail from rural Winfield, Kan.

According to the report, the Gaskill family and many others in the Cowley County community prayed for Tracy regularly since the accident, and she had daily visits.

Not only did Tracy live beyond the day after the accident, she gradually began to improve.

Then, about three weeks ago, she spoke for the first time since the accident, about the same time she began to swallow on her own.

Previous to that she was fed via a feeding tube, similar to Floridian Terri Schiavo, who died in March of starvation and dehydration after the court-ordered removal of her nourishment.

“It’s amazing, isn’t it?” Dr. David Schmeidler told the local paper. “I have never seen this happen in my career. I’ve read about it happening, the severely brain damaged recovering suddenly, but never seen it – until now.”

Continued Schmeidler: “She is actually able to speak and to speak coherently. In light of all this stuff on Terri Schiavo ... it makes you pause and think. For three years or so, (Tracy) was fed through a tube, then she swallowed a little bit and now she speaks.”

Lynda Marshall is a registered nurse who has worked with Tracy.

“It’s really quite amazing (that Tracy can speak),” she told the Traveler. “After they’ve been without speech and the ability to eat that long, it’s very rare they’re able to come back.”

Marshall said Tracy will get speech therapy, continue working on improving cognitive functions and eat on her own.

Tracy received what Schiavo did not – at least in the last several years – therapy.

According to the report, in the last few months, nurses worked with her to get her to hum. Eventually, she started to speak clearly.

Asked how old she was, Tracy reportedly answered, “Twenty-nine.”

“You’re 30,” her grandfather corrected her. “Remember, you had another birthday.”

Last week, it was reported Donald Herbert awoke from a coma and spoke for the first time in 10 years. A Buffalo, N.Y., firefighter, Herbert was severely brain injured while fighting a fire in 1995.

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Staying Alive (American Spectator, 050517)

If you’re still planning to see the Oscar-winning film “Million Dollar Baby” and don’t know the ending — go to the next column now! I’m giving it away. Maggie, played by Hilary Swank, takes a massive blow in the boxing ring and is left a quadriplegic on a respirator. After she repeatedly pleads to her crusty (but loving) aging manager Clint Eastwood to be allowed to die he finally complies both by “pulling the plug” and giving her a lethal dose of adrenaline.

Disability advocates claim the intent was to send a pro-euthanasia message. Certainly by law Swank could have simply asked her doctor to take her off life support. Instead, Eastwood’s character breaks the law in bypassing the doctor and changing the action from passive to active. That does sound like a message.

“It was a cheap manipulation of the worst stereotypes of disability to get the audience to sign on to the idea that killing was the only real solution to the problem the disability presented,” says research analyst Steven Drake of the disability rights group Not Dead Yet. “Let’s face it,” says Marcie Roth, executive director of the National Spinal Cord Injury Association, “the message of the movie was: ‘Better dead than disabled.’”

It also did not please these people that the best foreign-film Oscar went to The Sea Inside, about a quadriplegic who fought for decades to legally commit suicide. “Both of the best picture awards went to killing cripples,” says Drake incredulously.

John Kelly of Boston calls the film “a lie.” He’s not a film critic, but he knows something about the subject. “When I was 21 I was sledding on a piece of cardboard down a hill and a tree jumped up in front,” he told me. He’s now paralyzed from the neck down. “I’m everybody’s worst nightmare,” he says chuckling.

Now 41, Kelly is one of the approximately 11,000 new spinal cord injuries in the U.S. each year. Of these, about a fifth lead to what’s medically called “complete tetraplegia” or more commonly “quadriplegia.” But technology continually makes it easier for such persons to lead enjoyable and productive lives.

Mobility is vital, and at a single website you can find 55 different models of power wheelchairs, the descriptions of which sound like sports car reviews. They discuss horsepower, speed, turning radius, how high an object they can surmount. One has “Six wheels on the ground [to] provide superior stability and a smoother ride,” while another has tank-like treads for off-road driving. The iBOT, from the designer of the Segway Human Transporter, climbs and descends stairs.

Communication is also vital, aided now by tremendously improved voice-activated software. With it you can write books, surf the web, answer or dial the phone, and — O, joy! — even pay bills. Voice-activated e-mail allows quadriplegics the same opportunity to read and write letters and receive spam as the rest of us.

All of these technologies were either invented or vastly improved since Christopher Reeve’s accident. Moving higher up the tech ladder, new “functional electrical stimulation” (FES) devices implanted in the body can restore some hand movement and allow those with spinal cord injury (SCI) to feed themselves.

Just ten years ago, the chief causes of death of those with SCI were bladder infections and bowel complications. But FES devices can help control the functions of both organs, such that now the major cause of death in SCI persons is heart disease just as with the general population. Maggie could have used one of the new stimulation devices that assist with breathing, freeing many quadriplegics from the ventilator.

We’ve also greatly improved our knowledge of physical rehabilitation for recently-injured persons. “If I could have talked to Maggie,” says Kelly, “I’d say ‘We’re going to take you to a real rehab center with other people with spinal cord injuries and a gung-ho staff to help with physical therapy as well as being able to treat your depression.”

Those who work with the disabled talk guardedly about “a cure.” Research showing partial regeneration of injured rodent spines from adult stem cells goes back a decade, and is now undergoing human testing. Others have used mature Schwann cells from the brain to regenerate animal spinal tissue.

Yet for anybody who hasn’t been recently injured, even complete spinal regeneration would require tremendous rehabilitation to get atrophied body parts moving again. Roth thinks many SCI patients wouldn’t find it worthwhile. “These people have grown accustomed to their lives and many wouldn’t want to change them,” she says.

After his accident, Kelly got a master’s degree in sociology at Brandeis University. “I can do lights, appliances, air conditioning, make phone calls, control the television.” He says, “Sometimes I watch TV and work on the computer at one time like any multitasking American and it’s fun! I go shopping like anybody else. I really enjoy cooking. I enjoy music and can control my stereo (a jukebox-type variety that holds hundreds of CDs) with my wheelchair.”

Adds Kelly, “It’s annoying to have to say my life is good in order for people to stop thinking I’d be better off dead. But I love my life and everything in it,” he says.

Maggie might have ended up feeling the same way — if only the script hadn’t killed her off.

Michael Fumento (mfumento@pobox.com) is author of BioEvolution: How Biotechnology is Changing Our World, a fellow at Hudson Institute, and a nationally syndicated columnist with Scripps Howard News Service.

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The Culture of Death – Looking Back at Terri Schiavo (Christian Post, 050613)

Public controversies tend to dissipate over time, and front-page news stories have a relatively brief shelf life. Given the pace of contemporary life, events come and go with a mind-numbing rapidity, and today’s front-page news may be quickly forgotten.

Cultural forgetfulness comes with considerable risk — especially when issues of grave moral importance are concerned. Terri Schiavo died just a few weeks ago and her death, along with the grave moral issues involved, have been largely forgotten.

Thankfully, this is not the case in all quarters. The dominant media culture has put its final stamp on the entire Schiavo affair, suggesting that all sides had “learned” from the controversy and casting Terri Schiavo’s situation in largely political terms. The cultural elite, increasingly comfortable with the idea of death on demand, largely celebrates the outcome of the controversy — Terri Schiavo’s death — as the triumph of enlightened legal process over backward moral concerns, largely rooted in “religious values.”

Within the medical community, Terri Schiavo’s death, brought about by the court-ordered removal of her feeding tube, becomes a platform for urging all patients to adopt “living wills” or “advance directives,” supposedly in order to avoid putting a family in such an excruciating situation.

Paul McHugh finds all this to be quite unsatisfactory. University Distinguished Service Professor of Psychiatry at Johns Hopkins University, McHugh revisits Terri Schiavo’s case and sees even deeper dangers. In “Annihilating Terri Schiavo,” published in the June 2005 issue of Commentary, McHugh argues that public attention was largely diverted from the opinions, experience, and judgment of doctors and nurses “who customarily provide care to patients like Terri Schiavo.” Accordingly, “few people appear to have grasped that the way she died was most unusual. That, instead, it has been widely understood to be not only a proper but also a perfectly commonsensical way to die, a way approved of by most doctors and nurses, can only be explained by a deep change that has taken place over the last decades in our thinking about how to care for the helpless and disabled among us.”

McHugh writes as both a medical doctor and an academic. In his article, he retraces the most important developments related to Terri Schiavo’s condition, beginning with her cardiac arrest in 1990. He acknowledges that this medical emergency caused Terri to emerge from a coma “into an impaired state of consciousness.” As Dr. McHugh reminds us, Terri Schiavo “could swallow, breath, sleep, and awaken without assistance, and could react to sudden sounds with a glance, or to pain by grimacing or groaning. But she was apathetic to inner needs and external events. She was mute, mostly immobile, incontinent, psychologically blank.”

The precise nature of Terri Schiavo’s mental condition has been a matter of ongoing controversy. Based on his clinical experience, Dr. McHugh appears to accept the diagnosis that Terri Schiavo was properly described as being in a “persistent vegetative state” [PVS]. As he explains, “This diagnostic category encompasses individuals with cerebral diseases of various kinds who, though only dimly wakeful, retain the life-sustaining functions of respiration, blood circulation, and metabolic integrity.”

McHugh also explains that the metaphor of vegetation (contrasted with animation) is awkward at best. He recalls teasing the “admirable clinician” who invented the term by stating that “I had seen many patients but few carrots sleeping, waking, grunting, or flinching from pain.” The term “vegetative” can mislead, having “the unfortunate effect of suggesting that there is something less worthy about those in this condition.”

Next, Dr. McHugh establishes a very important matter of medical fact. A persistent vegetative state [PVS] “is not death hidden by machinery,” he insists. “It is human life under altered neurological circumstances. And this distinction makes all the difference in how doctors and nurses think about it and treat its sufferers.”

The following paragraph in Dr. McHugh’s essay is especially important: “The phrase ‘life under altered circumstances’ encompasses every human sickness and disability. It also speaks to what is entailed in the professional art of medicine — the art, that is, of identifying, differentiating, curing, rehabilitating, defending, and, in the words of the Hippocratic oath, ‘benefiting’ the sick. Given that doctors and nurses naturally align themselves with life, and are trained to care for whatever life brings, including ‘life under altered neurological circumstances,’ it is only to be expected that they would reject and shrink from actions that aim to kill. Exactly how they come to that civilizing point of view in their training to become doctors and nurses is a story unto itself.”

Dr. McHugh is on to something of incredible importance here. He is concerned that the public has misperceived Terri Schiavo’s situation, and thus has misunderstood both the moral and medical aspects of her case. He takes his readers into the context of the hospice, where “doctors, nurses, social workers, and physiotherapists” work together to “develop a plan to care for someone in an incurable and usually terminal phase of life.” Customarily there are no ventilators or cardiac monitors at a patient’s bedside in a hospice “because there is no plan to transfer the patient to an acute treatment center for respiratory or cardiac support.”

“The overarching principle that hospice doctors and nurses strive to represent and exemplify,” McHugh explains, “is never to betray a patient to death, or to act directly to kill. They may help a patient surrender to death, by forgoing active medical procedures when these provided nothing but empty time and extend the period of suffering. And their particular judgments in this regard may well be challenged as ambiguous — or even arbitrary — by those with a legal mind or an ax to grind. But those judgments are usually clear to everyone working in a hospice, just as the distinction between betrayal and surrender is clear in other situations in life.”

For Terri Schiavo, this was a context for disaster. Given the conflict and disagreement between family members, Terri’s life was transformed into a legal question and thrown into the mechanism of the courts.

Dr. McHugh, looking back at the controversy, understands that, once Terri Schiavo’s case was transferred to the disposition of the law courts, “the concept of ‘life under altered circumstances’ went by the boards — and so, necessarily, did any consideration of how to serve such life. Both have been trumped by the concept of ‘life unworthy of life,’ and how to end it.”

That is a truly ominous assessment — and it is accurate. Once Terri Schiavo’s case became a matter of legal combat, the entire question was transformed from a framework of responsibility to serving and respecting Terri’s life and medical condition, to a question of how her life would be ended.

In citing his case, Dr. McHugh returns to Germany, where the phrase, ‘life unworthy of life’ emerged. A book published in Germany in 1920, coauthored by a lawyer and a psychiatrist, took as its title, Lifting Constraint from the Annihilation of Life Unworthy of Life. “Terri Schiavo’s husband and his clinical and legal advisors, believing that hers was now a life unworthy of life, sought, and achieved, its annihilation. Claiming to respect her undocumented wish not to live dependently, they were willing to have her suffer pain and, by specific force of law, to block her caregivers from offering her oral feedings of the kind provided to all terminal patients in a hospice — even to the point of prohibiting mouth-soothing ice chips. Everything else flowed from there.”

Looking back to Nazi Germany offers a point of historical reference, but Dr. McHugh argues that “we in this country have our own, home-grown culture of death, whose face is legal and moral and benignly individualistic rather than authoritarian and pseudo-scientific. It has many roots, which would require a long historical treatise to unravel, with obligatory chapters considering such chapters as the growth of life-sustaining and life-extending technologies and the dilemmas they bring, the increasingly assertive deprecation of medical expertise and the understanding of patients’ ‘autonomous’ decision-making, the explosion of rights-related personal law and the associated explosion in medical-malpractice suits, and much else besides.” Much else indeed.

All this has spawned a new discipline, known as bioethics. Dr. McHugh sees this as a disastrous development. For the field of bioethics was largely co-opted by theorists who opposed the “aims” of doctors with the “rights” of patients. He sees the development of “Do Not Recessitate” [DNR] and so-called “living wills” as “signposts of our own culture of death.” These documents do not help, Dr. McHugh explains, because they cannot replace the actual judgments made by caring doctors and nurses within the context of a specific medical situation. “To most doctors and nurses, in any case, the idea that one can control the manner and pace of one’s dying is largely a fantasy,” Dr. McHugh asserts. “They have seen what they have seen, and what they know is that at the crucial moments in this process, no document on earth can substitute for the one-on-one judgment, fallible as it may ultimately be, of a sensible, humane, and experienced physician.”

Thus, modern bioethics “has become a natural ally of the culture of death,” rationalizing excruciating medical dilemmas and negotiating the value of human life in an inevitably downward spiral.

In the end, Dr. McHugh argues that in Terri Schiavo’s case, the culture of death “won out over the hospice’s culture of life, overwhelming by legal means, and by the force of advanced social opinion, the moral and medical command to choose life, to comfort the afflicted, and to teach others how to do the same.”

Dr. McHugh’s conclusion is truly ominous. “The more this culture continues to influence our thinking, the deeper are likely to become the divisions within our society and within our families, the more hardened our hatreds, and the more manifold our fears. More of us will die prematurely; some of us will be persuaded that we want to.”

Premature death, and the desire for the rationalization of death, are hallmarks of a culture flirting with moral disaster. We are indebted to Dr. Paul McHugh for his medical analysis and moral courage. The real question is what we are now prepared to do in confronting the culture of death. Now that Terri Schiavo is dead, most Americans have moved on to other concerns. Who will be next?

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R. Albert Mohler, Jr. is president of The Southern Baptist Theological Seminary in Louisville, Kentucky.

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England Faith Leaders Lobby Parliament Against Euthanasia (Christian Post, 051010)

Major faith groups in the United Kingdom published a joint letter to both Houses of Parliament on Friday in a bid to lobby against legalizing any forms of euthanasia ahead of this week’s debate on the proposed Assisted Dying for the Terminally Ill Bill in the House of Lords.

“We, the undersigned, hold all human life to be sacred and worthy of the utmost respect and note with concern that repeated attempts are being made to persuade Parliament to change the law on intentional killing so as to allow assisted suicide and voluntary euthanasia for those who are terminally ill,” the letter read, according to the Church of England.

Nine leading figures from the six major faith groups in the U.K., representing millions of adherents, addressed all Members of Parliament and of the House of Lords concerning the moral crisis over such legislation.

The leaders include General Director of Evangelical Alliance UK Joel Edwards, Archbishop of Cardiff of the Catholic Church in Great Britain Peter Smith, Bishop of Southwark of the Church of England the Rev. Tom Butler, His Eminence Archbishop Gregorios of Thyateira and Great Britain, the Chief Rabbi Sir Jonathan Sacks, Principal Muslim College and Chair Muslim Law Sharia Council Sheikh Dr M.A. Zaki Badawi and among others.

As the vulnerable people – the elderly, lonely, sick or distressed – often easily feel that they are the burden of their friends and families, the religious leaders were concerned that legalizing assisted suicide and euthanasia may inevitably pose pressure on these people to request early death.

The religious leaders warned the Parliament, stating in the letter that “the so-called ‘right to die’ would inexorably become the duty to die and potentially economic pressures and convenience would come to dominate decision-making.”

“Assisted suicide and euthanasia will radically change the social air we all breathe by severely undermining respect for life,” they stated.

As the pro-euthanasia argued that assisted suicide is necessary to ease the sufferings of the terminally ill, the religious leaders reaffirm in the letter that palliative care should be the real solution.

“Palliative care is advancing very rapidly both in relieving the spectrum of suffering experienced by those with a terminal illness, and in supporting their families,” the leaders explained.

Acknowledging that palliative care service is very unevenly distributed around the country, the leaders suggested a reprioritization of NHS resources in order to ensure that adequate training is given to doctors and nurses and that centers of specialist palliative care exist where they can be accessed by those who need them.

In addition, the leaders noted that countries which have legalized assisted suicide or euthanasia are experiencing serious problems in case of abuse of the law.

It is stated in the letter, “In Holland 1 in every 32 deaths arises from legal or illegal euthanasia: a similar law here could lead to some 13,000 deaths a year.” Most recently, Holland has even been planning on further relaxation of the law to allow infant euthanasia.

Furthermore, in the U.K., more medical professionals have realized the crisis of legalizing assisted suicide or euthanasia. The religious leaders said recent surveys show only 22-38% of doctors are in favor of a change in the law.

Meanwhile, the leading Christian charity CARE (Christian Action Research and Education) is launching a high-profile campaign to tackle the threat of euthanasia in the U.K.

The “Life Valued” campaign of CARE aims to motivate Christians and churches to take actions against the controversial euthanasia bill. CARE has joined disability charity, Through the Roof, established by U.S. campaigner Joni Eareckson Tada.

Tada is a leading disability advocate and campaigner against euthanasia and abortion in the U.S. state of California. Since she was paralyzed following a diving accident in 1967, she has written over 30 books on her faith and disability issues which have sold well in Christian bookshops in the U.K. and America for several decades.

CARE chairman Lyndon Bowring will be holding a series of public meetings across the U.K. in collaboration with Tada to address the euthanasia issue.

“We hope the public meetings will be a huge success,” said Bowring. “Joni is one of the most outstanding spokespersons worldwide, and a great ambassador for proclaiming the truth – that life is sacred and we are all special in the sight of God. She has been fearless in challenging abortion and euthanasia.”

The uprising campaigns against euthanasia in Britain come recently as a Select Committee of the House of the Lords is due to debate on the bill by Oct. 10.

The bill has been approved by the House of Lords at the second reading, on which it was agreed that the legislation and surrounding issues would be further considered by a special Select Committee of the House of Lords. The Committee, which took evidence between September 2004 and February 2005, was chaired by Lord Mackay of Clashfern and included members both supporting and opposing euthanasia.

The Assisted Dying for the Terminally Ill Bill was introduced by Lord Joffe in March 2004. This Bill was intended to “enable a competent adult who is suffering unbearably as a result of terminal illness to receive medical assistance to die at his own considered and persistent request,” or simply to introduce voluntary euthanasia.

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European Evangelicals Condemn ‘Neutral’ Stance on Euthanasia (Christian Post, 050704)

The Evangelical Alliance UK (EAUK) and a number of Christian and pro-life groups and charities have strongly condemned the decisions by the British Medical Association (BMA) to vote in favour to adopt a ‘neutral’ stance in the issue of euthanasia during the BMA’s conference held on 30th July 2005.

A release by the EAUK stated, “The Evangelical Alliance deeply regrets the BMA’s announcement of its amended position with regard to euthanasia and also to abortion.”

The protest comes about from the leading Evangelical group in the UK, who commented, “The physicians’ Hippocratic oath requires doctors to save and preserve life, so their unwillingness to support a reduction in the abortion limit and to become neutral rather than remain opposed to euthanasia is deeply worrying and inconsistent.”

The EAUK statement continued, “Looking first at abortion, advances in science have convincingly shown that a foetus is a sentient human being much earlier than previously thought. The BMA’s refusal to accept such evidence and press for a reduction in the 24-week abortion limit is very disappointing.”

The calls by the Evangelical Alliance has been backed by Roger Smith, the Head of Public Policy for CARE said: “It is deeply disappointing that the BMA has shifted its stance from outright opposition to neutral on the question of euthanasia.”

“It fails to take responsibility for the massive change in the relationship between doctor and patient that would follow any change in the law on homicide.”

CARE is the well-established mainstream Christian charity, which seeks to combine practical caring initiatives with public policy on social and ethical issues. It aims to bring Christian insight into all parts of society and one of the concerns is the issue of bioethics.

Dr Don Horrocks, who is the Head of Public Affairs at the Evangelical Alliance UK said, “the same time the BMA seems to be opting out of the debate on assisted dying and passing the decision on this issue to politicians, thus appearing to pave the way for the re-introduction of Lord Joffe’s Bill later this year. Euthanasia is consequently portrayed as a humane act especially to many elderly people and those suffering terminal illnesses as well as for their family and friends. But the long-term implications for society in legalising, assisting and encouraging assisted suicide are immense. We should be caring for the most vulnerable people in our society, whatever the cost, and stressing the alternatives to killing.”

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Daughter ‘shocked’ by dad’s pro-death caregivers: Attitude shift follows $200 million campaign to ‘transform the culture of dying’ (WorldNetDaily, 051117)

The daughter of a nursing home patient, who recently died under “suspicious” circumstances, mourns not only her father but her lost faith and trust in a health-care system she considers complicit in his death.

“One thing that has shocked me throughout this ordeal is the number of health-care ‘professionals’ that seem to major on killing rather than healing,” Deanna Potter told WND. “It’s truly frightening to think that these are people charged with overseeing health care for very old and very sick human beings.”

Potter is one of five surviving children of Jimmy Chambers, who suffocated in the early morning hours of Oct. 24 after his tracheotomy tubes became unhooked and the nursing home staff did not respond to alarms that should have sounded and attempt resuscitation. Potter and her siblings have requested an investigation by South Carolina authorities.

WorldNetDaily exclusively reported Chambers’ death came amid a bitter familial dispute over whether to keep the 79-year-old paraplegic man connected to the ventilator he had relied on since suffering a broken back and spinal chord injury during an Aug. 20 riding-lawnmower accident.

Viola Chambers asserted her husband of 58 years, who signed a living will in Iowa in 1990, did not want to be kept alive by artificial means. But 10 other family members – including four of the five children – and his initial treating physician, Dr. Kenneth Bookman, signed sworn statements that Chambers himself indicated he wanted to stay on the ventilator, receive rehabilitative therapy and live. They say he communicated this by nodding his head “yes” and “no” to questions put to him during a Sept. 8 family meeting witnessed by 13 people in his Naples, Fla., hospital room.

“He was asked specifically if he wanted to stay on the ventilator and his answer was ‘yes,’” wrote Bookman in a notarized letter documenting the event, a copy of which was supplied to WND. “He was asked if he understood that he would likely never go home again, and would likely live in a ventilator facility, on the ventilator, for the rest of his life and his answer was ‘yes.’”

According to Bookman, Chambers was off of sedation and aware enough to comprehend and make decisions regarding life support. Bookman and the 10 family members considered Chambers’ living will revoked.

Yet, the life and death tug-of-war continued after Chambers was transferred to Anne Maria Rehabilitation and Nursing Center in North Augusta, S.C., in late September. Viola Chambers made the staff and new treating physician, Dr. Nicholas Sanito, aware of the living will and obtained Sanito’s signature on a Do-Not-Resuscitate order, or DNR, according to documents filed with the local probate court.

Since Chambers had not designated a durable power of attorney, Mrs. Chambers was affirmed as his medical decision-maker by the South Carolina Long Term Care Ombudsman, the state agency charged with advocating on behalf of nursing home patients.

While Sanito found Chambers “awake, alert and interactive” and “trying to speak” during an examination on Sept. 26, according to the documents, Chambers was considered – although not formally declared – incapacitated. Potter asserts her mother requested morphine and ativan be dispensed to her father in such a way that he was infrequently sober enough to communicate and ordered the removal of all communication devices from his room, including his nurse call button.

According to Potter, her mother also ordered her husband not be given antibiotics for pneumonia, from which he suffered for two weeks before a court-appointed guardian ad litem intervened.

Viola Chambers repeatedly declined comment to WND. Nursing home administrator Marcy Drewry also declined to comment.

“What was so shocking to me was how determined my mother was that he should die,” said Potter. “She could see how responsive he was. But she had made up her mind … after his back surgery and there was no backing her down. There must be a spirit of death that overtakes people’s minds. I just don’t understand it at all.”

According to Potter, many of her father’s caregivers also appeared driven to end his life.

“One of the nurses who caused the most trouble for my dad was my mother’s favorite nurse at the hospital. She would come into the room and tell her that my father’s ‘not in there.’ ‘He’s not capable of making decisions.’ ‘He’s not aware. He’s not thinking. He’s not able to think.’ She would say the most horrible things,” said Potter. “I finally had her removed from the case. I finally told the social worker at the hospital, ‘If I see her in this room I will physically remove her myself.’ So they removed her.”

“One of the doctors also said, ‘If this was my father, I wouldn’t let him go on.’ Well, golly. I just don’t understand that,” she continued.

Hospice watchdog Ron Panzer with the Hospice Patients Alliance frequently hears this same complaint from relatives of nursing home and hospice patients across the country. He sees a utilitarian flavor of secular bioethics permeating decision making and actual practice within the medical community.

“The medical system is not so interested as it used to be on caring for the medically complex patients. They’re dumping them into hospice rather than maintaining them and trying to save them,” Panzer told WND. “The utilitarian approach is, ‘Well, you’re using too many dollars. You’re too expensive to care for. ... You’re better off dead.”

A recent national survey found nearly two-thirds of physicians support physician-assisted suicide.

The e-survey of 677 practicing physicians, conducted by HCD Research last month, found 62% believe they should be permitted to dispense life-ending prescriptions to “terminally ill patients who have made the decision to die due to unbearable suffering,” according to the marketing and advertising research company’s press release, which was virtually reprinted in the current editions of Mental Health Weekly, Health & Medicine Week, Biotech Business Week, Science Letter, Pharma Law Weekly, Life Science Weekly, Physician Law Weekly, Biotech Week, Obesity, Fitness & Wellness and Health Insurance Law.

Glenn Kessler, managing partner of HCD Research, told WND the survey was not commissioned, but done by the company as a public relations effort. The results were sent to the firm’s clients, who are pharmaceutical companies. Kessler readily admits he’s a “bleeding heart liberal Democrat,” but told WND the company doesn’t really care about the results of their polls.

“Although the high percentage of physicians who support the ability to prescribe such medications may be somewhat surprising, I believe it is the result of physicians’ personal relationships with their patients and the desire to act in the best interest of each patient,” Dr. Craig Alter, a specialist in the Pediatric Endocrinology Division of The Children’s Hospital of Philadelphia, is quoted as saying in the press release.

The attitude shift from always treating medically complex patients to embracing and, often, hastening their deaths also comes as a result of a decade-long campaign by leaders in the hospice industry and right-to-die advocates, funded by the Robert Wood Johnson Foundation and George Soros’ Project on Death in America. As WorldNetDaily reported, Soros’s PDIA and the RWJF invested nearly $200 million throughout the 1990s with the goal of “transforming the culture of dying.”

The initiative to promote palliative care and utilization of hospice succeeded in altering medical textbooks and curricula at medical and nursing schools across the country, as well as changing state laws to recognize and enforce the use of advance directives and DNRs.

What’s called the “third path” between pain and assisted suicide has become the generally accepted protocol within the health-care system. The “third path” involves hastening death through the removal of life-sustaining medical procedures and treatment – including assisted feeding, antibiotics and oral hydration and nutrition – accompanied by heavy, and sometimes terminal, sedation. While it may be appropriate for terminally ill patients suffering intractable physical pain and in the end stage of disease, Panzer and other critics view this “third path” as a backdoor to euthanasia for non-terminal individuals, like Terri Schiavo.

A WND analysis of the language used in the living wills approved by legislators in nearly half the states indicates they appear solely created for the purpose of supporting the “third path” protocol. Many states like Illinois, Iowa, New York, Rhode Island, Virginia and Washington articulate an aversion to “prolonging the death process” without requiring the patient actually be dying.

Only four states, Alabama, Idaho, Oklahoma and Tennessee, specifically call for patients to be “terminally ill” before their advance directive gets executed. Most other states instead reference a “terminal condition” or “incurable or irreversible condition,” which critics contend gives wide latitude to physicians and caregivers in hastening death.

The Iowa living will Chambers signed states that should he have an “incurable or irreversible condition that will result either in death within a relatively short period of time or a permanent state of unconsciousness” it was his desire that his life not be prolonged by the administration of life-sustaining procedures.

Death was not considered imminent, however. And when Chambers was taken off the morphine and ativan days before he died, nurses and family members – including Viola Chambers – found him conscious. The last time Deanna Potter saw her dad alive he blew her a kiss and reaffirmed his will to live and pursue therapy with a “big smile” and a thumb’s up. He died approximately 10 hours later.

“I want it to be made plain what happened to him. I want it to be made plain what a strong, determined man he was and how he wanted to live,” Potter told WND. “And the greatest injustice in my mind was that ... all the people around him were determined to deny him that right.”

Diana Lynne’s powerful, comprehensive book on Terri Schiavo’s life and death, entitled “Terri’s Story: The Court-Ordered Death of an American Woman.” is available at WorldNetDaily’s online store.

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Supreme Court Upholds Oregon Assisted Suicide Law (Christian Post, 060117)

The Supreme Court upheld an Oregon assisted suicide law today, stating that the federal government could not prohibit Oregon doctors from performing assisted suicides with federally controlled drugs.

In a 6-3 vote, the Justices ruled that a 1997 law, which has permitted the deaths of over 200 patients, can be upheld. Former Attorney General John Ashcroft had sued Oregon, claiming that using federally controlled drugs for euthanasia lacked a “legitimate medical purpose.”

The law only covers extremely sick patients.

The case Gonzales v. Oregon, which bears the name of the current Attorney General Alberto Gonzales, tested the limits of federal authority in enforcing drug laws.

Justice Anthony Kennedy, writing the opinion for the majority stated that the federal government can enforce laws against drug dealers and pass rules for insuring health and safety.

However he also said that the authority desired by the government was “inconsistent with the design of the statute in other fundamental respects. The attorney general does not have the sole delegated authority under law.”

The six judges in the majority were Kennedy, Sandra Day O’Connor, John Paul Stevens, David Souter, Ruth Bader Ginsburg, and Stephen Breyer.

The dissenting justices were Chief Justice John Roberts, and Justices Clarence Thomas and Antonin Scalia.

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Chile’s socialist president-elect wins praise (National Post, 060117)

President-elect Michelle Bachelet speaks in Santiago, Chile, Monday, Jan. 16, 2006. Bachelet, the first woman to be elected president in Chile, won 53 per cent of the vote in Sunday’s runoff. (AP Photo/Santiago Llanquin)

SANTIAGO, Chile — President-elect Michelle Bachelet, a socialist who was jailed and tortured by Chile’s military junta, began putting together her administration Monday while promising to give all Chileans a voice and a better deal.

“Because I was the victim of hatred, I have dedicated my life to reverse that hatred and turn it into understanding, tolerance and - why not say it - into love,” she said after her victory in Sunday’s runoff election against a conservative businessman.

Bachelet, the first woman president in this socially conservative Roman Catholic country, promised “a new Chile that we will all build,” vowing a government that will listen to a broader range of voices and include a lot more women.

She has come to symbolize Chile’s reconciliation after the brutal divisions spawned by a bloody 1973 military coup and 17 years of dictatorship under Gen. Augusto Pinochet.

But she insisted Monday that she is tough enough to deal with hard-charging male colleagues, rejecting suggestions that coalition party leaders would largely name her cabinet.

“I will make the decisions. I was the one who was elected,” she said.

Bachelet won 53 per cent of the vote Sunday, against 46 per cent for right-leaning Sebastian Pinera, who made a fortune in the credit-card business.

As a 22-year-old medical student when Pinochet ousted socialist President Salvador Allende in 1973, Bachelet was arrested along with her mother and forced into five years of exile. Her father, an air force officer, opposed the coup and died in prison.

Francisco Javier Cardinal Errazuriz was part of a clerical delegation that met Monday with Bachelet, a self-described agnostic, and praised her for “overcoming hatred.”

“The success of Mrs. Bachelet would be the success of the entire country,” he said.

Bachelet, 54, is only the third woman directly elected president of a Latin American country and the first to do it without rising to prominence because of a husband.

She said she would not bring radical change to this country of 16 million people, pledging to “walk the same road” as the outgoing centre-left administration, whose free-market polices helped turn Chile’s economy into one of the region’s strongest.

Bachelet will have a stronger hand than her predecessor because Dec. 11 legislative elections gave her centre-left coalition control of a majority in both houses of Congress for the first time since it took power in 1990.

During the campaign, she promised to reform labour laws, improve public education, bolster health services and raise pensions. She also said that half of her cabinet will consist of women.

Bachelet still will face challenges as a female leader, said Patricio Navia, a political scientist at the Universidad Diego Portales.

“People will be harder on her, precisely because she is a woman,” he said. “She herself has recognized that she will have to work twice as hard to demonstrate that she is capable of governing the country.”

Bachelet, who campaigned in part on her reputation as a decisive defence minister, said Sunday that she is accustomed to adversity.

“I have not had an easy life,” she told thousands of cheering supporters.

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Assisted suicide notes (Washington Times, 060123)

The Supreme Court last week overturned former Attorney General John Ashcroft’s finding that dispensing opiates and barbiturates for assisting suicide violates federal drug regulations. Oregon’s “Death with Dignity” law stands.

The high court decision mostly revolved around technical issues involving state and federal jurisdiction. But some have speculated it may also lead to a renewed flurry of interest in other states in copying the Oregon law. Under that law, if two physicians agree a patient is of sound mind and likely to die of a terminal illness within six months, they may fulfill a request for a lethal narcotics dose after a 15-day wait.

Official Oregon statistics show there have been 208 such assisted suicides since the law was enacted in 1997. In California and Vermont, assisted suicide laws have been introduced in the legislature in recent years. And in the abstract, polls find assisted suicide is popular with the public.

But in the end, such proposals seem a tough sell. Oregon’s law was approved by a narrow 51% of the voters. An assisted suicide measure was defeated 51-49 in Maine in 2000. The Hawaii legislature initially approved and then killed a legalization bill despite all-out support from then-Gov. Ben Cayetano. And in Michigan, once Ground Zero of the assisted suicide movement, a 1998 referendum initially polled 72% approval but it lost by an astonishing 3-1 margin.

True, the situation in Michigan was doubtless colored by the, er, terminal weirdness of Jack Kevorkian, a pathologist who never actually practiced medicine. He talked often and openly of his crusade to use assisted suicide to harvest organs and research the dying process. There were pictures of him making house calls to local motels in his rusty Volkswagen with his death-dispensing apparatus. And the vast majority of his 170 or so “patients” were women, many disabled or suffering depression.

Ultimately Kevorkian was sentenced to a long prison sentence for his self-videotaped offing of a man with Lou Gehrig’s disease, shown on “60 Minutes.” He was denied parole late last year by Democratic Gov. Jennifer Granholm despite reports he himself is now terminally ill.

But it’s also possible the more people generally think about the issue, the less attractive they find physician-assisted suicide. High-toned chatter about “death with dignity” and “individual autonomy” notwithstanding, assisted suicide can be far messier than it seems from afar.

For one thing, there is that slippery phrase, “terminally ill.” Medical studies show predictions of imminent death, even by experienced physicians, are highly unreliable.

Then there is the Netherlands, world capital of assisted suicide and euthanasia, where physicians have been prosecuted for helping kill people who were merely “tired of life.” And in Oregon there have been reports of cancer specialists making terminal diagnoses of patients with neurological problems.

A far safer middle ground is a focus on improved pain control. Model guidelines were promulgated in 1998, but many physicians may not be aware of them or reluctant to prescribe high doses of narcotics for fear of inducing addiction. As the New York Times’ Jane Brody wrote recently, they may also worry about being busted by the Drug Enforcement Administration if the medicine falls into the wrong hands.

The high court may be right to leave the matter of assisted suicide to the states. But out in the states, most voters are smart enough to sense the legal and moral thickets surrounding assisted suicide. When it takes 12,000 words to explain a ballot proposal, as the Michigan assisted suicide referendum did in 1998, you tend not to be reassured — much less think the state has any business authorizing mere men and women to exercise the God-like powers of life and death.

Tom Bray is a Detroit News columnist.

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When society celebrates suicide (townhall.com, 060123)

by Suzanne Fields

“Assisted suicide” is both oxymoron and euphemism. Suicide is an intensely personal, individual and solitary act. The “assistant” does not put his life at stake. It more accurately ought to be called “state-sanctioned murder.” That’s where last week’s Supreme Court decision puts it (stripped of euphemism).

Just as there are doctors who won’t perform abortions, there are doctors who won’t “assist” in suicide. The Supreme Court majority said, with a certain delicacy, their decision was “a very narrow one” based on the right of Oregon to decide that doctors may write prescriptions for lethal pills for patients reckoned to be dying, and the federal government cannot deprive such “assistants” from writing prescriptions under the Controlled Substances Act. The dissenters — Chief Justice John Roberts and Associate Justices Antonin Scalia and Clarence Thomas — said such lethal “medicine” in their view does not serve a “legitimate medical purpose.”

The narrow technicality of the decision, however, does not go to the authentic heart(less) issue. The morality of care for the sick and aging in our society bears witness to how we see ourselves and the world we want our children to inhabit. How we answer this question tells us more about how we live than how we die, and tells us, literally, who cares.

We once depended on religion and laws of the spirit to determine how we put science and technology to use. That’s difficult today when secularism has been elevated to the status of religion, reality has become virtual, and technology drives our sensibilities about what it means to be human. Consider, for a moment, what some call, without irony, “nurturing technology.”

Sherry Turkle, a psychologist at Massachusetts Institute of Technology, studies the psychological and social impact of technology. She tells of something she watched at a Boston nursing home. An elderly woman, abandoned by a son who once visited her but no longer does, became miserable and depressed. Paro, the “therapeutic robot,” was assigned to visit the old woman in the son’s place. The robot makes “eye contact” with the woman and responds to her touch as she projects her feelings onto him. “Yes, you’re sad, aren’t you,” she tells Paro. “It’s tough out there. Yes, it’s hard.” She strokes Paro’s mechanical head, as if attempting to comfort herself by showing concern for Paro.

It’s not so far-fetched to imagine Paro as the future of nursing-home care for the abandoned old. We’re compelled to ask whether we will allow science and technology to trump the human touch. Children who grow up with closer relationships to a screen or a cell phone than to a human may as adults have a very disturbing idea of what it means to be emotionally caring for another person.

The Greeks thought it important to “know thyself,” to understand the relationship of humanity to the larger universe, but we may have to expand that to “know others” to develop more lasting human bonds. We have drugs already that can enhance physical and intellectual capabilities, ensure greater happiness with the release of endorphins, to extend life — and to end it. These advances aim to benefit mankind, but many move quickly into the mainstream (and bloodstream) merely to enhance selfish and narcissistic desires and wishes.

The ethics of “assisted suicide” lubricates the descent on that slippery slope, ever more dangerous as an increasingly geriatric society anticipates a crisis in long-term care. Relieving pain may not always be the only consideration in assisting another person’s death. A lingering illness makes it easier for an adult child to become callous in the face of an elder’s suffering. We value independence of body and mind, but in old age, interdependence is crucial. Assisted suicide is merely the tip of a titanic iceberg.

In an aging society, we require more wisdom than Yahoo, Jeeves and Mr. Google can find for us. The findings of the President’s Council on Bioethics rings with the eloquence of an Old Testament prophet and the savvy of New Age understanding in its report, “Taking Care,” about “caregiving” in an aging society: “We will need greater ethical reflection on what the young owe the old, what the old owe the young, and what we all owe one another. And we will need prudence in designing effective public policies and in making loving decisions at the bedside, so that we accept the limits of modern medicine and economic resources while never abandoning conscientious and compassionate human care.”

The newspaper stories about the Supreme Court’s assisted-suicide decision were accompanied by creepy photographs of the winning plaintiffs grinning in triumph, free at last to kill themselves with the blessings of the state. Considerably more ominous, I thought, than uplifting.

Suzanne Fields is a columnist with The Washington Times.

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Montreal mom who assisted suicide spared a jail term (CTV, 060127)

A Montreal woman who pleaded guilty to helping her playwright son kill himself was today sentenced to three years probation.

Marielle Houle, 60, pleaded guilty on Monday to assisting Charles Fariala commit suicide in 2004.

Fariala, 36, was suffering from the degenerative disease multiple sclerosis.

Houle’s lawyer, Salvatore Mascia, described her crime as an act of unconditional love for her son and asked that she serve a suspended sentence, given her fragile physical, mental and emotional health.

The Crown left sentencing up to the judge, saying that although Houle seemingly committed her crime out of compassion, Canada is not a society that tolerates euthanasia.

Assisting a suicide is a crime punishable by up to 14 years behind bars.

Suicide plan

Fariala, who was a nursing assistant as well as a playwright, told his mother he did not want to end up like some of his former patients — unable to speak, walk, control his limbs or bodily functions, bedridden and in pain.

He spoke many times of suicide after his multiple sclerosis was diagnosed in 2002.

After Fariala’s symptoms began to worsen in early 2004, he hatched a plan that ended with his death in September of that year.

Houle, following her son’s plan, helped him take a series of pills and placed a plastic bag over his head after he lost consciousness.

But she ignored the final part of his plan, which called for her escape, instead dialling 911 and confessing shortly after.

Police said when they arrived, Houle was in a state of shock and needed to be carried from the home in a stretcher.

She was reportedly traumatized after being arrested, charged and arraigned in court under the media spotlight.

She stopped going out, spends her days alone watching TV, and recently moved from her Montreal apartment to a nursing home.

In court Monday she sobbed uncontrollably when the circumstances of her son’s death were described.

Louis Morissette, a psychiatrist who examined her, said Houle is simply waiting to die but probably won’t take her own life.

“In a certain way, she died with him,” he told the court.

‘Tragic’

Diane Rivard, spokeswoman for the MS Society of Canada in Quebec, described Houle’s case as tragic and said she did not deserve a severe sentence.

“She is in a sort of prison for the rest of her life,” Rivard told The Canadian Press Friday.

Rivard said the case highlights the need for better home care and support for people diagnosed with incurable, but livable, diseases such as multiple sclerosis.

“We want people to know that after a diagnosis of MS there is still a good life, an active life,” she added.

Suicide debate

Fariala’s death has reignited a passionate debate in Canada that pits the rights of those who want to die with dignity against those who believe in the sanctity of the lives of the vulnerable and handicapped.

It’s a debate that has waned during the past decade, since Saskatchewan farmer Robert Latimer was tried and convicted of murdering his 12-year-old handicapped daughter Tracy in 1997.

Latimer said he killed his daughter, who was suffering from a severe form of cerebral palsy, to spare her pain from an upcoming surgery.

Latimer was sentenced to 10 years in prison.

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Save Haleigh (townhall.com, 060125)

by Michelle Malkin

I have a question for the hordes of bleeding-heart Hollywood stars who joined the “Save Tookie” brigade, who bowed their heads in prayer with ex-Crip gangster Snoop Dogg and the Rev. Jesse Jackson and pleaded to protect convicted Death Row murderer Stanley “Tookie” Williams, and who lobbied so hard for the government to err on the side of life.

Where are you now?

In Boston, an innocent girl was sentenced to death by the state. Her name is Haleigh Poutre. Last fall, she was hospitalized after her stepfather allegedly burned her and beat her unconscious with a baseball bat. Haleigh was kept alive by a feeding tube and ventilator. Doctors said she was “virtually brain dead.” They said she was in a “persistent vegetative state.” The medical professionals pronounced her “hopeless.”

Less than three weeks after Haleigh’s hospitalization, the Massachusetts Department of Social Services was raring to remove Haleigh’s feeding and breathing tubes. Even her biological mother (who had been deemed unfit to care for Haleigh and whose former boyfriend was accused of sexually abusing the child) wanted her to be put to death. The only person who wanted Haleigh alive was her stepfather, who will likely be charged with murder if Haleigh dies.

Earlier this month, the Massachusetts Supreme Court ruled in favor of killing Haleigh, saying it was “unthinkable” to give the power to make a life-and-death decision to the man accused of putting Haleigh in a coma. Instead, the court did something just as unthinkable: It handed that power over life and death to the same child welfare agency that had failed time and time and time again to protect Haleigh from her abusers in the first place. According to the Boston Herald, a report by her court-appointed guardian showed that the Department of Social Services had received 17 reports of abuse or neglect involving Haleigh in the three years before her adoptive mother and stepfather were charged with pummeling her into a coma.

“State can let beaten girl die,” the headlines trumpeted. But there was just one small complication for all of those who, for whatever reason, were in such a rush to “let Haleigh die”:

Haleigh is fighting to live.

As state officials prepared to remove Haleigh’s life support, the supposedly impossible happened. She began breathing on her own, responding to stimuli and showing signs of emerging from what the medical establishment had deemed her hopeless condition. Everyone had given up on Haleigh — except Haleigh. “There has been a change in her condition,” announced a DSS spokeswoman, Denise Monteiro. “The vegetative state may not be a total vegetative state.”

Unbelievably, the state had weaned Haleigh off her breathing tube before the state Supreme Court had made its ruling — but the government failed to inform the court of the development. Haleigh’s medical records and the social service agency’s brief remain sealed.

Politicians in Massachusetts are vowing full-scale investigations of the state’s incompetent child welfare bureaucrats. But where’s the accountability for the medical experts whose faulty diagnosis led to Haleigh’s court-approved death sentence? Will they step forward and reveal themselves? Will they explain how they erred? Will they apologize?

It was The Experts’ unequivocal assessments that led the court to declare Haleigh in “an irreversible vegetative state” and to assert that “the child could not see, hear, feel or respond.” Now, they admit they were wrong. And now, Haleigh’s life depends on the whims of a hopeless government agency that didn’t think the court needed to know that the child was breathing on her own.

Haleigh’s story is a wake-up call to “right-to-die” ideologues who recklessly put such unlimited trust in the medical profession and Nanny State. With such uncertainty surrounding persistent vegetative state diagnoses, the presumption must be in favor of life. Yet, the “right-to-die” lobby’s mantra seems to be: When in doubt, pull it out.

While Haleigh clings to life, I’ve pondered how we might help persuade the plug-pullers to put off the child’s state-sanctioned death sentence. I propose nominating her for a Nobel Prize. It bought Tookie Williams five extra years.

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Haleigh Poutre: The 11-year-old Massachusetts girl who is defying the odd, and the courts. (Weekly Standard, 060127)

“Right now, things just don’t make sense.” - John Gamelli, January 19, 2006

[KH: what a sad tragedy that breaks your heart!]

THAT OBSERVATION came from a family friend of Haleigh Poutre, the 11 year old Massachusetts girl who was beaten into a coma this past September, allegedly by her adoptive parents. Gamelli’s comment is an apt description of Haleigh’s struggle to live once she entered the Massachusetts legal system.

Born in 1994 to a sixteen year old mother who wasn’t married to her biological father, Haleigh was four when she went to live with her aunt because she was being sexually abused by her mother’s boyfriend. Prior to relocating to her aunt’s, Haleigh became a ward of Massachusetts’s Department of Social Services (DSS). A few years later, Haleigh’s aunt got married to one Jason Strickland, and, a short while after that, she officially adopted Haleigh.

But DSS’ role in Haleigh’s life was far from over. After the adoption, DSS made no fewer than 15 investigations into possible abuse of Haleigh. The injuries Haleigh suffered varied in severity and nature, but many were alarming. One time Haleigh’s adoptive mother allegedly left her alone at a softball game. The result: Haleigh suffered serious head injuries when she was struck by a bat. Another time, the child allegedly burnt herself with hot water.

DSS concluded from its investigations that Haleigh had a propensity to injure herself. [KH: what uncaring people!] They left her in the care of her adoptive mother and Strickland. Then, on September 11, 2005, Haleigh entered a vegetative state, the result, police alleged, of a vicious beating at the hands of her adoptive mother and Strickland.

While the two awaited trial, the courts awarded DSS temporary custody of Haleigh. After being released on bail less than two weeks later, Haleigh’s adoptive mother was found dead in an apparent suicide. Strickland alone would face charges for the possibly fatal beating of Haleigh.

ONCE THE MATTER ENTERED the Massachusett s legal system, things took a bizarre and disturbing turn. A mere nine days after Haleigh’s beating, DSS pressed to remove Haleigh’s life support and feeding tube.

The swiftness with which DSS acted in this instance stands in stark contrast to the dawdling that characterized its efforts during Haleigh’s healthier days. What’s more, DSS’s efforts ran contrary to the prevailing medical opinion: the end result of a vegetative state is difficult to predict, especially so in the earliest days and weeks of such a condition. What’s more, children who come to this condition through a trauma, as Haleigh did, are far more likely to recover because of their still growing brains.

The DSS was present at the trial court level, expressing its view that Haleigh’s life should be terminated. Also there was a government-appointed attorney who was putatively representing Haleigh; she, too, argued for the removal of Haleigh’s life support and feeding tube. Jason Strickland, who would have argued for the extension of Haleigh’s life if for no other than reason than to avoid murder charges, was denied any role in the hearing that would determine Haleigh’s fate. Shockingly, no one other than government employees or appointees was involved in the hearings that were to decide Haleigh’s fate. All the parties with legal standing, including the judge, agreed—Haleigh’s life should end.

At the hearings, the DSS offered the testimony of two medical experts. One testified that both Haleigh’s life support and feeding tube should be removed; the other advocated leaving in the feeding tube. On October 5, a mere 24 days after the assault on Haleigh, the judge issued a written opinion stating that Haleigh’s “dignity and quality of life would be most respected by withdrawing both the ventilator and the feeding tube along with the issuance of a [DNR] order, with great sadness I so issue this day.”

Because the judge issued a ruling at the start of the proceeding that all court records be impounded due to Haleigh’s status as a minor, the public has little idea of what happened in his courtroom. How he reconciled the differing medical opinions remains a mystery.

THE NEXT DEVELOPMENT WAS AN APPEAL to the Massachusetts Supreme Judicial Court (SJC) by Strickland insisting that he had certain rights as Haleigh’s de facto father. Three attorneys from Springfield, Massachusetts—John J. Egan, John M. Thompson and Edward J. McDonough, Jr.—took Strickland’s appeal on a pro bono basis. [KH: no fees]

According to an interview with McDonough, the three attorneys took Strickland’s case solely so that Haleigh might have a voice. Because of the lower court’s decisions, ranging from excluding the public to denying Strickland any standing in the proceedings, no one had advocated for the continuance of Haleigh’s life or suggested that the court should take care to err on the side of life. While it seems oddly perverse that such an argument had to come from the attorneys of an alleged perpetrator, McDonough insists that there was no other way to get these arguments before the court. His claims are buttressed by the fact that he and his co-counsel took on the matter without compensation.

Despite the spirited efforts of Strickland’s attorneys, the SJC upheld the lower court’s rulings in their entirety. It ruled that the proceedings dominated solely by government appointees and officials were acceptable; what’s more, it endorsed the notion that having such hearings without public notice even when a child’s life is at stake is acceptable. [KH: ultraliberal Massachusetts!] Lacking the standing to address the lower court’s strange findings of fact regarding the conflicting medical testimony, and its ensuing declaration that Haleigh’s feeding tube should be removed, the SJC’s decisions gave the DSS total victory. The department was henceforth free to end Haleigh’s life.

FOR THOSE PHILOSOPHICALLY inclined to erring on the side of life, the actions of the Massachusetts court system and its various governmental agents seem noxious. But happily, one party who the courts and the DSS couldn’t consult seems to have refused to comply with their dictates.

While the SJC was considering her case, Haleigh Poutre began to show signs of improvement. She began to breathe on her own and no longer needed the life support equipment that the DSS had been in such a hurry to remove. According to family friend John Gamelli, Haleigh’s biological mother reported Haleigh was able to respond to simple commands like releasing objects from her hand. Because DSS, still Haleigh’s legal guardian, has declined to release any information regarding Haleigh’s substantive medical condition, the public is left to hearsay reports like Gamelli’s for information on Haleigh’s status.

The DSS currently seems to be back-pedaling furiously from its position of the past four months. The head of DSS has since held a press conference where he vowed to consult with additional medical experts. The public can only wonder why the DSS didn’t seek such consultations before it began to so vigorously pursue the termination of Haleigh’s life.

It is almost impossible to view Haleigh’s struggle without reflecting on the Terri Schiavo case of a year ago. Haleigh’s case does seem to bolster some of the arguments that Terri Schiavo’s supporters made, namely that doctors are not infallible. Perhaps most importantly, the Poutre case illustrates the benefits of erring on the side of life, and the dangers of not doing so.

Alas, what makes Haleigh’s case arguably more disturbing than that of Terri Schiavo is that there was no party arguing for life here. Even today, there remains no party to argue for life if the DSS and Haleigh’s court appointed lawyer should both decide that the time has come once again for her to “die with dignity.”

Over the past weekend, DSS spokesperson Denise Monteiro, in attempting to defend the DSS’s haste in trying to terminate Haleigh’s life, went so far as to claim to the Boston Herald that the agency never intended to actually remove Haleigh’s life support and feeding tube. If true, one wonders: Did the DSS simply want the court ordered right to end Haleigh’s life in its proverbial back pocket, available to use at a moment of its own choosing?

Dean Barnett writes about politics and other matters at soxblog.com

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Harm Done: Codifying the decline of the medical profession. (National Review Online, 060309)

In 2000, The New England Journal of Medicine reported that patients being euthanized in the Netherlands sometimes experienced significant side effects (apart from death, that is), such as nausea, convulsions, or coma. This belied the assertion oft made by euthanasia proponents that being killed by a doctor necessarily provides the euphemistic “gentle landing” of euthanasia lore.

Responding to the Netherlands report, the NEJM published an editorial authored by Dr. Sherwin Nuland, author of the bestselling book How We Die and an internationally prominent physician and bioethicist from Yale University. Nuland, a supporter of euthanasia in limited cases, proposed a remedy: that doctors be provided “thorough training in [euthanasia] techniques.” Yes, you read right: One of the country’s most celebrated doctors urged that continuing medical education classes teach doctors how to kill.

Such “how to kill your patients” classes would clearly violate the famous Hippocratic Oath under which doctors have for some 2,500 years pledged, “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”

Nuland knew that, of course. But he dismissed the relevance of the Oath, writing:

[T]hose who turn to the oath in an effort to shape or legitimize their ethical viewpoints [against euthanasia], must realize that the statement has been embraced over approximately the past 200 years far more as a symbol of professional cohesion than for its content. Its pithy sentences cannot be used as all-encompassing maxims to avoid the personal responsibility inherent in the practice of medicine. Ultimately, a physician’s conduct at the bedside is a matter of individual conscience.

For most people, this is a very radical idea. When I read this quote in my lectures, audiences invariably gasp in surprise and shocked concern. You see, real people — that is, patients — don’t blithely dismiss the Hippocratic Oath as if it were merely akin to a secret handshake. In their commonsense understanding, the Oath protects their welfare by making doctors honor-bound to always “do no harm” (a catchphrase that succinctly summarizes the moral thrust of the Oath, although it does not appear in the document itself).

Unfortunately, we live in an age when pledges of duty and fidelity of the kind found in the Oath are fast becoming passé. Indeed, there is little doubt that the medical profession generally sides with Nuland: Very few doctors take the actual Oath anymore. But there remains the pull of tradition. So, many medical schools and professional associations have instituted various watery pledges or declarations that are mere shadows of the great document itself.

Most recently, for example, Cornell Medical School published a rewritten oath for its graduating doctors to take. Gone, of course, is the proscription against performing abortions. No surprise there: Doctors ceased foreswearing that particular procedure decades ago (although it is interesting to note that recent newspaper stories complain that very few doctors are willing to perform abortions).

But now, Cornell has cast aside two other crucial affirmations of the Oath: First, the prohibition against euthanasia has been erased (“I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect), and second, Cornell’s oath does not require its graduates to avoid sexual relations with their patients.

This is most unfortunate. The author of the Oath (whether or not it was actually Hippocrates) understood that killing is not a medical act. Moreover, the requirement that doctors pledge (on all they hold most sacred) to refrain from either killing or having sex with patients reflects the wisdom that doctors should refrain from taking too much (potentially corrupting) power over their patients into their own hands.

Illustrating the dramatic difference between the rich patient-protecting impetus of the original and the mostly non-specific generalities of the Cornell version, compare these similar provisions in the two oaths:

Hippocrates: “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.” The clear call here is active, requiring doctors never to take advantage of patients in any way, with the specific example of engaging in sexual relations included to emphasize the point.

Cornell: “That into whatever house I shall enter, it shall be for the good of the sick. That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice.” This is a far more passive and vague approach. If Nuland is right, and a doctor’s own conscience is his only guide, what is deemed to constitute the “good of the patient” will vary from doctor to doctor. Indeed, if a physician believes that a patient’s ill health or serious disability makes his or her life not worth living, it would permit killing as the prescribed remedy — even if the patient never asked to be killed (a common practice, not by mere coincidence, in the Netherlands nowadays). Besides: What does “tempting others to vice” mean in the context of today’s anything goes morality?

Another poor substitute for the traditional Oath is the “Christian” physician’s pledge taken by graduates of Loma Linda University. Unfortunately, LLU has also emasculated the robustness of the original. Thus, LLU’s pledge states: “I will maintain the utmost respect for human life. I will not use my medical knowledge contrary to the laws of humanity. I will respect the rights and decision of my patients.” Why edit out the explicit promise not to kill, if respecting human life is a priority? And if respecting patient decisions is paramount, that would permit voluntary euthanasia among other potentially harmful “treatments,” such as amputating the healthy limbs of mentally disturbed patients known as “amputee wannabes.”

Of perhaps even greater concern, LLU’s oath adds a clause that could interpose a conflict of interest between doctors and certain of their individual patients. “Acting as a good steward of the resources of society and of the talents granted me, I will endeavor to reflect God’s mercy and compassion by caring for the lonely, the poor, the suffering, and those who are dying.”

Under the Hippocratic medical principles, the doctor’s sole loyalty was owed to each and every patient as individuals. That is, the doctor is not free to give optimal care to one patient but provide a lower standard to another. In contrast, LLU’s version now requires physicians to treat individual patients in the context of a potentially superseding duty to broader society to steward resources — which, in some hands, could be exercised at the direct expense of patients who are the most expensive to care for. Indeed, a fair reading of the LLU’s oath would justify bedside health-care rationing.

This is not to say, of course, that physicians shouldn’t make proper use of resources. But, to prevent discrimination and abuse, a doctor’s first duty must be to the individual patient, not to society as a whole. Placing a dual mandate on the doctor, as LLU’s oath appears to do, is dangerous precisely because resource management could trump the health, welfare, and even the lives of the sickest patients.

As the Christian bioethicist Gilbert Meilaender has written, the Hippocratic Oath commits doctors to “to the bodily life of their patients.” In an era when the economics of managed care and the growing utilitarian sway of contemporary bioethics increasingly endanger the weakest and most vulnerable among us, substituting the Oath’s venerable maxims with tepid generalities and the vagaries of individual consciences is precisely the wrong approach. Rather than being an archaic relic, the Oath’s “do no harm” approach to medical practice is more important than ever.

— Wesley J. Smith is a senior fellow at the Discovery Institute and a special consultant to the Center for Bioethics and Culture. His website is www.wesleyjsmith.com.

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Chilling Protocol: Ending young life — now, and even here. (National Review Online, 060313)

By Colleen Carroll Campbell

When little Chanou was born in 2000 with a rare and painful illness that leads to abnormal bone development, doctors gave the Dutch infant less than three years to live. As it turns out, she only had seven months.

That’s when her parents and physicians, discouraged by her grim prognosis, joined forces to do something that has become increasingly accepted in the Netherlands: They euthanized her.

“It is in some ways beautiful,” Dutch pediatrician Eduard Verhagen told the London Times, when describing the dying moments of children like Chanou. “But it is also extremely emotional and very difficult.”

Not as difficult as it should be. In the Netherlands, euthanasia of teenagers and adults is legal and baby euthanasia — already practiced among Dutch doctors — will soon be sanctioned by the government. According to the Times, a committee established at the urging of the Dutch Royal Medical Association will begin regulating baby euthanasia in a few weeks. Its standard for deciding who lives and dies will be Verhagen’s own invention, the Groningen Protocol.

The Groningen Protocol is chilling, not only because of its audacity in attempting to judge the worth of human lives but because of its subjectivity in making those judgments. The protocol says that a newborn can be euthanized if his diagnosis and prognosis are “certain,” his suffering is “hopeless and unbearable,” and his quality of life is “very poor,” according to the child’s parents and “at least one independent doctor.”

That standard assumes that physicians are infallible, our current medical knowledge is complete, and human beings are omniscient. How else could one assess with certainty another’s prognosis, experience of suffering, and quality of life? We can know a child suffers; we can know a disease has no known cure. But we cannot pronounce with certainty that another person has no hope or that his suffering has rendered his life worthless. Verhagen himself suggested as much when he told the Times, “No doctor likes to do this. You will always ask yourself, ‘Is there something I have not thought of?’ That is why it needs to be done under a spotlight: you can never, ever be wrong.”

But human beings will be wrong. Discouraged doctors, distraught parents, and distant bureaucrats will make mistakes. And even when their deadly decisions conform perfectly to the protocol, they will commit grave evil by destroying innocent human life in a futile quest to destroy suffering itself.

Americans may be tempted to think that such things could never happen here. But support for infant and child euthanasia has a long history in the United States, stretching from the founding days of the Euthanasia Society of America in 1938 to the recent pronouncements of Peter Singer, a prominent Princeton ethicist who favors a parent’s right to kill disabled newborns.

The threat of euthanasia is already a reality for some American children. Haleigh Poutre, the 12-year-old Massachusetts girl severely beaten by her stepfather last fall, had spent only eight days in the hospital when her state custodians began fighting for the right to remove her ventilator and feeding tube. Doctors had diagnosed her condition as a persistent vegetative state, but Haleigh recovered before they could euthanize her.

Haleigh’s case reminds us that child euthanasia can happen in any nation that has lost respect for the intrinsic value of life and the inviolable dignity of the person. The chilling reality is that although our depraved indifference to the sanctity of human life may not be as advanced as Holland’s, we are moving in that direction.

— Colleen Carroll Campbell, an NRO contributor, is a fellow at the Ethics and Public Policy Center, a former speechwriter to President George W. Bush, and author of The New Faithful: Why Young Adults Are Embracing Christian Orthodoxy.

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ETHICS: Death Marks an Anniversary—Have We Learned Anything? (Mohler, 060331)

Today, March 31, 2006, marks the one year anniversary of Terri Schiavo’s death by starvation. All too quickly, Terri’s name and cause disappeared from the national awareness as our attention-deficit culture moved on to other issues and other concerns.

Just in time for the anniversary of her death, publishers have released books written by Terri’s former husband, Michael Schiavo, and her parents—each offering competing visions of Terri’s life and the meaning of Terri’s death. Given the symbolic nature of this sad anniversary, another flurry of news stories, cable news programs, and media commentaries are likely to appear. But, has America learned anything about the sanctity of human life over the past twelve months?

There are signs that Americans may actually be resigning themselves to the inevitability of euthanasia and the Culture of Death. In the aftermath of Terri Schiavo’s death, a wave of commentary appeared, offering the suggestion that what Americans should have learned from the controversy was that personal autonomy should triumph over all other moral concerns and priorities. Beyond this, others have been quick to point accusing fingers at political figures, including George W. Bush, who attempted to intervene on behalf of Terri’s life.

All this suggests that most people address this controversy with considerable confusion. When it comes to matters of life and death, we moderns face quandaries and questions unimaginable in previous generations. Regrettably, we are now attempting to answer those questions while the very worldview that would offer hope and moral assistance is being undermined and rejected.

Robert P. George, McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University, argues that “a crucial line divides those who affirm and those who deny that the life of each human being possesses inherent and equal worth and dignity, irrespective not only of race, ethnicity, age, and sex (as everyone agrees), but stage of development, mental or physical infirmity, and condition of dependency.”

Professor George addressed these issues as a panelist at an event sponsored by the Pew Forum on Religion and Public Life, the Federalist Society, and the Constitution Project. An edited form of his comments is published as “Terminal Logic,” in the March 2006 edition of Touchstone.

As George rightly insists, those who attempt to distinguish between “mere biological human life” and a “person,” are on the wrong side of this divide. Most often, those who make this distinction are attempting to suggest that persons possess rights while those who are merely forms of “biological human life” do not.

Professor George’s clarification of these issues is urgently important and serves as a basic corrective to so much of the nonsense and confusion that characterizes the contemporary debate over human personhood, euthanasia, and related questions. If human beings are divided between those who are presumably persons and those who are not, this raises the whole question of how we are to understand “pre-personal” and “post-personal” human lives.

As Professor George explains, those who insist on the distinction between biological life and persons will “insist the question is not, When does the life of human being begin or end?, but, When does a human being qualify or cease to qualify as a person, and therefore a creature with a serious right to life? Those they regard as non-persons do not possess such a right, though killing them may be wrong for some reason other than that killing them denies the inherent dignity of persons.”

Every moral argument is based upon some preconditions and presuppositions. The argument that human beings are to be divided between those who are merely biologically alive and those who possess sufficient qualities to be considered as persons is based upon a worldview that privileges human autonomy over other moral goods. As Professor George explains, “The right of autonomy immunizes individual choice in matters having to do with how one leads one’s own life against interference by others, including the state, especially when the choices do not directly damage the interests or violate the rights of others.”

The triumph of personal autonomy over other moral goods has allowed abortion advocates to argue that a woman’s supposed right of personal autonomy trumps any claim that an unborn baby has an inherent right to life. After all, according to this logic, the woman is herself a person while the unborn baby is something less, perhaps a “pre-person” in some stage of development. When advocates and opponents of abortion argue with each other, they often talk past one another, with pro-life advocates often missing the fact that those arguing for abortion rights begin with the presupposition that the woman’s “right to choose” must triumph over all other concerns and claims, regardless of the circumstances.

In more recent years, debates over the use and destruction of human embryos in biomedical research has occasioned similar arguments. Those who argue for the validity of using and destroying human embryos in medical experiments or treatments argue that embryos are, at best, “pre-persons” who simply have no claim upon the moral equation. The claim of autonomy is assigned to those who would donate such embryos or make the moral decision to destroy those same embryos in the course of medical experimentation that is most often delivered with the promise that it will lead to medical treatments for “real” persons.

Of course, the issue of euthanasia brings the autonomy question into clear focus. Those arguing for a right to a “good death” do so on the grounds that a human person has the right to end his or her life as he or she may please. Once again, autonomy trumps all other moral concerns and claims.

Professor George sets the record straight: “Now, those who oppose abortion, infanticide, assisted suicide, euthanasia, and so forth, as I do, oppose them both because we reject the idea that there are or can be pre-personal or post-personal human beings, or human non-persons of any description, and because we do not accept the sweeping view of the value of autonomy. We affirm a doctrine of inherent and equal dignity that affirms all living human beings as persons, excludes the direct killing human beings, and demands respect for every individual’s right to life. Most of us also believe that the law should honor the principle of the sanctity of human life and not privilege the belief in autonomy over it.”

In one sense, the argument over these questions comes down to a hierarchy of moral goods and claims. The slide into abortion, euthanasia, embryo research, and worse is directly traceable to the rise of autonomy as the supreme moral good in the view of many persons. Of course, this is a fairly new development in human thinking, but it is perfectly fitted for our times—telling Americans that their personal autonomy is the most important moral claim we can conceive.

Terri Schiavo died because her husband sought and obtained a court order that feeding and hydration should be denied to her. Mrs. Schiavo had suffered a calamitous physical injury that had clearly affected her brain and powers of cognition. Still, this injury did not kill her and she did not die as a direct result of the injury. She died simply because she was starved and dehydrated until she died—all this at the order of successive courts and at the instigation of her husband.

The claim for removing her feeding tube and hydration was made on the basis of her own personal autonomy. Of course, there was no record that Terri Schiavo had indicated any wish to exercise her autonomy in this way, but the court received as sufficient her husband’s claim that she had done so in a recognizably minimal way.

Much of the debate over Terri Schiavo had to do with the contested question of whether she had actually made any such statement. This misses the more fundamental point—that such a statement would be immoral and unjustifiable even if made.

In 1992, a group of ethicists known as the Ramsey Colloquium adopted a statement entitled “Always to Care, Never to Kill.” That statement offers wisdom that is urgently needed in our reconsideration of the Terri Schiavo controversy one year later:

“Life, however, is not simply a ‘good’ that we possess. We are living beings. Our life is our person. To treat our life as a ‘thing’ that we can authorize another to terminate is profoundly dehumanizing. Euthanasia, even when requested by the competent, can never be a humanitarian act, for it attacks the distinctiveness and limitations of being human. Persons—ourselves and others—are not things to be discarded when they are no longer deemed useful.”

Further: “We can give our life for another, but we cannot give ultimate authority over our life to another. The painfully learned moral wisdom of our heritage is that persons cannot ‘own’ persons. The decision for euthanasia is not an exercise of human freedom but the abandonment of human freedom. To attempt to turn one’s life into an object that is at the final disposition of another is to become less than human, while it places the other in a position of being more than human—a lord of life and death, a possessor of the personhood of others.”

As Professor George argues, in agreement with the Ramsey Colloquium: “We are to maintain solidarity with those in disabled conditions, seeking to heal their afflictions when we can and making every effort to relieve their suffering and discomfort. At the same time, we should discourage anyone tempted to regard his life as valueless or merely burdensome to himself or others from thinking this and from committing suicide. We cannot encourage or assist suicidal choices and assisted suicide or euthanasia.”

Bad ideas often work their way out of a culture—but at great cost and over great time. The sad legacy of the twentieth century demonstrates that truly tragic, pernicious, and deadly ideas and ideologies can take millions upon millions of victims. We can only hope that Americans will regain some moral sense and the consciousness of what was lost when Terri Schiavo became yet another victim of the Culture of Death. When personal autonomy triumphs over all other moral claims, this kind of tragedy becomes inevitable. A year after Terri Schiavo’s death, have we learned anything at all?

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“We never say no.”: The right-to-die movement abandons pretense. (Weekly Standard, 060427)

THERE IS A PRETENSE in contemporary assisted suicide advocacy that goes something like this: “Aid in dying” (as it is euphemistically called) is merely to be a safety valve, a last resort only available to imminently dying patients for whom nothing else can be done to alleviate suffering.

Meanwhile, in the real world, the founder of the Swiss suicide facilitating organization Dignitas is just about done with pretense. The Sunday Times Magazine (London) reported that Dignitas’ founder, Ludwig Minelli, plans to create sort of a Starbucks for suicide: a chain of death centers “to end the lives of people with illnesses and mental conditions such as chronic depression.”

Minelli believes that all suicidal people should be given information about the best way to kill themselves, and, according to the Times story, “if they choose to die, they should be helped to do it properly.” Dignitas admits to having assisted the suicides of many people who were not terminally ill. As Minelli succinctly put it, “We never say no.”

The story about Minelli illuminates a deep ideological belief within the euthanasia movement: that we own our bodies, and thus, determining the time, manner, and method of our own deaths, for whatever reason, is a basic human right.

That is certainly how one of the other superstars of the international euthanasia movement, the Australian physician Phillip Nitschke, sees it. Nitschke travels the world presenting how-to-commit-suicide clinics. Several years ago he was paid thousands of dollars by the Hemlock Society (now merged into the assisted suicide

advocacy group Compassion and Choices) to create a suicide concoction made from common household ingredients (a formula he calls the “Peaceful Pill”).

Like Minelli, Nitschke is straightforward about his goals. In a 2001 interview, National Review Online asked him who should qualify for the Peaceful Pill. He responded:

My personal position is that if we believe that there is a right to life, then we must accept that people have a right to dispose of that life whenever they want . . . So all people qualify, not just those with the training, knowledge, or resources to find out how to “give away” their life. And someone needs to provide this knowledge, training, or resource necessary to anyone who wants it, including the depressed, the elderly bereaved, [and] the troubled teen.

Nitschke and Minelli’s position has a large constituency among euthanasia believers. Indeed, over the years, the movement has left many telltale signs that assisted suicide is not intended ultimately to be restricted to the imminently dying.

Take the “Zurich Declaration,” issued at the 1998 bi-annual convention of the World Federation of Right to Die Societies. (The WFRD is an umbrella group made up of 37 national euthanasia advocacy organizations, including Compassion and Choices and Hemlock founder Derek Humphry’s Euthanasia Research and Guidance Organization, or ERGO.) It states:

We believe that we have a major responsibility for ensuring that it becomes legally possible for all competent adults, suffering severe and enduring distress, to receive medical help to die, if this is their persistent, voluntary and rational request. We note that such medical assistance is already permitted in The Netherlands, Switzerland and Oregon, USA.

It should also be noted that one need not be dying or even sick to experience “severe and enduring distress.”

SUPPORT FOR A BROAD AND LIBERAL ACCESS to suicide extends far beyond activists in the euthanasia movement. It has been embraced by some people in the mental health professions, where a concept known as “rational suicide” is being promoted in professional journals, books, and at symposia.

Typical of this genre is a 1998 article by James W. Werth published in the journal Crisis, with the ironic title, “Using Rational Suicide as an Intervention to Prevent Irrational Suicide.” Werth urges that mental health professionals should not always save the lives of suicidal patients, but instead, should non-judgmentally facilitate the suicidal person’s decision making process. If the professional agrees that the desire to die is rational, then the suicide should be permitted, or perhaps even assisted.

To qualify for a rational suicide, the patient would have to demonstrate to the mental health professional that he has a “hopeless condition,” which Werth defines as, “terminal illnesses, severe physical and/or psychological pain, physically or mentally debilitating and/or deteriorating conditions, or qualify of life no longer acceptable to the individual.” This is circular thinking. By definition, if one is suicidal, he has a quality of life that he believes is no longer acceptable.

Not surprisingly, assisted rational suicide is already permitted in the Netherlands where the Dutch Supreme Court approved a psychiatrist’s facilitating the death of a distraught woman who wanted to die because her children were dead.

Similar

suicide-friendly attitudes are often expressed among mainstream bioethicists—and not just by Princeton’s Peter Singer. For example, the University of Utah’s Margaret Pabst Battin suggests that “suicide can be rationally chosen,” to “avoid pain and suffering in terminal illnesses,” as a “self-sacrifice for altruistic reasons,” or in cases of “suicides of honor and principle.” Along these same lines, Julian Savulescu, an up-and-comer in the international bioethics community, argues that respect for human freedom demands that society permit the suicides of competent persons—even when they are expressing an “unjustified desire to die.”

“Some freedoms are worth the cost of innocent life,” Savulescu wrote in a chapter for the book Assisted Suicide. “The freedom to finish one’s life when and how one chooses is, it seems to me, about as important as any freedom.”

The right to receive assisted suicide for virtually any reason is especially popular among self-declared “free thinkers” and humanists. Thus, Tom Flynn, the editor of Free Inquiry, the house organ for the Council for Secular Humanism, wrote in the April 19, 2006 issue, that the belief in human liberty must include an unfettered right to die. “While suicide has never been exactly popular, a new assault on our right to suicide is brewing. It’s something secular humanists ought to resist.” Why? Because Flynn (and other humanists) believe fervently that a right to suicide is a crucial element of human liberty:

What’s really in play here is the old dogma that individuals don’t own their own lives. Physician-assisted suicide is but part of the issue. If we trust our fellow humans to choose their occupations, their significant others, their political persuasions, and their stances on religion, we should also defend their right to dispose of their most valuable possessions—their lives—even if disposing of life is precisely the choice they make.

There are even ongoing discussions in bioethics suggesting that some people might have an ethical obligation to commit suicide. Thus, a 1997 cover story in the prestigious bioethics journal the Hastings Center Report, philosopher John Hardwig argued that there is not only a right, but also a “duty to die”:

A duty to die is more likely when continuing to live will impose significant burdens—emotional burdens, extensive caregiving, destruction of life plans, and yes, financial hardship—on your family and loved ones. This is the fundamental insight underlying a duty to die.

A duty to die becomes greater as you grow older. As we age, we will be giving up less by giving up our lives . . . To have reached the age of say, seventy-five or eighty years without being ready to die is itself a moral failing, the sign of a life out of touch with life’s basic realities.

Bioethicist Battin has also supported the concept of an eventual duty to die for those living in rich countries, not just to spare burdening our loved ones but to promote world egalitarianism. Thus, she wrote in a book chapter called “Global Life Expectancies and the Duty to Die” that the time may come when we will have the moral obligation to “conserve health care resources by forgoing treatment or directly ending [our] life” toward promoting “health prospects and life expectancies” that are more equal around the globe.

DESPITE THIS THICKENING ATMOSPHERE of suicide permissiveness, most assisted suicide advocates in this country continue to insist that “all” they want is for the terminally ill to have access to hastened death.

For some, clearly, this is a mere political tactic. The ultimate goal is a much broader death license. Others may actually mean for the initial terminal illness limitation to be permanent, believing that “restricted” assisted suicide, once accepted widely, would not spread to ever widening swaths of acceptable killing (as it has in the Netherlands).

Which camp one decides best represents the overall euthanasia movement doesn’t really matter. Once assisted suicide is accepted in law and culture, the premises of radical autonomy and allowing killing to alleviate human suffering would conjoin, unleashing the irresistible power of logic that would push us inexorably toward the humanist nirvana of death on demand.

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Thousands Petition Against U.K. ‘Assisted Dying’ Bill (Christian Post, 060503)

LONDON – More than 8,000 people have signed a national petition opposing a bill that could make euthanasia legal in the United Kingdom.

The petition will be presented at 10 Downing Street – London home and office of the British Prime Minister – before noon on May 12, the day the bill is to be debated in the House of Lords. Following that, opponents of the bill will hold a rally outside the House of Lords to protest against the legislation.

Dr Brian Iddon, MP for Bolton South and Chairman of the Care Not Killing Campaign, said, “This is just the latest step in a massive, nationwide campaign against this deeply flawed and immoral Bill.”

“We are encouraging everyone to stand up and be counted in the fight against the legalization of assisted suicide over the next few crucial days,” he sadded. “I therefore urge people to get involved in order to let parliament know what ordinary people think — every individual protest really matters now!”

Christian charity CARE, meanwhile, has been gathering protestors throughout the U.K. to unite and fight against the proposed euthanasia bill via their mobile phones and computers.

A new text and online petition campaign has been launched by the leading Christian organizations, in a firm drive to ensure that Lord Joffe’s Assisted Dying For the Terminally Ill Bill is rejected in Parliament.

The campaign comes as part of CARE’s “Life Valued Campaign,” which has seen many supporters gathering across Britain, focused on exposing and educating the public on some of the most widely believed “myths” about euthanasia.

Former human rights lawyer, Lord Joffe, put forward for consideration the bill which has been widely criticized by health professionals that say it would seriously endanger the rights of the people it is supposed to aid.

Andrea Williams of the Lawyer’s Christian Fellowship has said, “If the law is changed to allow ‘assisted dying,’ it is inevitable that emotional and financial pressures will be brought to bear on vulnerable people. The sick, frail or elderly often feel a burden on relatives, carers and a society short of resources. A law allowing assisted suicide would place them under huge pressure and no amount of safeguards would ever adequately protect the vulnerable.”

The bill is scheduled to be up for a public reading on May 12. At that time the bill will pass through without a vote taking place, and will be put forward before the committee stage, where it will be considered by the House of Lords.

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Leftist leaders unite after Bolivia’s energy takeover (Washington Times, 060505)

SANTA CRUZ, Bolivia — Four South American presidents announced an agreement on energy pricing last night, seeking to dispel the impression that the continent’s left-wing leaders were sharply divided over Bolivian President Evo Morales’ shock nationalization of the Andean nation’s energy sector.

“In this meeting, any concerns the presidents may have had have been dispelled,” Mr. Morales said after a summit in Puerto Iguazu, Argentina, where he and Venezuelan President Hugo Chavez joined the leaders of Argentina and Brazil.

They agreed that prices would not be changed without bilateral negotiations.

Earlier, Mr. Chavez threw his full support to Mr. Morales.

The summit had been expected to put on display the sharp divisions among South America’s left-wing leaders over the energy nationalization by the recently elected Bolivian president.

Venezuelan Energy Minister Rafael Ramirez told reporters at the emergency meeting that his government would help Bolivia implement the nationalization program announced Monday.

“Bolivia has asked us for aid in the hydrocarbon industry, and we are ready to comply,” Mr. Ramirez was quoted as saying by Reuters news agency.

The summit was called to discuss Bolivia’s action with the leaders of Argentina — another major beneficiary of Venezuelan oil largess — and Brazil which, with $1.6 billion invested in Bolivia’s natural gas industry, stands to be the biggest loser.

The center-left Brazilian government of President Luiz Inacio Lula da Silva said yesterday it was freezing future investment in its Andean neighbor, while leftist Argentine President Nestor Kirchner was also understood to be disturbed.

Brazil and Argentina rely on cheap gas from Bolivia and their leaders — both of whom are up for re-election — are worried about higher prices from the nationalization.

Mr. Chavez, who has used his nation’s oil bonanza to support leftist leaders from Cuba to Nicaragua and provided cheap loans to help Argentina pay off crippling debts to the World Bank, flew to Bolivia on Wednesday night to accompany Mr. Morales to yesterday’s summit.

“Our salute, and also — why not? — our congratulations for this resolution in the sacred exercise of Bolivian sovereignty,” Mr. Chavez declared upon his arrival in the Bolivian capital, La Paz, where he was greeted by Mr. Morales and Vice President Alvaro Garcia Linera.

Arriving in Puerto Iguazu yesterday, he acknowledged “internal tensions” among the region’s leftist leaders, but said, “Such tensions cannot persist when the political vision of great leaders dominates, when there is will for integration,” Reuters reported.

Even before Mr. Chavez’s arrival in La Paz, Venezuela had promised to send 400 accountants from its state oil company to help the Bolivians audit the books of foreign energy companies, presumably in search of evidence to support Mr. Morales’ order that the companies renegotiate existing contracts under threat of expropriation. Soldiers have been guarding company offices since the decree was announced on Monday.

Mr. Morales had previously proposed a merger of Bolivian and Venezuelan oil and gas reserves into a regional conglomerate called Petroamerica that would control South American energy production.

Sergio Gabrielli, president of Brazil’s national energy company, Petrobras, told reporters yesterday in Rio de Janeiro that Bolivia was violating existing contracts and said his company would seek international arbitration in New York courts.

“We are suspending all possibility of new investments in Bolivia,” he said, pledging to turn elsewhere for future gas supplies. Bolivia currently supplies 75% of gas needs to Brazil’s largest city, Sao Paolo.

Mr. Lula da Silva, who had supported Mr. Morales’ presidential bid last year, said going into yesterday’s summit that he would need “all my skills acquired as a past union negotiator” to try to “bridge an understanding.”

But Mr. Morales said before leaving La Paz that he would not back down from Monday’s action, and one oil executive complained that soldiers were preventing messengers from removing documents that needed to be stamped by lawyers and notaries for urgent legal transactions.

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Michael’s World (Christian Post, 060524)

Charles Colson

A Dangerous Place to Be

Michael Schiavo has published a book titled TERRI: THE TRUTH. It is about his well-known and, unfortunately, successful fight to end his wife’s life. Opening this book is like falling down Alice’s rabbit hole and ending up in a new and bizarre world.

You don’t even have to turn to the first page — just look at the front cover, where Michael proclaims, “My two babies were threatened with death. I was condemned by the president, the majority leaders of the House and Senate, the governor of Florida, the pope, and the right-wing media. . . . I didn’t respond to their attacks. I didn’t confront their lies. Until now.”

Well, a quick Internet search turns up page after page of Michael’s vigorous responses on Nightline, Larry King Live, and other venues, most of it very confrontational.

Why would he respond now? Books sales and talk shows are a lucrative business.

This turns out to be typical of the way things work in Michael Schiavo’s world. As readers of the book soon discover, Schiavo’s opponents deserve all the venom he can spew on them. To Michael Schiavo’s mind, nobody could possibly have a good reason for wanting to let Terri Schiavo live in her condition. So he paints his opponents as biased, liars, downright insane. Just as the book cover indicates, the pope, the president, the governor of Florida, Terri’s family, and several cranks who sent Michael death threats — which, by the way, I know from experience happens in these kinds of cases — are all lumped into the same category: people who opposed Michael’s noble crusade to kill his wife. Noble? Or was he after collecting the insurance money and marrying the woman he was living with? Michael Schiavo’s world, if you believe his book, is like the old Westerns where the good guys wore white hats and the bad guys all wore black hats and twisted their mustaches a lot.

Joking aside, Michael Schiavo’s world is a dangerous and scary place, a place where the “survival of the fittest” is taken to a whole new level — a place where a badly brain-damaged woman should have her food and water taken away simply because she is badly brain damaged and her husband says she would not want to live that way. It’s a place where it’s easy for even a registered nurse like Michael Schiavo to confuse food, which everyone needs, with the kind of life support, like a respirator, which his wife did not need. It’s a place where, as Schiavo is accustomed to saying with a straight face, taking someone’s food away is not starving her to death; it’s simply allowing her to die peacefully and painlessly. (Why a hospice needs to administer morphine to a person dying painlessly is something that Schiavo does not bother to explain, like so many other issues.)

The scariest thing about Michael Schiavo’s world is that he, and so many of his partisans in the media and the public, do not want to give the benefit of the doubt to a comatose person. Now, I admit that many people today think well of Michael and less of those of us who defended Terri Schiavo since the autopsy showed that she had been brain-dead when she was in a comatose state. But that’s beside the point. Our concern was with safeguarding the process and giving her the benefit of the doubt. After all, you can’t do an autopsy until the person is dead, and then it is too late to correct mistakes.

Reading Schiavo’s book is a sobering reminder that we must never give up our fight to guard the rights of the weak and the voiceless, or one day we will all be living — and dying — in Michael Schiavo’s world.

This is part five in the “War on the Weak” series.

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What’s the difference between Terry and Terri? (townhall.com, 060706)

By Terence Jeffrey

On a July evening 22 years ago, 20-year-old Terry Wallis climbed into a pickup truck with two friends and rode off down a rural Arkansas highway. He never came back — or, more precisely, he never came back the same.

The truck went off a bridge.

One of Wallis’ friends was uninjured; the other died. Wallis barely made it. First, he was in a coma, then in what doctors called a “vegetative state,” and then in what they called a “minimally conscious state.”

He was paralyzed from the neck down and couldn’t talk.

His parents assumed legal guardianship from his wife, made sure he was cared for at a rehabilitation center and brought him home for regular visits. Then on July 11, 2003, when Mrs. Wallis went to see her son, as the Chicago Tribune reported it then, Terry spoke his first word in 19 years: “Mom.” Soon, he was able to converse.

“There is nothing I know of to explain scientifically what happened,” Terry’s doctor, James Zini, told USA Today. “I think it was a miracle.”

Understandably, a group of medical researchers decided to seek a natural explanation. They did two sets of scans of Terry’s brain 18 months apart, and compared these to scans from healthy people, and from another man who had suffered a similar injury six years ago, but had not recovered. They published their findings this week in the Journal of Clinical Investigation (JCI). Their conclusion: “We propose that axonal regrowth may underlie these findings and provide biological mechanisms for late recovery.”

In other words, they believe Terry’s brain is repairing itself.

Since this revelation, some media reports have cited doctors keen to draw a distinction between Wallis and Terri Schiavo, the Florida woman whose deliberate killing by dehydration last year ought not to have been allowed, even if she had had no hope of recovery. Nonetheless, these reports suggest that Schiavo could not have experienced a recovery like Wallis did, because her brain injury was more severe.

CBS Evening News reported: “Now this discovery will change the way doctors think about patients in the so-called minimally conscious state. But it won’t affect all patients, like Terri Schiavo, who was in a kind of coma known as a persistent vegetative state.”

The Associated Press noted of Wallis’ recovery: “(D)octors said the same cannot be hoped for people in a persistent vegetative state, such as Terri Schiavo.”

This type of not-like-Terri claim is not new.

Donald Herbert, a New York state firefighter, went into a “decade-long stupor” in 1995, according to the Buffalo News, after “a roof collapsed on him” and “he was deprived of oxygen for up to 10 minutes.” Herbert, who died of pneumonia this February, suddenly began talking again in April 2005 after his doctor, Jamil Ahmed, treated him with a drug cocktail. Ahmed told the New York Times his patient’s pre-recovery condition had been “close to the persistent vegetative state.”

But NBC’s “Today Show” quickly cited doctors who drew a line between Herbert and Schiavo. “Neurologists who examined Terri Schiavo say her case was different, that she was in something called a persistent vegetative state, from which there is almost no chance of recovery,” the show reported

Yet, truly the most telling fact about Wallis’ recovery was stated by Dr. Nicholas Schiff of Cornell University, who co-authored the JCI study of Wallis’ case. “We read about these widely publicized cases of miraculous recovery every few years, but none of them — not one — has ever been followed up scientifically until now,” he told the New York Times.

Dr. Steven Laureys, a Belgian neurologist who co-authored a commentary in JCI that accompanied the Wallis study, told the Los Angeles Times: “It obliges us to reconsider old dogmas.”

So why should anyone now want to draw a bright line between Schiavo and almost-unstudied recoveries like the one Wallis made?

Lady MacBeth could never rub out the spot of a king’s blood she imagined on her hand — and no matter what science tells us tomorrow, there’s no erasing what’s already been done to Terri Schiavo.

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ETHICS: Anne Lamott Kills a Man – And Writes About It (Mohler, 060628)

Anne Lamott is a writer of incredible honesty and uncommon candor. Beyond this, she is a highly gifted artist, writing with a fluid and passionate style that attracts readers who quickly feel drawn into Lamott’s life and experiences.

Additionally, Anne Lamott is a zealous proponent of her own personal causes. Passionately liberal, she is known for her fervent support of abortion on demand (she recently wrote of women whose lives were “righted and redeemed” by Roe v. Wade). Yet, at the same time, she has managed to identify herself in some sense as a Christian writer, and she describes her own mode of Christian discipleship in terms of being “Jesusy.” She has become something of a literary icon among mainline Protestants and leftward evangelicals. Now, however, she appears to be launching out into previously uncharted territory.

Writing in the June 25, 2006 edition of The Los Angeles Times, Lamott begins with these words: “The man I killed did not want to die, but he no longer felt he had much of a choice.” The language is truly shocking, and Lamott obviously intends to catch the attention of readers when she speaks of “the man I killed.” If it is attention she wants, she is almost sure to get more than she intended.

In her essay, “At Death’s Window,” Lamott traces her involvement in the assisted suicide of a close friend. She introduces him as having “gone from being tall and strapping, full of appetites and a brilliant manner of speech, to a skeleton, weak and full of messy needs.” Lamott’s poetic description of her friend’s plight underlines the tragedy of his illness.

As Lamott traces his decline, the man who “had always been passionately literary” was losing his ability to read or write. No longer able to travel, hike, or share cherished experiences with his wife, he was only sixty when he was diagnosed with cancer.

The man Lamott helped to die is not identified with his real name. Instead, Lamott refers to the man and his wife as “Mel” and “Joanne.” Refusing aggressive chemotherapy treatment, Mel “wanted to feel as well as he could for as long as he could,” Lamott recounts, in order to “savor his family and friends and the beauty of life, on his own terms, in the strange basket of sickness.”

As is so often the case, the specter of precipitous physical decline accompanied by pain was a real concern. As the prescribed opiates no longer seemed to cover his pain, Lamott told Mel over lunch one day that “if he ever experienced too much pain or diminishment, I would try to help him die on his own terms, if he wanted.”

Taken in itself, this is a remarkable offer. Lamott’s essay appeared even as the legislature in California is debating the legalization of physician-assisted suicide. The proposal, now making its way through the California Senate and General Assembly, is modeled after Oregon’s statute. If adopted, California will become the second state to legalize assisted suicide.

Clearly, Anne Lamott is enthusiastic about the process. As she recalls her lunchtime conversation with Mel, Lamott recalled that she had not premeditated making her offer. She also recounted the experience she shared with her brothers when they contemplated assisting their own father to die, even as he was slipping away from them due to the ravages of brain cancer. “Two months before he died, when he lay in a hospital bed in our one-room cabin in what amounted to a coma,” Lamott recalls, “my younger brother and I crushed up some barbiturates that his doctor had given him to help him sleep, but we couldn’t do it. We were too young.” Now older, Lamott was apparently ready to act when it came to her friend Mel. When Mel asked Lamott about her understanding of death, she spoke of having heard an Eastern mystic “say that it was like slipping out of a pair of shoes that had never fit very well.”

The most revealing section of Lamott’s essay is this: “Mel was sort of surprised that as a Christian I so staunchly agreed with him about assisted suicide. I believed that life was a kind of Earth school, so even though assisted suicide meant you were getting out early, before the term ended, you were going to be leaving anyway, so who said it wasn’t OK to take an incomplete in the course?”

In the economy of just a few words, Lamott effectively turns the Christian understanding of life and death on its head.

No wonder Mel was “sort of surprised” that Lamott, identifying herself as a Christian, would agree to participate in an assisted suicide with such enthusiasm. Christianity teaches a distinctive understanding of human life. At the onset, the Bible reveals that we are not the lords of our own lives in the first place. Life is a gift, and human life is a special gift given to the only creatures who are made in God’s own image. We are, in effect, the only sentient beings able to ponder the meaning of our own lives and the reality of our own death. The Christian understanding of humanity insists that we are not autonomous creatures that have the right to determine when we shall live and when we shall die. To the contrary, our lives are in the disposition of the Creator, and human life is understood to posses inherent dignity from its natural beginning until its natural end. Any affirmation of assisted suicide or any form of euthanasia as a way of “releasing” persons by voluntary or involuntary intervention is a rejection of God’s sovereign prerogative and a denial of His providence as gracious, merciful, and righteous.

Furthermore, Christianity does not teach that life is just “a kind of Earth school.” To the contrary, Christianity affirms the inherent dignity and meaning of our earthly lives. Life is not a course we are taking, so much as it is a stewardship of a priceless gift. It is profoundly true that Christianity points to eternal life beyond this earthly life as the realm of our ultimate existence as believers, but we are not invited to “take an incomplete” in the course of life as we may choose.

As Anne Lamott continues her story, she tells of Mel reminding her of her offer. “I won’t be me for much longer,” he said. Having communicated with the Hemlock Society (a group that ardently supports euthanasia and offers advice to those wishing to die or to assist someone to die), Lamott “knew exactly how many Seconal pills it took to kill a big person.” As she recalls, she knew how to crush the pills and add them to applesauce, and then feed them to the sick person, along with toast and tea so that the pills would not be rejected.

Shortly thereafter, Lamott used what she describes as “wily and underground ways” to amass a sufficient number of Seconal pills to constitute a lethal dose. “That night, Mel and I had a cryptic phone conversation. ‘I got it,’ I said, like a spy, or a drug dealer.”

A month later, Lamott shared dinner with Joanne and Mel and, along with another friend, listened to his favorite music and told favorite stories. “He was absolutely clear as a bell, brilliant as ever,” she remembers. Using the full power of her descriptive ability, she wrote of the air smelling “faintly of honey and laundry, and illness.”

After dinner, Mel changed into comfortable pajamas and got into his bed, “wasted, sad, sweet and comfortable.” Lamott then went to the kitchen to get the pills, and then made the deadly applesauce “in a tiny Asian bowl.”

After eating the applesauce, Mel thanked his friends and wife, and “told us how much he loved his life, and how he wished he could live with us forever.” Finally: “After a while, Mel looked around, half smiled and fell asleep. People got up to stretch, for wine or water, or to change albums. He breathed so quietly, for so long, that when he finally stopped, we all strained to hear the sound.”

Those words end Lamott’s essay. There is no extended moral argument for her action in assisting the suicide of her friend. There is no engagement with the Christian moral tradition, and there is no real sense of moral reflection at all. As with the issue of abortion, Anne Lamott is simply guided by her own sense of what is right and wrong.

With the ease of an author beginning to write on a clean sheet of paper, Lamott effectively jettisons Christian concern for the preservation of life and dismisses centuries of Christian conviction on the questions of life and death. She describes herself as a Christian, but there is nothing even remotely Christian, in any distinctive sense, to be found in her essay on a matter as serious as ending a man’s life.

When Anne Lamott writes of “the man I killed” like this, she willingly enters uncharted terrain and forges a brave new morality, embracing assisted suicide as a moral good.

Mel was rightly shocked that a Christian would be such a staunch supporter of assisted suicide. Will Lamott’s Christian readers be equally shocked to read of her views now? Those views led directly to Mel’s poisoned applesauce.

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Docs May Have Evidence Man’s Brain Rewired Itself (Foxnews, 060704)

Doctors have their first proof that a man who was barely conscious for nearly 20 years regained speech and movement because his brain spontaneously rewired itself by growing tiny new nerve connections to replace the ones sheared apart in a car crash.

Terry Wallis, 42, is one of the few people known to have recovered so dramatically so long after a serious brain injury. He still needs help eating and cannot walk, but his speech continues to improve and he can count to 25 without interruption.

Wallis’ sudden recovery happened three years ago at a rehabilitation center in Mountain View, Ark., but doctors said the same cannot be hoped for people in a persistent vegetative state, such as Terri Schiavo, the Florida woman who died last year after a fierce right-to-die court battle. Nor do they know how to make others with less serious damage, like Wallis, recover.

“Right now these cases are like winning the lottery,” said Dr. Ross Zafonte, rehabilitation chief at the University of Pittsburgh Medical Center, who was not involved in the research. “I wouldn’t want to overenthuse family members or folks who think now we have a cure for this.”

Wallis has complete amnesia about the two decades he spent barely conscious, but remembers his life before the injury.

“He still thinks Ronald Reagan is president,” his father, Jerry, said in a statement, adding that until recently his son insisted he was 20 years old.

The research on Wallis, published Monday in the Journal of Clinical Investigation, was led by imaging expert Henning Voss and neurologist Dr. Nicholas Schiff at the Weill Medical College of Cornell University in New York City and included doctors at JFK Medical Center in Edison, N.J.

Wallis was 19 when he suffered a traumatic brain injury that left him briefly in a coma and then in a minimally conscious state, in which he was awake but uncommunicative other than occasional nods and grunts, for more than 19 years.

“The nerve fibers from the cells were severed, but the cells themselves remained intact,” unlike Schiavo, whose brain cells had died, said Dr. James Bernat, a neurologist at Dartmouth-Hitchcock Medical Center in New Hampshire, who is familiar with the research.

Nerve cells that have not died can form new connections; for example, nerves in the arms and legs can grow about an inch a month after they are severed or damaged. However, this happens far less often in the brain.

The new research suggests that instead of the sudden recovery Wallis seemed to make when he began speaking and moving three years ago, he actually may have been slowly recovering all along, as nerves in his brain formed new connections at a glacial pace until enough were present to make a network.

Researchers used a new type of brain imaging only available in research settings — not ordinary hospitals or rehabilitation centers — to establish the regrowth. It tracks the direction of water molecules in and around brain cells, an indicator of brain activity.

“It’s a roadmap of how the connections are running,” Schiff said.

Doctors compared Wallis’ brain function to that of 20 healthy people and another minimally conscious patient who showed virtually no recovery for six years. All were imaged twice, 18 months apart.

In Wallis’ brain, “what we first see is how overwhelmingly severe this injury was,” with many abnormalities compared to the healthy people, Schiff said.

The second set of images showed changes from the first, strongly suggesting that new connections had formed. These correlated with areas of the brain that affect the ability to move and talk.

The other minimally conscious patient — a 24-year-old man who suffered a severe brain injury in a car accident when he was 18 — also had evidence of changes in nerve connections, but they were not organized in a way that made a difference in his ability to function.

“We’ll have to understand more about why recovery occurred” in Wallis’ case, Zafonte said. “The question is ‘why?’ It’s not just ‘wait.’”

Until that is known, imaging cannot be used to predict who will recover, or to help patients’ brains rewire, he said.

The Charles A. Dana Foundation, which finances brain research, funded the scientific work. The lead author, Voss, also received money from the Cervical Spine Research Society, whose sponsors include companies that make spine care products. The British Discovery Channel and HBO paid to fly Wallis and family members to Cornell for tests.

“Most neurologists would have been willing to bet money that whatever the cause of it, if it hadn’t changed in 19 years, wasn’t going to change now,” Bernat said. “So it’s really extraordinary.”

Wallis’ father said his son is now able to make jokes. “That was something he wasn’t able to do early in his recovery,” Jerry Wallis said. “He now seems almost exactly like his old self. And he very often tells us how glad he is to be alive.”

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‘I felt trapped inside my body’ (Health reporter, BBC News, 060907)

Scientists have shown for the first time that a person diagnosed as being in a vegetative state can communicate.

For Kate Bainbridge, now 36, the news is especially significant.

In 1997, when Kate was 26, she caught an acute viral infection. It was so serious that it confined her to a vegetative state for six months.

While she was in hospital, unresponsive and seemingly unaware of her surroundings, Cambridge neuroscientist Dr Adrian Owen, who went on to make this latest discovery, scanned her brain.

He showed her familiar photographs, and realised from her brain activity that she was aware of the images that had been placed in front of her.

‘Scary experience’

As the months went on, and Dr Owen repeated the experiment, he found that Kate was becoming increasingly aware.

Kate says: “I don’t remember the scan at all.”

The first memories she had, she says, lasted for a few minutes when her occupational therapist came in.

Over the weeks, she gradually became more and more aware. But, she says, it was a very scary experience.

“Not being able to communicate was awful - I felt trapped inside my body. I had loads of questions, like ‘Where am I?’, ‘Why am I here?’, ‘What has happened?’.

“But I could not ask anyone - I had to work it all out.

“I could not move my face, so I could not show people how scared I was.”

A ray of hope

She said the scans changed everything.

“I just have to look and see what the scans did for me. They found I was there inside my body that did not respond.

Her parents, Bill and Gill Bainbridge, whom Kate lives with in Cambridgeshire, agree.

“The scan meant an enormous amount to us,” says Gill.

“Up until then it had been very difficult for us to cope with the fact that she was in this vegetative state, and although she could do small things like move her finger or twist her neck, we didn’t actually know what was going on with Kate.

“After the scan, the doctors were able to tell us for the first time that Kate’s brain was processing things.

“That was a big breakthrough and it meant when we were doing things with her - talking to her, showing her pictures, writing her notes - we felt, even if she didn’t understand, her brain was processing things.

“We realised something might be there to help her to cope with this horrendous experience she was going through.”

Vast improvements

It took Kate a further two years to recover full consciousness, and according to Gill, Kate has continued to improve over the years.

She uses a wheelchair and has some physical disabilities, but can communicate through a word-pad keyboard.

Kate thinks her recovery was spurred on by the scans.

She said: “I think the work Dr Owen is doing is so important.

“I can remember how awful it was to be like I was. It really scares me to think what could have happened if I hadn’t had the scan.”

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Major Brain Activity Found in Vegetative Patient (Foxnews, 060908)

WASHINGTON — Advanced brain scanning uncovered startling signs of awareness in a woman in a vegetative state, British scientists reported Thursday — a finding that complicates one of medicine’s ethical minefields.

The work is sure to elicit pleas from families desperate to know if loved ones deemed beyond medical help have brain activity that doctors don’t suspect.

“Can he or she hear and understand me?” is a universal question.

It’s far too soon to raise hopes, the British researchers and U.S. brain specialists stress. There’s no way to know if this 23-year-old woman, brain-damaged over a year ago, will recover, and therefore if her brain activity meant anything medically. Her brain injury may not be typical of patients in a vegetative state.

Scientists don’t even agree on whether the woman had some real awareness — she seemed to follow, mentally, certain commands — or if her brain was responding more automatically to speech.

“This is just one patient. The result in one patient does not tell us whether any other patient will show similar results, nor whether this result will have any bearing on her,” cautioned neuroscientist Adrian Owen of Britain’s Medical Research Council. He led the novel brain-scanning experiment, reported in the journal Science.

The work does raise calls for more research in this difficult-to-study population — because of the tantalizing prospect of one day learning how to predict whose brain is more likely to recover, and maybe even tailoring rehabilitation.

“It raises the questions of ethics and experience of these patients, I think, to a new level,” said neuroscientist Joy Hirsch of New York’s Columbia University Medical Center. “It raises the tension about how we treat these patients.”

But, “making medical decisions based on this information at this point in time we say is not appropriate,” warned Hirsch, who is conducting similar research and already receives “just heartwrenching” requests for help.

The woman was injured in a car crash. By the time Owen scanned her brain five months later, she had been pronounced in a vegetative state — physically unresponsive to a battery of tests. A small percentage of people make some recovery after spending a short period in a vegetative state.

Those who don’t improve after a longer period are classified as in a “persistent vegetative state,” such as the late Terri Schiavo, who became a subject of political controversy over the question of taking such patients off life support. An autopsy showed she had irreversible brain damage.

Doctors use MRI machines and other scanners to examine structural brain injuries. To see how the brain actually fires — what areas are activated during different processes — requires more advanced imaging called functional MRI, or fMRI.

Owen and colleagues contend their fMRI experiment showed the car-crash victim had some preserved conscious awareness despite her vegetative state.

How could they tell? First, they checked that she could process speech. Upon being told “there was milk and sugar in the coffee,” the fMRI showed brain regions reacting the same in the woman and in healthy volunteers.

Then came the big test. Owen told the woman to perform a mental task — to imagine herself playing tennis and walking through her house. Motor-control regions of her brain lit up like they did in the healthy people he compared with her.

“There is no other explanation for this than that she has intentionally decided to involve herself in the study and do what we asked when we asked,” Owen said in an interview.

Other scientists say that’s not clear-cut.

The results are “not totally convincing of consciousness,” neuroscientist Lionel Naccache of INSERM, France’s national science institute, wrote in a review in Science. He cautioned that the woman’s injuries weren’t as massive as those of most vegetative-state patients.

Columbia’s Hirsch said the woman is not conscious. But, “it tells me that this patient’s brain is operating the essential elements for consciousness. The machinery is there and operating,” she said.

Owen refused to disclose the woman’s current condition. But asked if the brain activity suggests she could recover, he said, “We just don’t know.”

Hirsch said there is little funding for research on the vegetative state, and legal hurdles to working with those patients, but the new report demands that more be done.

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‘Peaceful pill’ would give patients permanent rest: Australian founder of suicide group promotes plan at conference (WorldNetDaily, 060914)

An Australian doctor who promotes suicide as a way to die has introduced a new “peaceful pill” plan to advocates at a conference, touting the pill for its accessibility – and legality.

In a report on Canadian Television, Dr. Philip Nitschke of Exit International said that his plan allows for the self-appointed date with death he advocates.

“You can do everything yourself, acquire what you need, access what is ultimately the most peaceful way of a peaceful death,” he told those attending a Toronto conference.

“If you can manage things yourself you don’t break laws,” he said about the instructions in his book on the subject.

The book describes a lethal barbiturate concoction that acts by depressing the central nervous system, and observers say it appears similar to drugs used in the few countries where euthanasia is allowed.

In Australia, Nitschke is faced with a law that prohibits even giving how-to consultations on suicide and he has moved his group’s website to New Zealand to avoid that conflict. In Canada, a proposal to allow assisted suicide died at the conclusion of a recent Parliament, and in the United States, only one state, Oregon, now allows physicians to prescribe medications to be used for suicide.

The “self-help” idea earned some immediate opposition even from the right-to-die supporters.

Donald Babey of Dying with Dignity Canada said it doesn’t address the final solution of having physician assistance.

Christian organizations such as Focus on the Family in Colorado Springs have written extensively on the issue of suicide and euthanasia. In one interview former U.S. Surgeon General C. Everett Koop said he believes euthanasia someday will dwarf the abortion industry.

It’s like letting a snake out of a basket, Focus said: Once it’s out, there’s no telling where it will slither.

Nitschke said, in a LifeSiteNews.com report, that volunteers with his organization donated several thousand dollars to assemble a lab at a New South Wales farm where they were able to put the drug into a crystalline form.

Nitschke, who has been discussing the concept of such a pill for several years, said 100 people already are waiting to use it.

Other Exit International recommendations have included a plastic bag over one’s head, a homemade unit to generate carbon monoxide, or use of large amounts of sleeping pills such as Nembutal, according to the group’s website.

On his website, Nitschke has posted a letter from Bob Dent, who was helped by Nitschke into the hereafter in 1996.

“The Church and state must remain separate. What right has anyone, because of their own religious faith (to which I don’t subscribe), to demand that I behave according to their rules until some omniscient doctor decides that I must have had enough and goes ahead and increases my morphine until I die?” he wrote at the end of his battle with cancer.

“If you disagree with voluntary euthanasia, then don’t use it, but don’t deny me the right to use it if and when I want to,” he wrote.

Focus analysts, however, argue that this was the same way that the Nazi extermination of groups of people began: first with the old and infirm, then the handicapped, and eventually entire blocks of people just because they belonged to that group.

In the U.S., Vermont at one point considered the “Death With Dignity Act” and California has reviewed a plan, but Oregon’s physician-assisted suicide plan has been approved by the courts.

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When to let a baby die: experts set the guidelines (Times Online, 061115)

Babies born after only 22 weeks in the womb should not be routinely resuscitated, according to a report on guidelines for doctors and parents on treating premature babies, which was released today.

The Nuffield Council on Bioethics, an independent ethics body, has found that premature babies born at 22 weeks - whose chances of survival are low and disability high, should not be put through the stress and pain of intensive care treatment.

The controversial report called Critical Care Decisions in Fetal and Neonatal Medicine, sparked debate before its release, in particular from religious groups on whether premature or sick babies should be allowed to die.

Beginning its inquiry two years ago, the council says that advances in medicine mean that families and doctors can be faced with “extremely difficult decisions about the care of very premature or seriously ill babies”.

“These decisions are complex, emotionally demanding and may have lifelong consequences,” it said.

The council, an independent body, was established in 1991 to examine ethical questions raised by advances in biological and medical research.

While it has no enforcement powers, it has sent its report to the Department of Health and the Royal Colleges.

Figures suggest that no baby survives at 21 weeks while 1 per cent may survive at 22 weeks. Only about 1 per cent of babies born between 22 and 23 weeks survive to leave hospital.

The council recommends that normal practice should not be not to give intensive care at this age, unless parents request it after a thorough discussion of the risks and if the doctors agree.

“Natural instincts are to try and save all babies, even if the baby’s chances of survival are low,” said Professor Margaret Brazier, who was leading the working party.

“However, we don’t think it is always right to put a baby through the stress and pain of invasive treatment if the baby is unlikely to get any better and death is inevitable.”

Medical experts have argued that using invasive treatment on very sick babies - such as putting tubes down the throat or inflicting up to 15 procedures a day - actually “prolongs the process of dying”.

Doctors then face the question - which is not always clear cut, over which babies will survive and which will need constant care and assistance.

John Wyatt, professor of neonatal paediatrics at UCL, said that he welcomed the report, particularly the strong statement against the intentional ending of life in critically ill babies.

However he was concerned the findings put great emphasis on managing babies by their gestational age, when in practice, assessing the maturity of babies can be unreliable and can vary by up to two weeks.

“Although I welcome the guidelines, I believe that doctors must continue to individualise care in each unique situation - in other words cut off times don’t necessarily fit neatly with clinical practise,” he said.

The Church of England, in its submission, said that every life is valuable to God, but there could be rare circumstances when treatment was futile and a child could be allowed to die.

The report also offers guidance on how to resolve arguments between parents and doctors over the fate of their child.

The number of extremely premature babies being born has been increasing since the 1980s. The age at which premature babies can survive has been falling by around one week every decade over the past 40 years. But most will still die.

The UK has the highest rate of low-birth-weight babies in Western Europe, according to premature baby charity Bliss.

Because of the difficulty involved in being able to predict whether babies aged between 23-24 weeks will live, die or survive with disabilities, the council has recommended that parents, after thorough consultation with doctors, have the final decision.

After 25 weeks gestation, babies have a sufficiently high chance of surviving and a low risk of severe disability, and intensive care should be given, the council found.

The report also gives guidance on abortion decisions in pregnancy, when an abnormality becomes apparent. Under the Abortion Act 1967, pregnancies can be terminated up to 24 weeks.

The Royal College of Obstetricians and Gynaecologists has called for an open discussion on the ethics of euthanasia for the sickest babies.

In its submission the college urged the council to think radically about euthanasia of newborns and withholding treatment in the face of severe disability.

Paul Tully, the general secretary of the Society for the Protection of Unborn Children, said that he feared the report’s recommendations could encourage moves towards euthanasia for disabled babies.

Dr Tony Calland, the BMA’s Chairman of the Medical Ethics Committee had a similar view, stressing the importance of individual cases.

“Blanket rules do not help individual parents or their very premature babies,” he said.

“Each case should be considered on its merits and its own context. While we believe that not all patients – including babies – benefit from medical intervention if survival is unlikely, it is important that each patient’s circumstances are assessed independently. We therefore cannot agree with stringent cut-off points for treatment.”

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Swiss High Court Makes Way for Assisted Suicide for Mentally Ill (Christian Post, 070204)

LAUSANNE, Switzerland (AP) - A ruling by Switzerland’s highest court has opened the possibility that people with serious mental illnesses could be helped by doctors to take their own lives.

Switzerland already allows physician-assisted suicide for terminally ill patients under certain circumstances but the Federal Tribunal’s decision, which was released on Friday, puts mental illnesses on the same level as physical ones.

“It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term,” the ruling says.

It goes on to state that “if the death wish is based on an autonomous decision which takes all circumstances into account, then a mentally ill person can be prescribed sodium-pentobarbital and thereby assisted in suicide.”

Various organizations exist in Switzerland to help people who want to commit suicide, and assisting someone to die is not punishable under Swiss law as long as there is no “selfish motivation” for doing so.

The judges made it clear in their ruling that certain conditions would have to be met before a mentally ill person’s request for suicide assistance could be considered justified.

“A distinction has to be made between a death wish which is an expression of a curable, psychiatric disorder and which requires treatment, and (a death wish) which is based on a person of sound judgment’s own well-considered and permanent decision, which must be respected,” they said.

The case was brought by a 53-year old man with serious bipolar affective disorder, who asked the tribunal to allow him to acquire a lethal dose of pentobarbital without a doctor’s prescription.

The tribunal ruled against his request, confirming the need for a thorough medical assessment of the patient’s condition, which a prescription would confirm.

Whether any Swiss physician would be prepared to prescribe a lethal dose of pentobarbital to a mentally ill person remains unclear. The country’s national ethics commission could not be reached for comment late on Friday.

Switzerland is one of a number of countries in Europe that allow assistance to terminally ill people who wish to die.

Netherlands legalized euthanasia in 2001 and Belgium in 2002, while Britain and France allow terminally ill people to refuse treatment in favor of death.

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Life Lessons: What the Terri Schiavo case taught us, two years later. (Weekly Standard, 070402)

by Chris Gacek

THIS WEEKEND marked the second anniversary of Terri Schiavo’s death. It is widely asserted by the mainstream press, liberal activists, and some in the Democratic party that those who argued for congressional action in her case were not only wrong to do so, but acted without any reasonable justification. Quite to the contrary: The circumstances surrounding Terri Schiavo’s death demonstrate that reforms are needed to protect persons like her in the future.

In such situations, issues of life and death are involved. Yet unlike the cases of death row inmates, those in Terri’s position are now likely to receive only superficial review combined with inadequate safeguards. An overview of the events provides the key. There are two questions that must be addressed to reexamine the Schiavo case properly: First, did Florida interpret its laws correctly? Second, what did Congress actually do when it got involved?

Under Florida law, the case’s central issue was what end of life decision Terri Schiavo have made if she were competent. A decision to end life-sustaining measures needed “clear and convincing” evidence that Terri would have preferred that option. This standard requires less than the criminal law’s “beyond a reasonable doubt” standard, but demands more than the evidentiary “preponderance” standard generally applied in civil cases. Controlling Florida case law at the time required that evidence meeting the standard must produce “a firm belief or conviction, without hesitancy, as to the truth of the allegations sought to be established.”

Terri’s injury occurred in February 1990, but the probate court’s sole hearing convened by Judge George Greer to gather evidence about her end-of-life wishes occurred almost ten years later. In that hearing, numerous witnesses described long-past events and provided speculative reasons to support contentions that Terri would have either wanted her life maintained or ended. The testimony was divergent and contradictory.

Notre Dame law professor O. Carter Snead argues powerfully that the Florida courts “abandoned” their “clear and convincing” standard, thus making it impossible “to have any confidence that Mrs. Schiavo’s actual intentions were honored.” Snead says further that Judge Greer applied the standard “in an unrigorous and unreliable manner “ while relying on evidence that constituted “a veritable parade of every species of presumptively unreliable statement long rejected by courts across the nation called upon to adjudicate end of life disputes.”

It is difficult to maintain that Judge Greer correctly applied the clear and convincing standard, and the appellate court’s review can only be described as cursory. Realizing that decisive legal errors remained uncorrected, the Congress attempted to obtain an expeditious federal court review. That action represented the kind of fail-safe protection liberals usually favor—a court critique. But not this time.

Presidential candidate Mitt Romney recently reiterated the “accepted wisdom,” stating that the case would have been better left to the courts. Romney seemed to be implying that Congress tried to legislate the case’s outcome. Not true: Congress merely sought an emergency review in the courts. Legal scholar, Michael Paulsen, described the congressional enactment’s function as being “very similar to what the federal habeas statute does.”

Unfortunately, in the great rush of events, the federal courts misapplied the standard for granting temporary injunctions. Typically, the “likelihood of success on the merits” is balanced with the severity of any “irreparable injury” resulting from the injunction’s denial. As Paulsen observed, “As irreparable injuries go, death is a pretty absolute and irrevocable one.”

There would have been no harm in letting Terri Schiavo live until the legal matters were thoroughly analyzed. Instead of deferring to the “irreparable injury” that would befall Terri and recognizing the possibility that not all of the case’s complex issues had been fully considered, the federal courts found there was little likelihood of success and therefore did not stay Judge Greer’s order.

Sadly, Terri Schiavo’s death showed America that the laws and institutions meant to protect the disabled are much weaker than those protecting felons. If our governments, both state and federal, are going to issue orders putting innocent, disabled persons to death, they should be afforded at least as much protection and judicial review as a convicted murderer would receive. Potential reforms could include using the “beyond a reasonable doubt” standard to judge end of life claims, having juries assess disputed factual claims, and/or instituting processes for review akin to habeas corpus.

State and federal legal reforms are clearly needed to address the deficiencies made evident in the Schiavo case. Taking a life is no small thing and all of our laws should reflect this truth.

Chris Gacek is senior fellow for Regulatory Affairs at the Family Research Council,

Washington, D.C.

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Poll: Americans Evenly Divided Over ‘Mercy Killings’ (Christian Post, 070529)

NEW YORK (AP) - More than two-thirds of Americans believe there are circumstances in which a patient should be allowed to die, but they are closely divided on whether it should be legal for a doctor to help terminally ill patients end their own lives by prescribing fatal drugs, a new AP-Ipsos poll finds.

The results were released Tuesday, just days before Dr. Jack Kevorkian is freed from a Michigan prison after serving more than eight years for second-degree murder in the poisoning of a man with Lou Gehrig’s disease.

Kevorkian’s defiant assisted suicide campaign, which he waged for years before his conviction, fueled nationwide debate about patients’ “right to die” and the role that physicians should play.

Though demonized by his critics as a callous killer, Kevorkian — who is to be released Friday — maintains relatively strong public support. The AP-Ipsos poll found that 53% of those surveyed thought he should not have been jailed; 40% supported his imprisonment. The results were similar to an ABC News poll in 1999 that found 55% disagreeing with his conviction.

The new AP-Ipsos poll asked whether it should be legal for doctors to prescribe lethal drugs to help terminally ill patients end their own lives — a practice currently allowed in Oregon but in no other states. Forty-eight percent said it should be legal; 44% said it should be illegal.

More broadly, 68% said there are circumstances when a patient should be allowed to die, while 30% said doctors and nurses, in all circumstances, should do everything possible to save the life of a patient.

A majority of respondents — 55% — said they would not consider ending their own lives if ill with a terminal disease. Thirty-five percent said they would consider that option.

Oregon’s physician-assisted suicide law took effect in 1997. Through last year, 292 people — mostly stricken with cancer — have died under its provisions, which allow terminally ill, mentally competent adults to administer life-ending medication prescribed by a physician.

In addition to Oregon, three European countries — Switzerland, Belgium and the Netherlands — authorize assistance by doctors in the deaths of patients.

Oregon’s law has been reaffirmed by state voters and has survived intense legal challenges, but has yet to be emulated in any other state. Bills have been defeated by lawmakers in Vermont, Hawaii, Wisconsin and Washington; ballot measures to allow physician-assisted death have lost in Washington, California, Michigan and Maine.

The current battleground is California, where a bill similar to Oregon’s law is moving through the legislature. Even if it were to win final passage, there is uncertainty whether Gov. Arnold Schwarzenegger would sign it; he recently suggested the issue should go directly to voters as a ballot initiative.

Assemblywoman Patty Berg, a co-author of the bill, said it gives a terminally ill patient “the power to chose the time, place and circumstances of their death.” She contended that most Californians support the measure, but that it faces tough opposition from the Roman Catholic Church, some conservative Protestant churches, and the California Medical Association.

“Physicians look at it as the ultimate abandonment of a patient,” said medical association spokesman Ron Lopp. “That’s not the physician’s role, to aggressively hasten death.”

The AP-Ipsos poll showed that religious faith is a significant factor in views on the subject.

Only 34% of those who attend religious services at least once a week think it should be legal for doctors to help terminally ill patients end their own lives. In contrast, 70% of those who never attend religious services thought the practice should be legal.

Just 23% of those who attend religious services at least weekly would consider ending their own lives if terminally ill, compared to 49% of those who never attend religious services.

There also was a divide along partisan lines, with 57% of Democrats saying it should be legal for doctors to help terminally ill patients end their own lives compared to 39% of Republicans. Similarly, 56% of Republicans felt Kevorkian should have been jailed, compared to 31% of Democrats.

Men were more likely to say they would consider ending their own lives if faced with a terminal illness — 43% of men would consider the option, compared to just 28% of women. And 53% of men think it should be legal for doctors to help end the lives of terminally ill patients, compared to 44% of women.

Southerners and Midwesterners are most likely to oppose assisted suicide. The poll found that 59% of Northeasterners feel the practice should be legal, compared with 52% in the West, 45% in the Midwest, and 43% in the South.

The AP-Ipsos poll involved telephone interviews with 1,000 randomly chosen adults from May 22-24. The margin of sampling error was plus or minus 3%age points.

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Man Set to Be Euthanized Regains Consciousness (Christian Post, 080628)

A Gulf War veteran who was set to die in an Arizona hospital was found to have regained complete consciousness on Tuesday.

A decision to pull Jesse Ramirez, 36, from his feeding tubes on June 8 had been reversed after a lawsuit filed by the rest of his family. The move has paid off now that the man is responding and is set to move to a rehabilitation center.

“We have had a lot of miracles,” said Betty Valenzuela, Ramirez’s aunt, in the Arizona Republic. “He would have been gone.”

On May 30, Ramirez was part of a serious car accident where he suffered multiple injuries and was put into a comatose state. He was placed onto feeding tubes where he received nourishment and water.

Ten days later, the man’s wife, Rebecca, 33, asked doctors to pull him from the tubes after they explained that the accident would probably leave the man blind or in vegetative state.

For five days, the hospital withheld sustenance from the injured man, but restored the tubes after the Alliance Defense Fund (ADF) – an Ariz.-based Christian law firm – filed a lawsuit on behalf of the rest of Ramirez family.

On Tuesday, a settlement was reached in which all decision-making for the patient will move from wife Rebecca to a court-appointed guardian. The man will also be moved to a rehabilitation center.

Ramirez has regained many skills now, including hugging and kissing, nodding his head, responding to voice commands, and knowing his and his family’s identity.

“The decision to withhold food and water was hasty and wrong under Arizona law,” explained Byron Babione, a senior legal counsel for ADF who argued two weeks ago before an Arizona judge on behalf of Ramirez’s sister, Marlene.

“Jesse had only ten days – about 240 hours – before his feeding tube was removed,” he added in a statement.

The incident is similar to case involving Theresa Marie “Terri” Schiavo in Florida in 2005. She too was placed on feeding tubes and was eventually starved to death after authorities removed them. She had been in a vegetative state since 1990, however.

According to a report from Rebecca Ramirez, who was also in the Toyota SUV when it crashed, the accident was a result of a heated argument in the car between the husband and wife about a man’s phone number on Rebecca’s phone. It was reported that Jesse was suspicious of an affair.

After refusing to let the woman out of the car, she opened her door as if to jump, causing concern to Jesse which led to him to flip the car over and throw them both from the vehicle.

Police are still investigating the reports, however.

Some people have questioned Rebecca’s motives in deciding to pull her husband from his feeding tubes so early but Judith Morse, the court-appointed lawyer assigned to mediate the family, felt her concerns were sincere.

“I have no reason to think she doesn’t have his best interests in mind,” she explained in the Arizona Republic. “All the family members are doing what they think is best.”

Others, meanwhile, are blaming the hospital, saying they should not have so quickly complied with the wife’s demands. The decision was rushed, they feel.

“Everyone deserves a chance to recover from an injury, and now Jesse has that chance,” said Babione. “Jesse put his life on the line for us during the Gulf War. The least that should be done for Jesse and his family is to give him a chance to recover.”

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Death on Demand: The assisted-suicide movement sheds its fig leaf. (Weekly Standard. 070705)

by Wesley J. Smith

SHOULD LAWS AGAINST assisted suicide be rescinded as “paternalistic?” Should assisted suicide be transformed from what is now a crime (in most places) into a sacred “right to die”? Should assisted suicide be redefined from a form of homicide into a legitimate “medical treatment” readily available to all persistently suffering people, including to the mentally ill?

According to Brown University professor Jacob M. Appel, the answer to all three of these questions is an unequivocal yes. Writing in the May-June 2007 Hastings Center Report (“A Suicide Right for the Mentally Ill?”), Appel argues in that assisted suicide should not only be available to the terminally ill, but also to people with “purely psychological disease” such as victims “of repeated bouts of severe depression,” if the suicidal person “rationally might prefer dignified death over future suffering.”

Given the emphasis assisted suicide advocates and the media normally give to the role of terminal illness in the assisted suicide debate, it might be tempting to dismiss Appel as a fringe rider. But he most definitely is not. Over the last several years, advocacy for what is sometimes called “rational suicide” has been growing increasingly mainstream, discussed among the bioethical and academic elite in mental health publications, academic symposia, and books. Indeed, it is worth noting that Appel’s essay appeared in the world’s most prestigious bioethics journal.

As disturbing as Appel’s proposal is—it is essentially a call for death-on-demand—it is refreshing that Appel has written so candidly. After years of focus group-tested blather from the political wing of the euthanasia movement claiming that legalizing assisted suicide would be strictly limited to the terminally ill, we finally have a clearer picture of where the right-to-die crowd wishes to take America.

Moreover, unlike a restricted right to assisted suicide, Appel’s call for near death-on-demand is logically consistent. There are two weight-bearing intellectual pillars that support euthanasia and assisted suicide advocacy: (1) a commitment to a radical individualism that includes the right to choose “the time, manner, and method of death” (often called “the ultimate civil right” by assisted suicide aficionados); and (2) the fundamental assumption that killing is an acceptable answer to the problems of human suffering. Appel describes these conjoined beliefs succinctly as the “twin goals of maximizing individual autonomy and minimizing human suffering” by avoiding “unwanted distress, both physical and psychological” through creation of a legal right “to control . . . when to end their own lives.”

HOPING TO whistle past the graveyard, some might dismiss all of this as mere theoretical posturing. Were it so. Assisted suicides for the mentally ill are already taking place in euthanasia-friendly locales. Indeed, nearly every jurisdiction that has legalized assisted suicide for the seriously ill—as well as those that have refused to meaningfully enforce anti-assisted suicide laws—has either formally expanded the legal right to die to those suffering existentially, or shrugged in the face of illegal assisted suicides of the depressed. To wit:

Switzerland: In February, the Swiss Supreme Court ruled that the mentally ill have a constitutional right to assisted suicide, because, as reported in the International Herald Tribune, “It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term.”

The Netherlands: The Dutch Supreme Court issued a similar ruling back in 1993 when it approved a psychiatrist assisting the suicide of his chronically depressed patient who wanted to die due to unremitting grief caused by the deaths of her adult children—even though the doctor never attempted to treat the woman. The basis for the ruling followed the above described logic of euthanasia: Suffering is suffering and it doesn’t matter whether the cause is physical or emotional, meaning that Dutch mercy killing need not be limited to the sick and disabled.

The United States: We saw a similar phenomenon in America’s reaction to the decade-long assisted suicide campaign of Jack Kevorkian. Not only were the majority of Kevorkian’s “patients” not terminally ill (most were disabled)—but several were not even sick. For example, Marjorie Wantz, Kevorkian’s second assisted suicide who died on October 23, 1991, complained about severe pelvic pain. Her autopsy revealed that nothing was wrong physically. It turned out that she had been hospitalized previously for mental problems. In 1996 Rebecca Badger went to Kevorkian complaining of having multiple sclerosis. Her autopsy proved that she was disease free. It was later reported that she had been depressed and addicted to pain pills. Despite these and other such cases of his assisting the depressed to kill themselves, Kevorkian remained publicly popular until he was finally jailed in 1999 after he videotaped himself murdering Lou Gehrig’s patient Thomas Youk by lethal injection.

Oregon: Advocates for legalizing assisted suicide frequently tout Oregon’s law as proving

that assisted suicide can be restricted to the terminally ill. In actuality, little is known about what is happening in the state because it gets information about these practices almost exclusively through self-reporting by participating doctors.

Even so, the curtain was pulled back briefly when a peer-reviewed article in the June 2005 American Journal of Psychiatry appeared describing a potential assisted suicide of a psychotic man that was disturbingly similar to what is happening in the Netherlands and Switzerland. After cancer patient Michael J. Freeland received a lethal prescription, he had to be hospitalized for mental illness. Despite being delusional, his psychiatrist permitted him to keep the fatal overdose, in the doctor’s words, “safely at home”—even though this same doctor advised a court that Freeland would “remain vulnerable to periods of delirium” and would “be susceptible to periods of confusion and impaired judgment.” (Freeland died naturally nearly two years after receiving his lethal prescription—meaning he was also not terminally ill as defined by Oregon’s law when he was prescribed the lethal overdose in the first place.) Needless to say, nothing was done to remedy this apparent breach of law.

THE NATURAL TRAJECTORY of assisted suicide advocacy leads to such ever-widening expansions of killable categories: from the terminally ill, to the disabled and chronically ill, to the “tired of life” elderly, and eventually to the mentally ill. Appel understands this and approves. He writes:

Contemporary psychiatry aims to prevent suicide, yet the principles favoring legal assisted suicide lead logically to the extension of these rights to some mentally ill patients. But now that several Western nations and one U.S. state have liberalized their laws, it seems reasonable to question the policies that universally deny such basic opportunities to the mentally ill.

With the truth now clearly in view, the time has come to have real debate about the so-called right to die. This debate should not pretend that the practice will be limited and rare and it should fully address the societal implications of transforming assisted suicide into a mere medical treatment.

So, let’s argue openly and frankly about the wisdom of permitting near death-on-demand as a method of ending serious and persistent suffering. Let’s discuss whether “choice” and “individual autonomy” requires that we permit licensed and regulated euthanasia clinics to serve anyone who has made an irrevocable decision to die.

Indeed, let’s argue whether or not society owes a duty of prevention to the self-destructive who are not acting on mere impulse. But finally, let’s stop pretending that assisted suicide legalization would be just a tiny alteration in public policy restricted only to the terminally ill. That clearly isn’t true.

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Vatican: Feed ‘Vegetative’ People Regardless of Prognosis (Christian Post, 070916)

The Vatican reaffirmed its teaching on the sanctity of human life by stating Friday that nutrition and hydration should be provided to individuals in persistent “vegetative state.”

Patients in a “vegetative state” are living human beings with inherent dignity and deserve the same basic care as other patients, responded the Holy See to the formal questioning of the U.S. Conference of Catholic Bishops. Basic care includes nutrition and hydration, even when provided through artificial assistance.

“The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life,” responded the Congregation for the Doctrine of the Faith, the Vatican department that oversees Catholic doctrine, according to the USCCB.

“It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient,” the Congregation added. “In this way suffering and death by starvation and dehydration are prevented.”

The Vatican further affirmed that a patient should receive ordinary care, such as food and water, regardless of prognosis of recovery and recommendation by physicians.

In response, the Terri Schindler Schiavo Foundation thanked the Holy See for reaffirming the moral need to care for people in “vegetative” state.

“It is our fervent hope that the clergy, religious and those who administer Catholic health care, as well as the laity who persistently ignored the basic right to life of our daughter and sister Terri…will begin to open their eyes and hearts to the immutable and incontrovertible truth re-affirmed by the Holy See today,” the foundation expressed in a statement.

Terri Schindler Schiavo, who remained in a “vegetative” state for 15 years, died in 2005 when her feeding tube was removed against the will of her family after the court ruled in favor of her husband and guardian Michael Schiavo. Since her death, the Schindlers have started a foundation in her name to help people with disabilities and facing potential life-threatening situations avoid an outcome like Terri’s.

In its clarification, the Vatican did, however, note exceptions to the church teaching. Exceptions include people living in remote places or in extreme poverty where provision of food and water may be physically impossible.

In addition, basic care can morally be terminated if a patient is unable to assimilate food and liquids so as the care becomes useless or if the nourishment causes the patient significant discomfort.

“These exceptional cases, however, take nothing away from the general ethical criterion, according to which the provision of water and food, even by artificial means, always represents a natural means for preserving life, and is not a therapeutic treatment,” clarified the Vatican. “Its use should therefore be considered ordinary and proportionate, even when the ‘vegetative state’ is prolonged.”

The USCCB had asked the Holy See for clarification of the Church’s teaching after Pope John Paul II’s address on March 20, 2004, to an international congress sponsored by the Pontifical Academy for Life and the World Federation of Catholic Medical Associations.

“We are grateful that the Congregation for the Doctrine of the Faith responded to our request with such a thorough investigation and explanation,” said Bishop William E. Lori of Bridgeport, Connecticut, chair of the U.S. bishops’ Committee for Doctrine.

“We hope the Church’s documents on this issue will provide help and guidance to pastors, ethicists, doctors, nurses and families involved in the care of those diagnosed as being in a persistent ‘vegetative state.’”

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Man Declared Dead Awakens During Autopsy (Reuters, 070917)

CARACAS, Venezuela — A Venezuelan man who had been declared dead woke up in the morgue in excruciating pain after medical examiners began their autopsy.

Carlos Camejo, 33, was declared dead after a highway accident and taken to the morgue, where examiners began an autopsy only to realize something was amiss when he started bleeding. They quickly sought to stitch up the incision on his face.

“I woke up because the pain was unbearable,” Camejo said, according to a report on Friday in leading local newspaper El Universal.

His grieving wife turned up at the morgue to identify her husband’s body only to find him moved into a corridor — and alive.

Reuters could not immediately reach hospital officials to confirm the events. But Camejo showed the newspaper his facial scar and a document ordering the autopsy.

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The burden of mercy: Forces for society’s most vulnerable convene at conference (National Post, 071201)

For the physicians, ethicists and academics attending the First International Symposium on Euthanasia and Assisted Suicide in Toronto this weekend, the world is being softened up for state-sanctioned killing of the weak.

“Once you bring death into the equation, then everything changes for the most vulnerable,” said Alex Schadenberg, one of the organizers of the event.

Mr. Schadenberg, executive director of the Euthanasia Prevention Coalition in Canada, believes right-to-die forces are well organized and on the march.

Although Oregon has been the only jurisdiction in North America to approve physician-assisted suicide, there have been efforts to make it legal in California, Vermont and Washington. Laws similar to Oregon’s are in place in Switzerland, Belgium and the Netherlands. A Gallup poll this year found 71% of Americans approve of doctors ending the lives of terminally ill patients who request it.

Mr. Schadenberg, and the like-minded who have convened this conference, insist it is only a short step from the seemingly benign notion of allowing those in the final thronges of a terminal illness to legally take their own lives with the help of doctors, to killing those who are a burden to society.

“When it comes down to how it would apply to society in the long term, it will mean people who are most vulnerable will feel a subtle pressure from a society that often sees death as the best choice.”

That is why, he said, a conference is needed to unite anti-euthanasia forces and develop a singular strategy to get their point across. Among other things, the conference will hear how the Nazi euthanasia program of the disabled relates to events today and how the medical language used by pro-euthanasia groups can disguise the “horror” of what is simply killing.

Many also feel that Canada may soon see legalized physician-assisted suicide. The majority of the Supreme Court of Canada ruled in 1993 that the law banning assisted suicide did not violate the Charter of Rights and Freedoms, in response to a challenge by Sue Rodriguez, a British Columbia woman who suffered from Lou Gehrig’s disease. (She died the following year from a lethal overdose of drugs.) But the vote was only 5-4, meaning another court may rule differently on another challenge. And two years ago, a private member’s bill to make physician-assisted suicide legal in Canada was introduced but faded when the election was called.

Oregon made physician-assisted suicide legal 10 years ago and since then 300 patients, most with cancer, have used the system to end their lives.

Lovelle Svart was one of them. In fact, the 62-year-old cancer patient’s preparations to take her own life are methodically documented on the Web site of The Oregonian newspaper. In a video, Ms. Svart is shown surrounded by family and friends while a volunteer from Compassion and Choices of Oregon walks her through the procedure to take the lethal medicine.

The volunteer, who has attended three dozen such suicides, says, “Is this what you really want?” Ms. Svart replies, “Actually, I’d like to go on partying. But yes.”

Supporters of Oregon’s Death With Dignity Act say it is a humane system that allows cogent adults to avoid horrific pain and die with some measure of control and peace, which certainly looks to be the case with Ms. Svart.

“For many patients, the first goal is simply the reassurance of knowing it’s going to be available,” said Dr. Nick Gideonse, who has prescribed six lethal doses to terminal patients. “Patients will say, ‘This disease has robbed me of my life, my strength, my future. But darn it, the last day I’m the one going to make the call here.’ “

But opponents call it an unnecessary loss of life that puts doctors in the role of executioner. They say many who opt for physician-assisted suicide could have experienced a fulfilling, pain-free life almost to the end.

“It’s an inherent conflict of interest for physicians,” argues William Toffler, a physician from Oregon who will be in Toronto this weekend. “It’s at odds with a tradition of being an unimpeachable advocate for the health and well-being of our patients.”

Critics also argue that as painful as it may be to deny someone a legal and quick procedure to end their suffering, the damage to society outweighs the benefit to the individual.

“I can understand at the individual level that in some cases you wish it was all over with, but the problem is as a society you have to choose what’s going to be your norm,” said Margaret Somerville, the founding director of the McGill Centre for Medicine, Ethics and Law, one of the main speakers at this weekend’s meeting.

“We have this idea that what happens to me is nobody’s business. The problem with euthanasia is it requires another person to do it, and it requires a complicit society to authorize it.”

She fears that in a society in which such things as health care costs are hugely important, it is easy to imagine decisions of life and death being made on the basis of dollars. “One Australian politician said, which was completely amazing, ‘When you have passed your best-before or used-by date you should be checked out as quickly, cheaply and efficiently as possible.’ It’s like we’re a supermarket product.”

She also said there is no controlling this once it starts. The Netherlands, the first country to legalize euthanasia, was originally set up like the Oregon model. But then three years ago, guidelines were released for the mercy killing of terminally ill newborns.

Professor Mark Mostert, of Regent University in Virginia, goes even further: He says the same economic rationale that eliminated “useless eaters” under the Nazi program of killing the disabled, is subtly at work today.

“If you’re terminally ill and it’s going to cost us thousands of dollars, and you’re still going to die, then maybe it would make better economic sense to use the money for somebody else,” he said.

But 10 years into Oregon’s experience with physician-assisted suicide there is little evidence that such a nightmare scenario of killing poor and vulnerable people is taking place.

Records kept by the state show that all patients, except one, had health insurance, and 22% had some university education, while 41% had a bachelor’s degree or greater. The two most cited concerns for taking the life-ending drugs were loss of autonomy (87%) and losing the ability to engage in activities that make life enjoyable (87%). Twenty-six per cent cited inadequate pain control or concerns about pain control.

Of the 65 patients prescribed a lethal dosage in 2006, for example, 35 took their own lives, 19 died from their disease and 11 were still alive at the end of 2006.

Dr. Linda Ganzini, a professor of psychiatry and medicine in Oregon, whom many consider one of the few objective researchers in the state, interviewed physicians, hospice nurses, social workers, chaplains and family members who were involved with someone who took their lives under the law.

“At a moral level, I’m somewhat uncomfortable with assisted suicide,” she admits. “Of the 100 most important things you can do for people at the end of life, this is not one of them. On the other hand, I find it offensive [to question] them and their families for a making a choice that’s consistent with their values.”

She said the typical patient who chooses to die puts a high value on independence, wants to be in control and is not religious. “No one is making them do this. If anything, they’re manipulating their world to make it OK.

“I came into this with the idea that if I could inform the debate it would help people form an opinion,” Dr. Ganzini said. “But what’s interesting is the more information people have, the more they don’t change their opinion, they just change their argument. There’s really something at a gut level about this issue that is not about the data.”

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Car Accident Victim Dies After Family Loses Australian Court Battle to Maintain Life Support (Foxnews, 071220)

[KH: now the court can overrule the family, worrying signs]

DARWIN, Australia — An Australian car accident victim died Thursday after his family lost a legal battle to keep him on life support in a hospital, an official said.

Paulo Melo, 29, from Darwin on Australia’s north coast, slipped into a coma after suffering brain and spinal injuries in a Dec. 5 accident.

His family gained a temporary injunction in the Northern Territory Supreme Court on Tuesday preventing the Royal Darwin Hospital from switching off his life support system, which had kept him alive.

But a judge lifted the injunction Wednesday, describing the patient’s medical condition as futile.

Melo’s family said his life support was removed late Wednesday but he continued to breath unaided.

Police spokeswoman Katie Fowden said Melo died in hospital Thursday.

Hospital officials declined to comment.

Melo’s siblings and parents maintained that he had been making progress, moving his eyes and head in response to his family’s visits.

But more than 20 medical experts agreed there had been no chance of recovery.

Melo’s sister, Isabel, said he appeared to try to speak to his father before his life support was turned off.

“Various people went in and it always appeared as though he was trying to speak,” she told Australian Broadcasting Corp. radio.

“We thought that he was calling out for dad and things like that, but it wasn’t clear speech but it appears as though he did speak,” she added.

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Canadian judge to rule on Jew facing euthanasia (Jerusalem Post, 080106)

A Canadian judge is due to decide this week whether to renew a temporary injunction against Winnipeg’s Grace General Hospital, whose doctors want to detach an 84-year-old Orthodox Jew from a respirator and hasten his death, against his family’s wishes.

However, it was learned Sunday that the patient, Samuel Golubchuk, regained consciousness several days ago and appears to be improving.

Although a hospital doctor treating Golubchuk wrote “Awoke” on his chart, the hospital did not disclose this to the court. The family said the hospital had been trying to make the patient appear to be dying and with minimal brain function. Grace General Hospital has received the backing of the Canadian Medical Association in its efforts to bring about active euthanasia.

According to the chart, which the judge was apparently not shown, the supposedly “imminently dying” Golubchuk is not only awake but has interacted with people and made purposeful movements.

The case has aroused anger and anxiety within the North American Jewish community that it will set a precedent for doctors to have exclusive power over life and death decisions. Rabbinical and community leaders worry that budget-conscious hospital systems may decide to shorten patients’ lives to save money or to free up beds.

The US Association of Orthodox Jewish Scientists discussed the case at its annual meeting in New York two weeks ago, and passed a resolution expressing grave concern about this case. Agudath Israel of America has also expressed concern.

Prof. Shimon Glick, a leading Israeli medical ethics expert and former dean of Ben-Gurion University’s Health Sciences Faculty, said: “From a halachic point of view, removing a feeding tube from a patient who has any brain function is active euthanasia, equivalent to murder... But here, in addition, unless the patient has specifically indicated by advance directive that such is his desire, one has a violation of the patient’s autonomy, as well.”

A Grace General Hospital lawyer told the court that doctors “have the sole right to make decisions about treatment - even if it goes against a patient’s religious beliefs.”

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Assisted suicide causes furor in Germany (Paris, International Herald, 080702)

FRANKFURT: When Roger Kusch helped Bettina Schardt kill herself at home on Saturday, the grim, carefully choreographed death ritual was like that in many cases of assisted suicide - with one exception.

Schardt, 79, a retired X-ray technician from the Bavarian city of Würzburg, was neither sick nor dying. She simply did not want to move into a nursing home and, rather than face that prospect, she asked Kusch, a German campaigner for assisted suicide, for a way out.

Her last words, after swallowing a deadly cocktail of the anti-malaria drug Chloroquine and the sedative diazepam, were “auf Wiedersehen,” Kusch said Monday at a news conference.

It was hardly the last word on her case, however. Schardt’s suicide - and Kusch’s energetic publicizing of it - has kicked off a national furor over the limits of the right to die in a country that has struggled with this issue more than most because of the euthanasia practiced by the Nazis.

“What Mr. Kusch did was particularly awful,” Beate Merk, the justice minister of Bavaria, said in an interview. “This woman had nothing wrong other than her fear. He didn’t offer her any other options.”

Germany’s conservative chancellor, Angela Merkel, declared on a German news channel Wednesday, “I am absolutely against any form of assisted suicide, in whatever guise it comes.”

On Friday, Bavaria and four other German states will push for a new law in Parliament that would ban commercial ventures that help people kill themselves. Suicide is not illegal here, nor is aiding a suicide, provided that it does not cross the line into euthanasia, or mercy killing.

But many here do not want Germany to follow the example of Switzerland, where liberal laws on euthanasia have led to a bustling trade in assisted suicide.

In the last decade, nearly 500 Germans crossed the border to end their lives with the help of a Swiss group.

“We want to make it illegal for people here to offer ‘suicide by reservation,”‘ Merk said. “That is inhumane.”

By helping Schardt end her life and then broadcasting the deed, Kusch has, in effect, hung out a shingle. A former senior government official from Hamburg, Kusch, 53, said he would help other people who decide of their own free will to commit suicide.

“My offer, since last Saturday, is to allow people to die in their own beds,” he said in a telephone interview Wednesday. “That is the wish of most people, and now it is possible in Germany.”

With his penchant for in-your-face publicity, Kusch recalls Jack Kevorkian, the euthanasia crusader in Michigan known as Dr. Death who all but dared the authorities to stop his assisted suicides and ended up in prison. But Kusch, who is trained as a lawyer, was careful not to cross the legal line in Schardt’s case.

He counseled her about how to commit suicide but did not administer the drugs. He left the room after she drank the poisonous brew, returning three hours later to find her dead on her bed. And he videotaped the entire process as proof that he was not an active participant.

Prosecutors have looked into the case, but it does not appear that Kusch is in legal jeopardy.

He also videotaped five hours of interviews with Schardt, in which she discussed her fears and why she wanted to die. He showed excerpts at the news conference, which caused an outcry.

While Schardt was not suffering from a life-threatening disease and was not in acute pain, her life was hardly pleasant, Kusch said. She had trouble moving around her apartment, where she lived alone. Never having married, she had no family. She also had few friends and rarely ventured out.

In such circumstances, a nursing home seemed the likely next stop. And for Schardt, who Kusch said had a low tolerance for those less intelligent than her, that was an unbearable prospect.

“When she contacted me by e-mail on April 8, she had already decided to commit suicide,” Kusch said, noting that she had also been in touch with Dignitas, the Swiss group that aids suicides.

In a goodbye letter to Kusch, posted on his Web site, Schardt thanked him, saying that if her death helped his battle, it would fulfill her goal to have “the freedom to die in dignity.”

To some champions of assisted suicide, Germany’s laws do not allow for enough dignity.

Ludwig Minelli, a former journalist who runs Dignitas, noted that those helping have to leave the person to die alone or risk being prosecuted. In Switzerland, he said, “The helping person, as well as family members or friends, could stay with the person who has decided to leave.”

The larger lesson of Schardt’s solitary death may have to do with how Germany treats its old.

“The fear of nursing homes among elderly Germans is far greater than the fear of terrorism or the fear of losing your job,” said Eugen Brysch, the director of the German Hospice Foundation.

“Germany must confront this fear, because fear, as we have seen, is a terrible adviser.”

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Woman Wakes After Heart Stopped, Rigor Mortis Set In (Foxnews, 080523)

Val Thomas’ doctors honestly can’t explain how she is alive today.

Thomas, who lives in West Virginia, is being called a medical miracle after she suffered two heart attacks and had no brain waves for more than 17 hours; reports NewsNet5.com.

Thomas’ heart stopped around 1:30 a.m. Saturday and doctors said she had no pulse. Rigor mortis started to set in, and she was placed on a respiratory machine.

“Her skin had already started to harden and her fingers curled,” Thomas’ son, Jim, told NewsNet5.com. “Death had set in.”

Thomas, 59, was rushed to a West Virginia hospital, where she was put on a special machine to induce hypothermia. This would allow her body to cool down for 24 hours before they would warm her up again, doctors explained.

However, Thomas’ heart stopped again after the procedure.

Her family said their goodbyes and Thomas’ tubes were removed, but she remained hooked on a ventilator as the possibility of organ donation was discussed.

However, Thomas woke up 10 minutes later and started talking.

“The nurse said, ‘I’m so sorry, Mrs. Thomas,’ and mom said, ‘That’s OK, honey, that’s OK,’” Jim Thomas said.

Val Thomas was transferred to the Cleveland Clinic so that specialists could check her out, but doctors said they could find nothing wrong with her.

“I know God has something in store for me, another purpose,” Val Thomas said. “I don’t know what it is, but I’m sure he’ll tell me.”

NEWSNET5 STORY:

CLEVELAND, Ohio — A West Virginia woman was being transferred to the Cleveland Clinic after walking the line between life and death.

Doctors are calling Val Thomas a medical miracle. They said they can’t explain how she is alive.

They said Thomas suffered two heart attacks and had no brain waves for more than 17 hours. At about 1:30 a.m. Saturday, her heart stopped and she had no pulse. A respiratory machine kept her breathing and rigor mortis had set in, doctors said.

“Her skin had already started to harden and her fingers curled. Death had set in,” said son Jim Thomas.

They rushed her to a West Virginia hospital. Doctors put Thomas on a special machine which induces hypothermia. The treatment involves lowering the body temperature for up to 24 hours before warming a patient up.

After that procedure, her heart stopped again.

“She had no neurological function,” said Dr. Kevin Eggleston.

Her family said goodbye and doctors removed all the tubes.

However, Thomas was kept on a ventilator a little while longer as an organ donor issue was discussed.

Ten minutes later the woman woke up and started talking.

“She (nurse) said, ‘I’m so sorry Mrs. Thomas.’ And mom said, ‘That’s OK honey. That’s OK,” Jim Thomas said.

Val Thomas and her family strongly believe that the Lord granted them their miracle and they want everyone to know.

“I know God has something in store for me, another purpose. I don’t know what it is but I’m sure he’ll tell me,” she said.

She was taken to the Cleveland Clinic for specialist to check her out. Doctors said amazingly she has no blockage and will be fine.

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“Licensing People to Put Others Down” — The End of Human Dignity (Mohler, 080923)

Baroness Mary Warnock is one of the most influential figures in British life today, and one of the most influential specialists in medical ethics on the international scene. When she speaks, the medical community listens. Given what she has just said, every single one of us had better pay attention.

The Baroness, known for her 1984 report that led to the legalization of so-called “test-tube” babies and embryo research in Britain, recently granted an interview to Life & Work, a magazine published by the Church of Scotland. In “A Duty to Die?,” Warnock makes some incredible arguments, including her assertion that those suffering from mental dementia should be “put down,” or euthanized.

Here is the most clarifying statement in the media coverage of the interview:

“If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service.”

In other words, if you are suffering from Alzheimer’s disease or any other form of mental incapacity, you should simply die and get out of the way, freeing up precious resources and relieving your family of the obligation of your care.

This is a chilling argument, but one that is absolutely consistent with the direction of much modern secular thought.

“I’m absolutely, fully in agreement with the argument that if pain is insufferable, then someone should be given help to die, but I feel there’s a wider argument that if somebody absolutely, desperately wants to die because they’re a burden to their family, or the state, then I think they too should be allowed to die,” she said.

Those words, frightening enough in their own right, seem to suggest that this decision to end life would be made by the individual suffering the dementia — presumably through an advance directive that would set the plan in motion when the sufferer still possesses mental capacity.

But, in another statement, Warnock goes on to put this decision into the hands of others:

“If you’ve an advance directive, appointing someone else to act on your behalf, if you become incapacitated, then I think there is a hope that your advocate may say that you would not wish to live in this condition so please try to help her die.

“I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”

Licensing people to put others down? This is the stuff of nightmares. Baroness Warnock is no stranger to controversy, but her stature means that these arguments have to be taken seriously. As reported in The Telegraph [London], Neil Hunt of the Alzheimer’s Society said: “I am shocked and amazed that Baroness Warnock could disregard the value of the lives of people with dementia so callously. With the right care, a person can have good quality of life very late in to dementia. To suggest that people with dementia shouldn’t be entitled to that quality of life or that they should feel that they have some sort of duty to kill themselves is nothing short of barbaric.”

Few issues throw the chasm between the Christian and secular understandings of humanity into such sharp focus. The biblical worldview begins with the premise that every single human being possesses full human dignity at every stage of life and development, simply because each human being is made in the image of God. Life is a divine gift to be celebrated and received under God’s own dominion. Human life is thus to be treasured and protected from conception until natural death.

The secular worldview, on the other hand, can see human beings as no more than highly-developed organisms in an accidental cosmos. Given that starting point, it is virtually inevitable that life will then be defined in terms of certain capacities or qualities that are more and less present in human beings. Thus, ethicists such as Peter Singer (and Baroness Warnock) start from the assumption that the ability to communicate and possess self-consciousness is necessary in order for an individual to be considered fully human — and thus to possess basic human rights.

Before long, the secular worldview devolves into a cost/benefit analysis. Some lives are simply more important and more valuable than others, this worldview implies. Like the medical motto taken up by Nazi Germany asserts, some people represent “life unworthy of life.” Baroness Mary Warnock now extends that argument to the mentally incapacitated.

This is a challenge that touches every family at some point. Given the longer life spans of modern populations, the number of people suffering dementia in advanced years is growing. Euthanasia for the demented elderly is a concept soon obvious to those who are ready to define some lives as not worth living.

Of course, the cost to the society at large is nothing less than the subversion of human dignity — the discounting of all human dignity and the unraveling of human rights.

Baroness Warnock now offers the perfect poison pill for a society running headlong into a social suicide pact and a massive death wish. We can only hope that the horror so many have expressed in the face of her proposal is a sign that not all are yet ready to embrace the Culture of Death.

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Montana Judge Rules Doctor-Assisted Suicide Is Legal (Foxnews, 081206)

HELENA, Montana — A Montana judge has ruled that doctor-assisted suicides are legal in the state, a decision likely to be appealed as the state argues that the Legislature, not the court, should decide whether terminally ill patients have the right to take their own life.

Judge Dorothy McCarter issued the ruling late Friday in the case of a Billings man with terminal cancer, who had sued the state with four physicians that treat terminally ill patients and a nonprofit patients’ rights group.

“The Montana constitutional rights of individual privacy and human dignity, taken together, encompass the right of a competent terminally (ill) patient to die with dignity,” McCarter said in the ruling.

It also said that those patients had the right to obtain self-administered medications to hasten death if they find their suffering to be unbearable, and that physicians can prescribe such medication without fear of prosecution.

“The patient’s right to die with dignity includes protection of the patient’s physician from liability under the state’s homicide statutes,” the judge wrote.

Attorney General Mike McGrath said Saturday that attorneys in his office would discuss the ruling next week and expected the state will appeal the ruling.

“It’s a major constitutional issue and the Supreme Court should rule on it,” said McGrath, who will be sworn in as chief justice of the Montana Supreme Court in January.

The plaintiff, Robert Baxter, said he was comforted by McCarter’s ruling.

“I am glad to know that the court respects my choice to die with dignity if my situation becomes intolerable,” the 75-year-old retired truck driver said in a statement.

Kathryn Tucker, the legal director of patients’ right group Compassion & Choices who helped argue the case, said the court found “it is the individual patients who should be entitled to make these critical decisions for themselves and their families, and not the government.”

The state attorney general’s office had argued that intentionally taking a life was illegal, and that the issue was the responsibility of the state Legislature.

Assistant Attorney General Jennifer Anders had argued the state has no evaluation process, safeguards or regulations to provide guidance or oversight for doctor-assisted suicide. The state also said it was premature to declare constitutional rights for a competent, terminally ill patient because the terms “competent” or “terminally ill” had yet to be defined.

The ruling noted that doctors are often asked to “determine the competency of their patients for the purposes of guardianship and other legal proceedings.”

“Whether a patient is terminally ill can also be determined by the physician as an integral component of the physician-patient relationship,” McCarter wrote.

McCarter’s ruling makes Montana the third state after Oregon and Washington to allow doctor-assisted suicides. The U.S. Supreme Court ruled in 1997 that terminally ill patients have no constitutional right to doctor-assisted suicide but did nothing to prevent states from legalizing the process.

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Death on TV Reveals a Swiss Haven for Suicides (Foxnews, 081213)

SCHWERZENBACH, Switzerland — Twice a week, on average, in a nondescript building by the railroad tracks, a foreigner comes to die.

Most are terminally ill. Some are young and physically healthy except for a permanent disability or severe, debilitating mental disorder.

Drawn by Switzerland’s reputation as a trouble-free place for foreigners to end their lives, more than 100 Germans, Britons, French, Americans and others come to this small commuter town just east of Zurich each year to lie down on a bed in an industrial park building and drink a lethal dose of barbiturates.

Now the country’s suicide practices are under the spotlight after British TV last week showed Craig Ewert, a 59-year-old Chicago man with a severe form of motor neuron disease, killing himself in Switzerland two years ago.

Other countries, including the Netherlands, Belgium, and Oregon and Washington in the U.S., have recently passed laws allowing the incurably sick to seek out a doctor who — under tightly regulated circumstances — can hasten their death.

But only Switzerland, in a law dating back to 1942, permits foreigners to come and kill themselves, placing few restrictions on the how, when and why. Doctors have relative freedom to prescribe a veterinary drug for that very purpose

Five minutes after drinking a glass of water laced with sodium pentobarbital, they fall asleep.

Death follows about half an hour later.

Like Ewert, most foreigners turn to Dignitas, one of several Swiss organizations dedicated to the cause. Dignitas’ founder, Ludwig A. Minelli, has built the group into a thriving nonprofit operation.

Critics accuse it of turning Switzerland into a magnet for so-called “suicide tourism,” and of operating on the fringes of medical ethics and public opinion.

Dr. Bertrand Kiefer, editor-in-chief of the Revue Medicale Suisse, a medical journal, fears some people are killing themselves not to escape intolerable suffering but to relieve family or society of a burden.

Dignitas says its members’ right to self-determination is paramount. The only criteria for assisting a suicide are that the person “suffers from an illness that inevitably leads to death, or from an unacceptable disability, and wants to end their life and suffering voluntarily.”

Kiefer also says assisted-groups lack financial transparency.

Dignitas says it charges 10,000 Swiss francs ($8,300) for its services, which include taking care of legal formalities and arranging consultations with a doctor willing to prescribe the deadly medicine. The group says it pays its staff salaries and invests any profit in its advocacy and counseling work, which includes suicide prevention efforts.

Other such organizations in Switzerland say they are cheaper and do not charge the patient directly, relying instead on membership fees and donations.

“We need to ensure that there’s no economic incentive for these organizations to encourage people to commit suicide,” says Kiefer.

A small religious party is campaigning to ban groups from charging for their services — an idea which the pugnacious Minelli calls the product of “sick brains.”

Officials in the canton of Zurich threatened to restrict their activities by making doctors see each patient more than once, and by limiting the supply of sodium pentobarbital. So some groups hoarded the drug and Dignitas turned to alternative methods, coming under scrutiny this spring after it was reported they were suffocating people with plastic bags and helium.

The bag is placed over the head of a person who then opens a flow of helium, falls into a coma and dies “in 99.9% of cases,” according to Derek Humphry, a British author whose suicide manual “Final Exit” has sold at least a million copies.

The canton of Zurich examined the practice and found in May that the group had done nothing illegal. But the use of helium smacked to many Swiss of Nazi gas chambers, and made Minelli a tabloid hate figure — a sentiment widely shared in Schwerzenbach.

Like most Swiss, the townspeople support the principle of assisted suicide, but “the helium was the last straw,” says Manfred Milz, who is evicting Dignitas from his building.

It has to leave by June — its third move in two years. Dignitas previously used a private home, hotel rooms, even mobile homes.

But demand continues to grow, Dignitas says, and its membership has reached nearly 6,000 over the past decade. Some are merely supporters of its work, others intend to die with its help when the time comes.

The government is weighing rules that could spell the end for “suicide tourism,” which James Harris of London-based Dignity in Dying, would only mean more agonizing suicides, often botched.

Bernard Sutter, a spokesman for Exit, Switzerland’s largest assisted-suicide group, which only helps Swiss residents, says other countries should change their laws.

“We can’t solve all the problems of Germany, England, France and Italy,” he said.

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Assisted Suicide Case Revives Right-to-Die Debate (Christian Post, 090227)

ATLANTA – The case against an alleged assisted suicide ring known as the Final Exit Network has revived a long-simmering debate over the right to die.

The network’s president, its medical director and two other members are due in court Friday on charges they aided the suicide of a 58-year-old Georgia man who suffered for years from cancer of the throat and mouth.

Voters in Oregon and Washington have legalized doctor-assisted suicide, and a district judge in Montana ruled in December that such suicides are legal there, though the state Supreme Court could overturn that decision.

But most other states have laws that carry stiff penalties for those found guilty of assisting suicide. People convicted of assisting in suicide in Georgia can be sentenced to up to five years in prison.

Advocates of assisted suicide pounced on the arrests, saying they’re a signal that there should be renewed dialogue over end-of-life choices.

Barbara Coombs Lee, president of the national advocacy group Compassion and Choices, said lawmakers should consider changes to allow those suffering with terminal illnesses to “die gracefully.”

“We shouldn’t make people feel ashamed for wanting a graceful exit at the end of their valiant fight,” she said.

Critics, meanwhile, said the arrests highlight the drawbacks of assisted suicide groups.

“How is this not murder?” asked Stephen Drake of the group Not Dead Yet, an advocacy group for the disabled that opposes assisted suicide and euthanasia.

“This is predatory. These are people who get off on being there for death. They target certain types of people,” he said. “And when we make laws, when we talk about people who want to commit suicide, we’re getting into very dangerous territory.”

Georgia authorities began investigating the group shortly after John Celmer killed himself in June. Now they say the organization may have been involved in as many as 200 other deaths around the country.

Celmer’s mother says he had suffered for years from cancer, but authorities say he had recovered and was embarrassed about his appearance after surgeries when the network helped him take his life.

The group’s members bristle at the term assisted suicide, saying they don’t actively aid suicides but rather support and guide those who decide to end their lives on their own. Authorities, though, say the group blatantly violated the law.

Thomas E. Goodwin, the group’s president, and Claire Blehr were both arrested Wednesday in metro Atlanta. They were released from jail overnight on $66,000 bond each, authorities said. The two are scheduled to appear in court Friday.

Maryland authorities arrested the group’s medical director, Dr. Lawrence D. Egbert of Baltimore, and Nicholas Alec Sheridan, a Baltimore man who is a regional coordinator for the group. They were scheduled for an extradition hearing Friday.

According to court documents in the case, Blehr detailed each step of the process to an undercover agent who infiltrated the group claiming to be interested in committing suicide.

Blehr told the agent that he would place the hood on top of his own head, like a shower cap, and then inflate it by turning on the helium tank. After a few breaths, she told him the “lights would go out.”

The guides would then let the helium tanks run for 20 minutes after they last felt his pulse to make sure he was dead. They would also stand by his side to ensure he didn’t pull the bag off his head, according to the documents.

Some legal experts said they hope details of the network’s work would help stoke a deeper discussion over assisted suicide. William Colby, an attorney who is a fellow with the Center for Practical Bioethics, said prosecuting the group wouldn’t support that goal.

“People are trying to understand how we navigate the end of our lives, and we need to keep talking about it,” said Colby. “But trying to round up people in groups on either extreme end of our social spectrum is not necessarily the best way to move public dialogue.”

Georgia prosecutors will seek to prove the four violated the state’s 1994 assisted suicide law, which defines assisted suicide as anyone publicly advertising or offering to “intentionally and actively assist another person” in ending their life.

To Jerry Dincin, the Final Exit Network’s vice president, the prosecution is “the epitome of stupidity.” And he said that the group’s members didn’t actively aid the suicides, but directed members to a manual called “The Final Exit” to guide them through the process.

“If this case goes to court, we’ll be dealing with the notion of what is ‘assistance,’” he said. “If we point somebody to a book, maybe that’s considered assistance in the courts. But we don’t think so.”

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Washington State to Allow ‘Dignity’ Deaths (Christian Post, 090303)

OLYMPIA, Wash. (AP) — Terminally ill patients with less than six months to live will soon be able to ask their doctors to prescribe them lethal medication in Washington state.

But even though the “Death with Dignity” law takes effect Thursday, people who might seek the life-ending prescriptions could find their doctors conflicted or not willing to write them.

Many doctors are hesitant to talk publicly about where they stand on the issue, said Dr. Tom Preston, a retired cardiologist and board member of Compassion & Choices, the group that campaigned for and supports the law.

“There are a lot of doctors, who in principle, would approve or don’t mind this, but for a lot of social or professional reasons, they don’t want to be involved,” he said.

But Preston said discussions about end-of-life issues between doctor and patient will increase because of the new law, and he thinks that as time goes on more and more doctors who don’t have a religious or philosophical opposition will be open to participating.

“It will be a cultural shift,” he said.

The U.S. Supreme Court ruled in 2006 that it was up to states to regulate medical practice, including assisted suicide, and Washington’s Initiative 1000 was passed by nearly 60% of state voters in November.

It became the second state, behind Oregon, to have a voter-approved measure allowing assisted suicide.

In December, a Montana district judge ruled that doctor-assisted suicides are legal. That decision, which was based on an individual lawsuit, is before the Montana Supreme Court. While Montana doctors are allowed to write prescriptions pending the appeal, it’s unknown whether any actually have because there’s no reporting process.

Under the Oregon and Washington laws, physicians and pharmacists are not required to write or fill lethal prescriptions if they are opposed to the law. Some Washington hospitals are opting out of participation, which precludes their doctors from participating on hospital property.

Dr. Stu Farber, director of the palliative care consult service at the University of Washington Medical Center, voted against the measure and doesn’t plan to prescribe lethal medication to his patients for now.

“I am not here to tell people how they should either live their life or the end of their life,” Farber said. “There’s possibly a story out there, in the future, that’s so compelling that maybe I would write a prescription.”

Farber said he would refer patients to Compassion & Choices of Washington, the state’s largest aid-in-dying advocacy group, after talking about how they came to their decision.

The advocacy group is compiling a directory of physicians who aren’t opting out of the law, as well as pharmacies willing to fill the prescriptions, said executive director Robb Miller.

“Physicians don’t understand yet exactly how the law works,” Miller said. “Whenever there’s lack of understanding, there tends to be some reluctance.”

Dr. Robert Thompson, an internist and cardiologist at Swedish Medical Center in Seattle who voted for the measure, said that in his 32 years of practice he has treated patients who would have benefited from this law.

“I believe for the sake of compassion, and for a person’s own individual rights, that this should be an option for them,” he said.

Washington’s law is based on Oregon’s measure, which took effect in late 1997. Since then, more than 340 people — mostly ailing with cancer — have used that state’s measure to end their lives.

Under the Washington law, any patient requesting fatal medication must be at least 18 years old, declared competent and a state resident. The patient would have to make two oral requests, 15 days apart, and submit a written request witnessed by two people, one of which must not be a relative, heir, attending doctor, or connected with a health facility where the requester lives.

Two doctors must certify that the patient has a terminal condition and six months or less to live.

Some doctors who opposed the measure have argued that a six-month terminal diagnosis is never a sure thing.

“There is no question in my mind that, if this is too easy of a task, people will die prematurely,” said Dr. Linda Wrede-Seaman, a family physician and palliative care specialist in Yakima.

Health care providers writing a prescription or dispensing medication also must file a copy of the record with the state Department of Health, which is required to create an annual report on how the law is used.

The University of Washington health system and Group Health Cooperative chose not to opt out.

That decision was made easier by the law’s clear option that physicians could opt out if they wanted to, said Dr. Larry Robinson, vice dean for clinical affairs at the UW School of Medicine.

“We’re not forcing anyone to do anything,” he said.

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Euthanasia ‘favourable’ to Quebec MDs: survey (National Post, 091013)

[KH: evidence of a very liberal Quebec and doctors forgotting their own pledge]

‘A moral issue, not a medical issue,’ critic says

Amending the Criminal Code to make euthanasia legal in Canada would likely gain the support of three-quarters of Quebec’s medical specialists, says a new survey that is the latest chapter in a growing debate on physician-assisted suicide.

The Quebec Federation of Medical Specialists, which represents more than 8,700 physicians in the province, said yesterday that “75% of medical specialists would certainly or probably be favourable to euthanasia within a clearly defined legislative limit.”

Dr. Gaetan Barrette, president of the federation, told a Montreal news conference the controversy over euthanasia has similarities to the abortion debate that took place in Canada decades ago, when doctors followed the lead of the public.

“Society was ahead,” he said. “Doctors came after, and then governments legislated much later after [the] Superior Court had to rule [on the issue],” he said.

Sometime this fall, it is expected that the Quebec College of Physicians and Surgeons, the licensing body for all doctors in the province, will ask the federal government to amend the Criminal Code to allow euthanasia in certain cases.

All this comes as Bill C-384, which would make euthanasia legal in Canada, is going through second reading in Parliament. Although the bill will likely not pass, opponents believe that Canadians are becoming more accepting of the idea of physicians taking a life, which will open the door for legalized euthanasia.

“This [survey] really scares me, because doctors are supposed to be the first line and last line in protecting our lives,” said Moira McQueen, director of the Toronto-based Canadian Catholic Bioethics Institute. “It’s one thing to use sedation to relieve pain and quite another to give sedation to cause death. It scares me too because doctors are a force for shaping other people’s opinions and most ordinary people are very impressed by what doctors say.

“I actually don’t think doctors should have the final say because this is a moral issue, not a medical issue.”

Ms. McQueen and others have said that doctors receive inadequate training in palliative care, which may lead many to think that euthanasia is a correct and humane option.

“There are studies to show that the less you know about palliative care and the less experienced and the less training you have the more likely you are to support assisted suicide,” said Dr. Jose Pereira, medical director of palliative care at Bruyere Continuing Care in Ottawa. “The overwhelming number of doctors in practice have not had sufficient training to provide some good basic palliative care.”

Don Hutchinson, chief legal counsel for the Evangelical Fellowship of Canada, said there are very sound reasons for keeping euthanasia illegal.

“The laws in our country don’t forbid suicide but they do forbid helping someone to take someone’s life and there’s good reason for that,” he said. “An individual may have a moment of expression about dying without a genuine desire to really do so. Look at the number of people who have been let out of prison because we found out they didn’t commit a crime. If we had the death penalty we wouldn’t be able to do that.”

“Besides,” he added, “I’m more likely to trust a doctor more interested in relieving my pain than a doctor who may have a willingness to take my life.”

The Canadian Medical Association is opposed to physician-assisted suicide and euthanasia because it believes a doctor should never take a life.

However, polls in Canada have consistently shown strong support among the general population for euthanasia. This summer, Angus Reid found 77% of Quebecers believe euthanasia should be allowed. In 2004, Environics Research Group found 68% of all Canadians approved of euthanasia and in a poll last year it found 44% would choose euthanasia and 44% would opt for palliative care.

The Quebec Federation of Medical Specialists sent out the survey to all its members and 23% responded. It also found that about 20% of those who were favourable to euthanasia would not use it in their medical practice.

The margin error was 1.9%age points, 19 times out of 20.

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Poll: Americans divided on PAS legalization, but most would not choose it (Euthansua.com, 2007)

An Associated Press telephone poll of 1,000 randomly selected adults found that Americans are almost evenly divided on whether physician-assisted suicide should be legal. The poll—conducted by Ipsos Public Affairs from May 22-24, 2007—asked, “Do you think it should be legal or illegal for doctors to help terminally ill patients end their own life by giving them a prescription for fatal drugs?” Forty-eight percent (48%) said it should be legal, 44% said illegal, 5% had no opinion, and 3% did not answer the question.

However, responses to the next question revealed a larger point spread. When asked, “If you were seriously ill with a terminal disease, would you consider ending your own life, or not?” 55% said no, 35% yes, 3% probably, 2% maybe, and 5% had no answer.

Responses to whether PAS should be legal followed partisan lines, with 57% of Democrats saying yes compared to 39% of Republicans. The split along gender lines revealed that 53% of male respondents thought it should be legal versus 44% of females. Forty-three percent (43%) of men would consider it for themselves while only 28% of women would. The poll had a ±3.1 margin of error. [AP/Ipsos Poll, 5/29/07]

***

These are some of the results of The Harris Poll®, a nationwide survey of 2,694 adults conducted online between August 7 and 13, 2007 by Harris Interactive

Physician assisted suicide is supported by 39% and opposed by 31%. One in five (21%) neither supports nor opposes;

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Angus Reid Poll (Euthansua.com, 2005)

Support of legalization of assisted suicide: 45%

Oppose legalization: 39%

Undecided: 16%

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New Study Highlights Importance of Spiritual Support for Terminally Ill (Christian Post, 091221)

Terminally ill cancer patients who receive spiritual support from their medical team are, on average, found to be in a better state of being near death than those who don’t, according to a recently published study.

Additionally, among patients relying on their religious beliefs to cope with their illness, spiritual support reduced their risk of receiving aggressive medical interventions at the end of life, reported researchers at the Dana-Farber Cancer Institute, who conducted the study.

“Our findings suggest that spiritual care from the medical system has important ramifications for patients at the end of life, including helping them transition to comfort-focused care and improving their well-being near death,” commented the study’s senior author, Dr. Tracy Balboni of Dana-Farber.

“Furthermore, they highlight the need to educate medical caregivers in being attentive to the frequent role of religion and spirituality in patients’ coping with advanced illness and importance of integrating pastoral care into multidisciplinary medical teams,” she added.

For the study, researchers interviewed 343 incurable cancer patients at hospital and cancer centers around the country, asking about their means of coping with their illness, the degree to which their spiritual needs were met by the medical team and their preferences regarding end-of-life treatment.

Researchers then tracked each patient’s course of care during the remainder of his or her life from September 2002 through August 2008.

What researchers found was that support of patients’ spiritual needs by the medical team was associated with better patient well-being at the end of life, with scores on average being 28% higher among those receiving spiritual support.

Researchers also found that patients whose spiritual needs were largely or completely supported by the medical team were likely to transition to hospice care at the end of life.

The study, which was submitted for review in June, has been published by the Journal of Clinical Oncology on its web site and in its Dec. 14 print edition.

Financial support for the study was provided by grants from the National Cancer Institute, the National Institute of Mental Health, the American Society of Clinical Oncology, and the Fetzer Institute.

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Guidelines on assisted suicide taking U.K. into unchartered territory (National Post, 100221)

Britain is poised to enter unchartered legal and ethical territory in the contentious area of assisted suicide.

Next week, Keir Starmer, the director of public prosecutions, is expected to issue unprecedented guidelines on when prosecutors are likely to pursue a case — even though the act helping someone in a suicide will remain illegal, as it is in most countries.

The topic is back in the spotlight with a vengeance. Last week, Ray Gosling, a veteran broadcaster, confessed during a television program to killing his lover, who had AIDS, 20 years ago.

“I picked up the pillow and smothered him until he was dead,” he told the BBC.

“When you love someone, it is difficult to see them suffer.”

He was arrested on suspicion of murder, but has been released on bail.

Observers are also worrying about the effect of the new guidelines.

“This is completely new area of law that is being created — to let someone know how prosecutors will decide what they will do in certain cases,” said Jonathan Rogers, a professor of law at University College London.

“In the past we would say as long as the criminal law is clear that was all that was needed. So this is really novel. It is an attempt to change the law by stealth.”

Assisted suicide is the act of an ordinary person helping another to take his or her life. But depending on circumstances — possibly for reasons of compassion or the practical sense no court would convict — British prosecutors have often decided not to lay charges even though the law had clearly been broken. They have this discretion for many crimes, but some critics say they have been inconsistent when applying it to assisted suicide.

Some examples:

• In 2008, Daniel James, 23, who was left paralyzed from the chest down from a rugby accident, went with his parents to Switzerland to die (the country allows foreigners to take advantage of its liberal laws).

In reaching his decision not to prosecute, Mr. Starmer noted the parents had continually tried to dissuade their son and he had made the decision on his own accord. So even though the parents had broken the law, no charges were laid.

• Dr. Michael Irwin was questioned last year for breaking the same law because he helped cover the cost of an assisted suicide in Switzerland. He has yet to be charged.

• Debby Purdy, who has multiple sclerosis, went to court to determine whether her husband would be charged if he accompanied her to Switzerland, if she decided to end her life. The highest appeals court agreed that she should have the right to know and forced Mr. Starmer to start creating guidelines. Preliminary guidelines were issued in September for the purpose of consultation.

“The particular point Purdy was making was that the state had a right to make assisted suicide illegal but it had a duty to make the law clear and accessible,” said Prof. Rogers.

“She said no one really knows what the law means. So the court agreed that she should be able to predict with some certainty whether her husband would be prosecuted for helping her.”

The guidelines will only be in effect in England and Wales.

Professor David Jones, director of the Centre for Bioethics at St. Mary’s University in Twickenham, near London, said they will give people the impression they can second-guess prosecutors.

“I agree that prosecutors need to have some discretion in the system about when to prosecute because sometimes it’s not prudent or in the public interest to prosecute a case of assisted suicide — even though it’s not technically legal,” he said.

“But once you start codifying that you are making law on the hoof. The trouble is, when you write it down, then discretion stops being discretion and becomes guidelines. It’s important to keep people on their toes.”

Several incidents have highlighted the thin line between assisted suicide and murder.

They include two cases in which mothers killed their children. Both were charged with murder, but only one was convicted. In the case of the woman found not guilty, the judge praised the jury for reaching the proper decision.

“The difference can be very thin,” said Prof. Rogers, adding this is what makes prosecution so difficult.

The determining factor, he said, should be: whose act caused the death? The person assisting or the person trying to commit suicide.

He believes it would be better to change the assisted suicide law, then make it crystal-clear what is acceptable.

“It would be better procedurally to change the law a little bit to allow assisted suicide in very carefully designed circumstances with lots of safeguards including medical approval,” he said.

Prof. Jones, who does not support changing the law, also points to potentially serious consequences that could occur with the new guidelines, based on the preliminary guidelines.

For example, preliminary factors listed as reasons “not to prosecute” included “a terminal illness, or a severe and incurable disability or a severe degenerative physical condition.”

“[W]hat it means is that the guidelines have a fundamental standard: you are more likely to be prosecuted if you help kill an able-bodied person,” he said.

“The moment you put that sort of thing in you’re saying some lives are worth living more than others.”

Cases of interest:

December 2008: Keir Starmer, director of public prosecutions for England and Wales, decided not to charge the parents of rugby player Daniel James, left paralyzed from the chest down after a sporting accident. Though not compelled to do so, Mr. Starmer made his reasons public. He said the parents tried to dissuade their son and the decision was his alone. However, they did break the law by helping him travel to Switzerland, where he committed suicide.

July 2009: Debby Purdy, who has multiple sclerosis, successfully argued in appeals court it was a breach of her human rights not to know whether her husband would be prosecuted for assisted suicide if he helped her to get to a clinic in Switzerland where she could end her life. The court agreed with Ms. Purdy and ordered Mr. Starmer to produce clear prosecutorial guidelines.

August 2009: Dr. Michael Irwin was arrested and questioned by police for giving £1,500 ($2,400) to help Raymond Cutkelvin, 58, who had terminal pancreatic cancer, travel to the Dignitas clinic in Switzerland. Dr. Irwin has dared Mr. Starmer to charge him. Mr. Cutkelvin’s partner of 28 years was arrested on suspicion of aiding or abetting the suicide of another and released on bail.

January 2010: Kay Gilderdale was found not guilty of murdering her daughter, Lynn, 31. The mother admitted she gave Lynn drugs and injected air into her veins. The daughter, who wanted to die, had chronic fatigue syndrome and had already tried to kill herself. The judge in the case said: “I do not normally comment on the verdicts of juries but in this case their decision ... shows common sense, decency and humanity ...” Ms. Gilderdale was also charged with assisting in a suicide, found guilty and given a 12-month suspended sentence.

January 2010: Frances Inglis was found guilty of murdering her son Tom, 22, after injecting him with a lethal dose of heroin. She barricaded herself in her son’s hospital room to prevent staff from interfering. She told the court she wanted to release him from the “living hell” of his vegetative state. She was sentenced to a minimum of nine years.

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Britain’s Weather Office Proposes Climate-Gate Do-Over (Foxnews, 100224)

At a meeting Monday of 150 climate scientists, representatives of Britain’s weather office proposed that the world’s climatologists start all over again and produce a new trove of global temperature data that is open to public scrutiny and “rigorous” peer review.

Met Office Hadley Centre projections of temperature change relative to pre-industrial levels, under two different emissions scenarios. Now the agency is proposing starting its climate models scratch.

After the firestorm of criticism called Climate-gate, the British government’s official Meteorological Office has decided to give its modern climate data a do-over.

At a meeting on Monday of about 150 climate scientists in the quiet Turkish seaside resort of Antalya, representatives of the weather office (known in Britain as the Met Office) quietly proposed that the world’s climate scientists start all over again on a “grand challenge” to produce a new, common trove of global temperature data that is open to public scrutiny and “rigorous” peer review.

In other words, conduct investigations into modern global warming in a way that may help to end the mammoth controversy over world temperature data that has been stirred up in the past few years.

The executive summary of the Met Office proposal to the World Meteorological Organization’s Committee for Climatology was obtained by Fox News. In it, the Met Office defends its historical record of temperature readings, along with similar data collected in the U.S., as a “robust indicator of global change.” But it admits that “further development” of the record is required “in particular to better assess the risks posed by changes in extremes of climate.”

Among other things, its older data is maintained on a monthly basis, and the Met Office proposal says that is “grossly inadequate” to providing information on a daily and “sub-daily” basis.

A Met Office spokesman, Dave Britton, declared that the decision to re-do the data collection had been gestating for “a long time,” then added: “But it would be naïve to say that [the Climate-gate controversy] didn’t have an impact.” He added: “It’s not something that we can do alone.”

As a result, the proposal says, “we feel that it is timely to propose an international effort to reanalyze surface temperature data in collaboration with the World Meteorological Organization (WMO), which has the responsibility for global observing and monitoring systems for weather and climate.”

The new effort, the proposal says, would provide:

• “verifiable datasets starting from a common databank of unrestricted data”

• “methods that are fully documented in the peer reviewed literature and open to scrutiny;”

• “a set of independent assessments of surface temperature produced by independent groups using independent methods,”

• “comprehensive audit trails to deliver confidence in the results;”

• “robust assessment of uncertainties associated with observational error, temporal and geographical in homogeneities.”

Click here to read the executive summary.

The Met Office proposes that the new international effort to recalibrate temperature data start at a “workshop”‘ hosted by its Hadley Climate Research Centre, which maintains data in collaboration with the controversial Climatic Research Unit (CRU) at Britain’s East Anglia University. The Met Office would invite “key players” to start the “agreed community challenge” of creating the new datasets. A Met Office spokesman said the new effort would take about three years to complete, but would not estimate the cost.

The Met Office proposal asserts that “we do not anticipate any substantial changes in the resulting global and continental-scale ... trends” as a result of the new round of data collection. But, the proposal adds, “this effort will ensure that the datasets are completely robust and that all methods are transparent.”

Those strongly underlined assurances put the Met Office in strong contrast to the accusations that have been hurled at its collaborator, CRU, epicenter of the Climate-gate controversy. Among other things, the CRU had stonewalled climate skeptics who demanded to know more about its scientific methods in establishing a dramatic record of global warming, especially in the 20th century. (An inquiry established that the institution had flouted British freedom of information laws in refusing to come up with the data.)

The stonewall began to crumble after a gusher of leaked emails revealed climate scientists, including the CRU’s chief, Phil Jones, discussing how to keep controversial climate data out of the hands of the skeptics, keep opposing scientific viewpoints out of peer-reviewed scientific journals, and bemoaned that their climate models failed to account for more than a decade of stagnation in global temperatures.Jones later revealed that key temperature datasets used in Hadley’s predictions had been lost, and could not be retrieved for verification.

Jones stepped down temporarily after the British government announced an ostensibly independent inquiry into the still-growing scandal, but that only fanned the flames, as skeptics pointed out ties between several panel members and the East Anglia center. In an interview two weeks ago, Jones also admitted that there has been no “statistically significant” global warming in the past 15 years.

The Met Office’s desire for more robust and transparent data could also prove to be a blow for Rajendra Pachauri, head of the United Nations-backed International Panel on Climate Change (IPCC), whose most recent report, published in 2007, has been exposed by skeptics as rife with scientific errors, larded with un-reviewed and non-scientific source materials, and other failings.

As details of the report’s sloppiness emerged, the ranks of skeptics of the work have swelled to include larger numbers of the scientific community, including weather specialists who worked on the sprawling IPCC report. Calls for Pachauri’s resignation have come from organizations as normally opposed as the Competitive Enterprise Institute and the British chapter of Greenpeace. So far, he has refused to step down.

The Met proposal argues says that its old datasets “are adequate for answering the pressing 20th Century questions of whether climate is changing and if so how. Bet they are fundamentally ill-conditioned to answer 21st Century questions such as how extremes are changing and therefore what adaptation and mitigation decisions should be taken.”

Those “21st Century questions” are not small and they are very far from cheap. At Copenhagen, wealthy nations were being asked to spend trillions of dollars on answering them, a deal that only fell through when China, India, and other near-developed nations refused to join the mammoth climate-control deal.

The question after the Met Office’s proposal may be whether environmentalists eager to move those mountains of cash are also ready to stand down until the 21st century questions get 21st century answers.

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Bali-Hoo: U.N Still Pushing for Global Environmental Control (Foxnews, 100225)

[KH: one step towards world government?]

Despite the debacle of the failed Copenhagen climate change conference last December, the United Nations is pressing full speed ahead with a plan for a greatly expanded system of global environmental governance and for a multitrillion-dollar economic transfer scheme to ignite the creation of a “global green economy.”

In other words: Copenhagen without the authority — yet — of Copenhagen.

The world body even has chosen a time and a place for the culmination of the process: a World Summit on Sustainable Development to be held in Rio de Janeiro in 2012, the 20th anniversary of the famed “Earth Summit” that gave focus and urgency to the world environmentalist movement.

The 2012 summit date is significant for another reason: It marks the end of the legal term of agreement for the Kyoto Protocol on greenhouse gas emissions, which includes carbon reduction targets, and provided the legal basis for an international cap-and-trade market for carbon, centered in Europe. The U.S. first signed then backed away from the Kyoto deal without ratifying it; until its apparent collapse, the comprehensive Copenhagen deal was intended to include the U.S. and supplant Kyoto with a new, legally binding regime.

The new Rio summit will end, according to U.N. documents obtained by Fox News, with a “focused political document” presumably laying out the framework and international commitments to a new Green World Order.

Just exactly what that environmental order will look like, and the extent of the immense financial commitments needed to produce it, are under discussion this week at a special session in Bali, Indonesia, of the United Nations Environment Program’s 58-nation “Governing Council/Global Ministerial Environmental Forum,” which oversees UNEP’s operations.

The GC/GMEF, as it is known, is made up of environmental ministers and top-level bureaucrats from a roster of supervising nations — the U.S. is one of them — and its meeting is surrounded by a galaxy of environmentalist non-government organizations (NGOs) and environmental journalists from around the world.

Idyllic Bali is a favored venue for U.N. environmental meetings, in part because of its seclusion from too many outside eyes, and because its Pacific location and small size make it a highly congenial hothouse for environmental enthusiasm. In 2007, it served as a launching pad for the Bali Action Plan, which laid the negotiating basis for the Copenhagen treaty process.

The latest Bali session runs from Feb. 24 to 26, and is accompanied by a welter of other UNEP activity ranging from sessions on international waste management and chemical disposal, to the start of a process aimed at a new international treaty covering the storage and disposal of environmental mercury.

But the major topics are a global system of governance and what amounts to the next stage of a radical transformation of the world economic and social order, in the name of saving the planet.

Alongside that, as always, are discussions of vast sums of money that should flow to developing nations to help them make the transition to the new, greener world. As one of the papers written in advance of the meeting to “stimulate discussion” puts it, “the situation ... presents genuine opportunities for a dramatic shift from what can be termed ‘business as usual.’”

For the anonymous bureaucrats who wrote the discussion papers, “business as usual” apparently means the current world economy, which the anonymous authors disparagingly term the “brown economy,” or the “current dominant economic model.” It is, according to the UNEP documents, a model in crisis, “which currently consumes more biomass than the Earth produces on a sustainable basis,” and also “depletes natural capital” and “risks perpetuating and exacerbating persistent poverty and distributional disparities.”

The new green economy under discussion at Bali will be something very different: For starters, it is much more vague, and as far as the discussion paper authors are concerned, it will stay that way.

The paper paints the coming green order in nebulous and utopian terms. It “implies the decoupling of resource use and environmental impacts from economic growth.” It involves “substantially increased investment in green sectors, supported by enabling policy reforms.” The investments will “provide the mechanism for the reconfiguration of businesses, infrastructure and institutions, and for adoption of sustainable consumption and production processes.” It will lead to “more green and decent jobs, reduced energy and material intensities in production processes, less waste and pollution, and significantly reduced greenhouse-gas emissions.”

But when it comes to measuring the achievement of those goals, the paper says, “it is counter-productive to develop generic green economy indicators applicable to all countries given differences in natural, human and economic resources.” In the process of turning brown to green, “a green economy in one country may look quite dissimilar to a green economy in another country.”

All of which may make judging the value of investment in the ecological transformation difficult to evaluate, except for insiders. But then, the paper suggests that the world may have an additional governing structure composed of exactly those insiders. As the paper puts it:

“Moving towards a green economy would also provide an opportunity to re-examine national and global governance structures and consider whether such structures allow the international community to respond to current and future environmental and development challenges and to capitalize on emerging opportunities.”

The discussion paper, published — but not distributed — on Dec. 14, 2009, assumes that the goal of the green economic transformation is the same as that of the ill-fated Copenhagen conference: a 50% reduction in global carbon dioxide emissions by 2050. That, the paper says, will require a staggering $45 trillion dollar to accomplish — much of it in transfers from rich nations to poorer ones.

The paper, however, paints that as a bargain — “an average yearly investment of just over $1 trillion.” About half of that would go for “replacing conventional technologies with low-carbon, environmentally sound alternatives.”

Another major investment target would be “ecosystem-based adaptation and mitigation”—paying people and governments to maintain and expand forests, wetlands, coral reefs and other productive sources of “natural capital,” which the current “dominant economic model” — the paper provides no other specifics — abuses.

But that is only the beginning of the transformation. Consumption patterns must change, so that fewer wasteful products are consumed, and more ecologically proper ones are produced — organic food and beverages, for example. The UNEP authors, citing other analytical papers produced by UNEP, claim that “the global market for environmental products and services is projected to double from the present $1.37 trillion per year to $2.74 trillion by 2020.”

Beyond the organic food market, however, “environmental products and services” are not defined in much detail. One area would be the management of chemicals and solid and hazardous waste — as the paper puts it, “solid waste management alone consumes on average 20-50% of most city budgets.”

In social terms, one of the most important goals of the transformation would be jobs, jobs, jobs — all of them green, and many of them, as it happens, already in existence.

The report notes, for example, that the U.S. recycling industry as of 2002 already employed over 1 million people; more investment would thus provide “significant opportunities” for more job creation. The same goes for looking after trees: Citing the U.N. Food and Agriculture Organization, the paper claims that “10 million new green jobs could be created by investing in sustainable forest management.”

The report argues that significant amounts of the money developed countries have thrown at the problem of ending their current steep recessions could be counted as the type of green investment it envisages as part of the trillion-a-year future. In the U.S., for example, the document says that 11.6% of the economic stimulus as of August 2009 — about $112.8 billion — is the type it sees as vastly increasing in the future.

Where is all the money supposed to come from? The paper is emphatic that government alone doesn’t have enough. The paper says that “regulated market mechanisms” are needed to “to promote new and innovative investments in green technology.”

But above all, the paper asserts, the focus on ecological transformation must become all-encompassing if it is to succeed. Quoting from UNEP’s formal medium-term strategy for 2010 to 2013, it says that “linkages between environmental sustainability and the economy will emerge as a key focus for public policymaking and a determinant of future market opportunities.”

In other words, the green economy requires a green-oriented political revolution. As UNEP’s medium-term strategy puts it: “The current environmental challenges and opportunities will cause the environment to move from often being considered a marginal issue at the intergovernmental and national levels to the center of political and economic decision-making.”

The authors of the UNEP “discussion” papers see that organization — the U.N.’s principal environmental watchdog — and especially its governing “Governing Council/Global Ministerial Environmental Forum,” as the central nexus of that new eco-centric regime — and that strengthening its authority at both the national and international levels will be a growing theme as the 2012 Rio Conference looms nearer.

“It is clear that environmental ministers alone cannot meet today’s environmental challenges,” asserts yet another Bali discussion paper. “One step towards strengthening their standing vis-à-vis other sectors is to strengthen the national [environmental] governance system.”

Meantime, UNEP’s GC/GMEF “is mandated to bring all environmental aspects together and to formulate broad policy advice and guidance” in the area of “international environmental governance reform” — with the aim of having it all ratified, eventually, by the U.N. General Assembly.

In all of this, it appears, the 2012 Rio Conference on Sustainable Development and the preliminary meetings that will determine its agenda is intended to play an important role in focusing attention on the agenda being discussed at Bali, and in creating the suggested frameworks of future “international governance.” Above all, the planned Rio summit will be a framework that welds together the UNEP framework of environmentalism with the U.N.’s traditional anti-poverty agenda — which also involves huge investment transfers to poor countries from rich ones.

The two agendas come together in the rubric for Rio: sustainable development. As the paper on governance turgidly puts it: “eradicating poverty, changing unsustainable patterns of production and consumption and protecting and managing the natural resource base of economic and social development [are] overarching objectives of and essential requirements for sustainable development.”

Vast international wealth transfers, crash investments in “green” technologies for energy, food, transportation and virtually everything else, with the aim of making enormous cuts in carbon emissions by 2050 — the sum of all the discussions underway at Bali appears indistinguishable from the Copenhagen agenda that was declared dead in December.

Except the U.N. and many nations — including the U.S. — apparently don’t think so. Indeed, a series of new Copenhagen process negotiations have just been set for Bonn in April, with another set for late May to early June.

Their official aim is to bring Copenhagen back from the dead by the end of this year at a final negotiating session in Mexico.

In a press release announcing the negotiating round, Yvo de Boer, head of the United Nations Framework Convention on Climate Change (UNFCCC), which manages the Copenhagen negotiating process, declared that “this constitutes a quick return to the negotiations” — and a continuing determination to put a new treaty in place as the capstone of the Green World Order.

But at the same time, he made clear that a deal by the end of the year is unlikely; 2011 is more feasible.

If that happens, de Boer won’t be applauding from his current position. He has resigned, effective July 1, to become a consultant.

The first major preparatory meetings for the Rio summit in 2012 will be held at U.N. headquarters in New York City in mid-May.

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Assisted suicide: the new CPS guidelines (London Times, 100225)

The DPP today outlined the 16 factors in favour of prosecution and the six factors that made prosecution less likely

Public interest factors tending in favour of prosecution

A prosecution is more likely to be required if:

1 the victim was under 18 years of age;

2 the victim did not have the capacity (as defined by the Mental Capacity Act 2005) to reach an informed decision to commit suicide;

3 the victim had not reached a voluntary, clear, settled and informed decision to commit suicide;

4 the victim had not clearly and unequivocally communicated his or her decision to commit suicide to the suspect;

5 the victim did not seek the encouragement or assistance of the suspect personally or on his or her own initiative;

6 the suspect was not wholly motivated by compassion; for example, the suspect was motivated by the prospect that he or she or a person closely connected to him or her stood to gain in some way from the death of the victim;

7 the suspect pressured the victim to commit suicide;

8 the suspect did not take reasonable steps to ensure that any other person had not pressured the victim to commit suicide;

9 the suspect had a history of violence or abuse against the victim;

10 the victim was physically able to undertake the act that constituted the assistance him or herself;

11 the suspect was unknown to the victim and encouraged or assisted the victim to commit or attempt to commit suicide by providing specific information via, for example, a website or publication;

12 the suspect gave encouragement or assistance to more than one victim who were not known to each other;

13 the suspect was paid by the victim or those close to the victim for his or her encouragement or assistance;

14 the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care;

15 the suspect was aware that the victim intended to commit suicide in a public place where it was reasonable to think that members of the public may be present;

16 the suspect was acting in his or her capacity as a person involved in the management or as an employee (whether for payment or not) of an organisation or group, a purpose of which is to provide a physical environment (whether for payment or not) in which to allow another to commit suicide.

On the question of whether a person stood to gain, the police and the reviewing prosecutor should adopt a common sense approach. It is possible that the suspect may gain some benefit - financial or otherwise - from the resultant suicide of the victim after his or her act of encouragement or assistance. The critical element is the motive behind the suspect’s act. If it is shown that compassion was the only driving force behind his or her actions, the fact that the suspect may have gained some benefit will not usually be treated as a factor tending in favour of prosecution. However, each case must be considered on its own merits and on its own facts.

Public interest factors tending against prosecution

A prosecution is less likely to be required if:

1 the victim had reached a voluntary, clear, settled and informed decision to commit suicide;

2 the suspect was wholly motivated by compassion;

3 the actions of the suspect, although sufficient to come within the definition of the offence, were of only minor encouragement or assistance;

4 the suspect had sought to dissuade the victim from taking the course of action which resulted in his or her suicide;

5 the actions of the suspect may be characterised as reluctant encouragement or assistance in the face of a determined wish on the part of the victim to commit suicide;

6 the suspect reported the victim’s suicide to the police and fully assisted them in their enquiries into the circumstances of the suicide or the attempt and his or her part in providing encouragement or assistance.

The evidence to support these factors must be sufficiently close in time to the encouragement or assistance to allow the prosecutor reasonably to infer that the factors remained operative at that time. This is particularly important at the start of the specific chain of events that immediately led to the suicide or the attempt. These lists of public interest factors are not exhaustive and each case must be considered on its own facts and on its own merits. If the course of conduct goes beyond encouraging or assisting suicide, for example, because the suspect goes on to take or attempt to take the life of the victim, the public interest factors tending in favour of or against prosecution may have to be evaluated differently in the light of the overall criminal conduct.

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Assisted suicide - reaction to new guidelines (London Times, 100225)

[KH: more pro-euthanasia speakers selected, including the first and the last ones]

Campaigners for and and against assisted suicide today praised, and in some cases vilified, the new CPS policy

Debbie Purdy, multiple sclerosis sufferer and right-to-die campaigner: “I am still overwhelmed and delighted by this victory. It was the right decision by the Law Lords and people I meet every day in the street tell me how glad they are that we won. Omar and I can now get on with our lives.

“Because I will know the likely consequences of any decisions I choose to make about my death, I won’t have to make those decisions early. I will continue to campaign for assisted dying to be legal in the UK.”

Sir Terry Pratchett, author: “They don’t conform to my distant goal of what I want but I think it represents probably the best that we can get without a change in the law. It doesn’t look like such a tick box exercise as it used to. There are some very sensible things that avoid controversy.

“Originally if someone who helped someone to die had any financial gain in so doing, that would be automatic Mr Plod knocking on the door. It has been realised that if a well-meaning wife helps a husband who is relatively determined to see his life ended she might well benefit but, as I understand it, if she has acted compassionately she will be safe (from prosecution). I think we should consider looking to the medical profession to do with care and attention and with understanding and with full explanation of the circumstances, to allow us to die at a time of our choosing,”

Jayne Spink, Director of Policy & Research at the MS Society: “While we welcome the guidance and the clarity it provides we remain concerned that the law on assisted suicide continues to place a burden on individuals to seek end of life care and support themselves, rather than on society to provide it.

“There is still a long way to go before the palliative and end of life care offered to people with MS is the best it can be. The DPP guidance does not detract from the unfulfilled duty of care from the government.”

Richard Hawkes, chief executive of disability charity Scope: “We do not support any weakening of the protection offered under the law on assisted suicide, which is exactly what these new guidelines do.

“Many disabled people are frightened by the consequences of these new guidelines and with good reason. There is a real danger these changes will result in disabled people being pressured to end their lives.”

Lord Carlile QC, chairman of Care Not Killing: “Our main concern was that the interim guidelines singled out as a group those who were disabled or ill, thereby affording them less protection than other people under the law.

“We are very glad this has been removed. There are still some flaws and problems which will need attention, such as how a compassionate suspect’s motives are to be determined in practice.”

Sarah Wootton, chief executive of Dignity in Dying: “The guidelines are a victory for common sense and compassion. The guidance represents a significant breakthrough for choice and control at the end of life for those who feel they are suffering unbearably.

“Critically, the guidelines recognise the difference between assisting someone to die out of compassion, at their request, and a malicious or self-serving act which results in the death of another.”

Evan Harris, Liberal Democrat MP: “The fundamental problem remains that the law needs to be changed by Parliament.

“The Law Lords have essentially ruled that our existing law on assisted suicide is far too wide. It captures ethical acts of compassion which should not be prosecuted, as well as immoral acts of helping a depressive commit suicide, which deserve punishment - of up to 14 years in prison.

“No guidelines will ever be able to distinguish, with the clarity needed, between compassionate assistance to relieve terminal suffering of competent adults and wicked assisted suicide of the mentally ill - legislation is needed, and Parliament should act.”

The Bishop of Winchester, the Right Rev Michael Scott-Joynt: “The guidelines make absolutely clear that assisted suicide remains illegal and that every case must be looked at on its merits. There is a very strong presumption that there will be prosecution. I am very clear that we have to keep the law as it is. Anything else is likely to be profoundly uncompassionate to people who are vulnerable, elderly, confused, disabled, depressed.”

The Church of England: “We believe that the most compassionate course is to provide love, support and the best possible medical and nursing care, not to acquiesce in requests for assisted suicide. Compassion does not always mean saying ‘yes’.

“Protecting the vulnerable, ensuring that every life is appreciated as being valuable and maintaining the indispensible bond of trust between health professionals and patients outweighs arguments in favour of individual choice.”

Paul Tully, of anti-euthanasia group SPUC Pro-Life: “The new policy effectively decriminalises assisted suicide in a wide range of circumstances.

“Assisting suicide is wrong in itself, not merely because there may be coercion or ulterior motives involved. The intentional killing of the innocent is always wrong. The disabled and chronically ill remain the most likely victims of this weakening of the right to life.”

Andrew Copson, of the British Humanist Association: “The guidelines attempt to do in part what Parliament has thus far failed to, and that is to distinguish between where a person has compassionately assisted another to die, and where that was done with malicious intent or murder. But these guidelines will always be retrospective, after an assisted death has taken place.

“Terminally ill or incurably suffering people do not have full autonomy and choice at end of life and those that are vulnerable are still at risk because legal safeguards, which would accompany the legalisation of assisted dying, are not in place to protect them from coercion or other malice.”

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Terry Pratchett and Debbie Purdy back new suicide guidelines (London Times, 100225)

Frances Gibb, Legal Editor

[KH: just by the heading reveals which side the newspaper is on]

The motivation of people who help loved ones to die will be the crucial factor in deciding if they should face prosecution under landmark guidelines issued today.

The Director of Public Prosecutions, Keir Starmer, has revised his draft policy on assisted suicide to shift the focus away from the plight of those who die to the intentions of those who help them.

Campaigners for the right to die welcomed the ground-breaking guidelines, in which compassion is a key factor and which set out for the first time factors the Crown Prosecution Service will take into account when deciding on whether to prosecute.

But the policy does not change the law, decriminalise assisted suicide or in any way open the door to “mercy-killing”, Mr Starmer insisted. No case of assisted suicide could be guaranteed immunity; and the decision about a prosecution would look at each case on its merits. “It is not a tick-box exercise. Nor can be it described as a numbers game.”

He added: “The policy does not change the law on assisted suicide. It does not open the door for euthanasia. It does not override the will of Parliament. What it does do is to provide a clear framework for prosecutors to decide which cases should proceed to court and which should not.”

The new final version of the policy, arrived at after responses to the draft from nearly 5,000 individuals and organisations, makes some key changes.

These would not make prosecution more or less likely, the DPP said. Nor do they relax or tighten the policy. But there was a strong view that factors against prosecution “should not focus on the behaviour and characteristics of the victim but should more properly be centred on the actions and role of the suspect”.

Reaction to the new guidelines was as swift as it was varied. While Sarah Wootton, chief executive of Dignity in Dying, called the guidelines a “victory for common sense and compassion”, Paul Tully, of anti-euthanasia group SPUC Pro-Life, said the new policy “effectively decriminalises assisted suicide in a wide range of circumstances”.

Author Sir Terry Pratchett, who suffers from Alzheimer’s disease, welcomed the guidance as “the best we can get without a change in the law”.The 61-year-old used a lecture earlier this month to call for “tribunals” in cases where people were seeking to end their lives.

Right-to-die campaigner and multiple sclerosis sufferer Debbie Purdy said they clarified “the difference between malicious encouragement and compassionate support for somebody’s decision”. She added: “The current guidelines are enough to give me my life back and to know that I can carry on living and don’t have to worry about making a decision now.”

The Church of England repeated its call for relatives and carers to resist requests to help a loved one die, saying that the guidelines “do not provide blanket immunity from prosecution, nor do they give prior permission to break the law”. It added that the “most compassionate course is to provide love, support and the best possible medical and nursing care, not to acquiesce in requests for assisted suicide. Compassion does not always mean saying ‘yes’.”

The factors against prosecution “are now centred on the voluntary, clear, settled and informed decision of the victim and the behaviour of the suspect and the rationale behind his or her encouragement or assistance”. As a result, the new policy drops the issue of whether the “victim” has a terminal, incurable illness or disability or severe degenerative condition from which there is no possibility of recovery.

There was concern that the inclusion of this could be seen as discriminatory, such as to those with a serious illness or disability. Some groups representing those with disabilities also felt that including this factor implied that the lives of those affected “were less valued”.

Lord Carlile, QC, chairman of Care Not Killing, welcomed the move, saying: “Our main concern was that the interim guidelines singled out as a group those who were disabled or ill, thereby affording them less protection than other people under the law.

“We are very glad this has been removed. There are still some flaws and problems which will need attention, such as how a compassionate suspect’s motives are to be determined in practice.”

Richard Hawkes, chief executive of disability charity Scope, said: “We do not support any weakening of the protection offered under the law on assisted suicide, which is exactly what these new guidelines do. Many disabled people are frightened by the consequences of these new guidelines, and with good reason. There is a real danger these changes will result in disabled people being pressured to end their lives.”

The new policy also removes the question of whether the suspect was a spouse, partner or close relative or friend. Responses to the initial guidance, published last September, argued that such relationships could be “antagonistic or manipulative”.

The eight pages of guidelines, which contain 16 public interest factors in favour of prosecution and six public interest factors against, were released this morning along with a 45-page summary of responses.

The policy takes immediate effect. The vast majority of responses were from individual members of the public. Academics, health workers, politicians and religious groups also contributed their views.

A majority did not support a factor in favour of prosecution if the person who died had made a “clear, settled and informed decision” to commit suicide. But Mr Starmer said that in his view, this factor was central to any assessment of a case of assisted suicide.

The factor therefore remains in an amended form, making clear that the decision is also voluntary. There is also a new factor in favour of prosecution where the suspect had a history of violence or abuse against the victim. A further change is that now a factor in favour of prosecution is where the suspect was acting as a medical or health care professional or was a “person in authority”.

Mr Starmer has also removed the previous weighting given to some factors, to make the policy clearer and more accessible.

Assisted suicide remains a criminal offence in England and Wales, punishable by up to 14 years in prison, but individual decisions on prosecution are made depending on the circumstances in each case.

The interim policy was published in September and has been in force since.

Mr Starmer was forced to issue the guidelines after a Law Lords ruling in favour of Ms Purdy. She wanted to know whether her husband would be prosecuted for helping her to end her life.

Campaigners for the right to die welcomed the initial guidelines and called for the Government to legislate on the issue, but ministers were reluctant to intervene. Critics have complained that Mr Starmer was effectively legalising assisted suicide.

In the Commons today, MPs called for a debate on the issue. Conservative MP Mark Pritchard said: “There is real concern out in the community that this House is not having a say. People are very concerned that this is a new back door to euthanasia in the UK.”

Labour’s David Winnick stressed the importance of debating the policy “in view of the controversy about assisted suicide”.

Evan Harris, the Liberal Democrat MP, called for the law to be changed by parliament. “No guidelines will ever be able to distinguish, with the clarity needed, between compassionate assistance to relieve terminal suffering of competent adults, and wicked assisted suicide of the mentally ill - legislation is needed, and Parliament should act,” he said.

Gordon Brown has warned against legalising assisted suicide, saying it would run the risk of putting vulnerable people under pressure to end their lives.

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Do You Know Jack? The Prudential Case Against Suicide (Christian Post, 100314)

By Chuck Colson

According to an upcoming HBO movie, “You Don’t Know Jack,” folks. The “Jack” in this case is Dr. Jack Kevorkian, a.k.a., “Dr. Death.” The title also means “you don’t know anything.”

Actually, we know quite a bit about assisted suicide-it’s those who insist otherwise that need instruction.

While the movie hasn’t aired or even been viewed by critics, we can infer its perspective on Kevorkian from the comments made by its stars, Al Pacino and Susan Sarandon.

According to Pacino, viewers “don’t know this guy.” Kevorkian “is more than meets the eye...[the film is] a portrait of a zealot. I don’t think we see that often.”

Kevorkian’s “zealotry” also appealed to Sarandon, who said that people who dedicate themselves to a cause at the expense of anything else in their lives “are really fascinating people.”

For his part, Kevorkian is said to be “enthused about helping with the film.” His lawyer thinks the film won’t be “scathing and critical.”

I guess not. I certainly doubt that three Oscar-winners-Pacino, Sarandon, and director Barry Levinson-have come together to make a film that won’t be at least a little sympathetic to its subject.

What viewers will probably see is a story about a man whose excesses hurt an otherwise noble cause and led to his downfall at the hand of religious zealots.

Of course, there’s nothing noble or “compassionate” about physician-assisted suicide-and you don’t have to be religious to believe that.

No one would call the British magazine Spiked religious or even traditionalist. Yet, it recently ran two pieces about why assisted-suicide should remain illegal. In one of them Kevin Yuill of the University of the Sunderlands makes clear what many assisted-suicide advocates try to obscure: The ultimate goal isn’t to alleviate suffering, but to enshrine in law “the right of any person to end their life.”

This “right,” according to Yuill, threatens the “assumption that human life is valuable.”

He calls suicide a “deeply anti-social act” that destroys “possibilities”-not just, obviously, for the individuals themselves, but for others too. Yuill insists that it’s this social harm and not what he terms “outmoded religious beliefs” that lies behind the “taboo against suicide.”

In the other piece, editor Mick Hume adds that the “right to die” is the result of a “loss of faith-not in God, but in humanity.” Hume decries the lack of belief in “the human capacity to transcend the limitations of our lives.” In this “demoralized” setting, the wish for a “good death” replaces “the aspiration for a better life.”

What Hume and Yuill miss completely is the connection between Christian ideas and the beliefs whose passing they lament. What Hume calls “faith in humanity” is inseparable from the idea of our being created in the image of God. What Yuill calls “possibilities” is derived from Christian ideas about hope.

But that’s OK. When it comes to assisted suicide, the next big so-called rights campaign that the left will wage, we Christians welcome good, prudential arguments. So that even non-believers can come to understand the “aspiration for a better life.”

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Remembering Terri Schiavo: A Five-Year Anniversary Marked By Cruel Bigotry (townhall.com, 100331)

by Bobby Schindler

March 31st will mark the five-year anniversary of the needless death of my sister, Terri Schiavo.

It is difficult to believe this much time has passed since that horrible event which will be forever seared into my memory.

I wish I could say things have changed for the better since my sister’s death or that people with cognitive disabilities are now better protected in response to the horror she had to endure.

Tragically, however, it seems the rights of the brain-injured, elderly and others are still being violated.

All one has to do is look at what happened just last week. On March 21st, Fox aired an episode of The Family Guy that featured a “sketch” called “Terri Schiavo: The Musical.” I was astonished at the producer’s cruel bigotry directed towards my sister and all cognitively disabled people.

Sadly, although more offensive than what my family has seen in the past from the media since Terri died, the bald-faced ignorance expressed in that episode of The Family Guy was nothing new. In fact, all signs indicate that we have embarked on a very disturbing path.

There is no disputing that Terri’s life – and death – had an astonishing impact on our nation. Our family still receives letters, emails and phone calls almost every day from people who tell us how Terri’s story touched them in profound ways, particularly when they come to know the facts.

Indeed, it was because of my family’s experience trying to protect Terri that we realized how all persons with similar cognitive disabilities are completely vulnerable to state laws that currently make it “legal” to deny them the most basic care – food and water.

This horrifying realization was why we established Terri’s Foundation. In Terri’s name, my family now works to protect tens of thousands of people with similar brain-injuries from having their fundamental freedoms taken away by an aggressive anti-life movement hell-bent on portraying severely disabled and otherwise vulnerable human beings as nothing more than “useless eaters”.

If the amount of phone calls we receive is any indication, what happened to Terri has become common. I think most people have no idea how our individual rights to make decisions about basic care like food and water, antibiotics, etc., have been so dramatically eroded. This not only includes family members advocating for loved ones but also protecting oneself by medical directive.

We recently heard from a woman whose mother was being cared for at a hospice facility. The daughter was powerless to effectively advocate for her mother because she had no power of attorney.

Even though she was her mother’s next-of-kin, and despite the fact her mother was begging her for food, the daughter was not allowed to feed her. It had been determined the mother was no longer able to swallow. But the daughter said her mother was eating safely just prior to being sent to hospice and questioned whether she still could. The mother was not given a feeding tube, and died just a short time later.

Perhaps the “Death Panels” Sarah Palin spoke of sounded like bombastic language. Yet when Palin added this term into our nation’s debate on health care, I believe she did not realize that many hospitals and facilities already have something frighteningly similar. Ethics committees are making many life and death decisions about patients, including whether to withhold simple provisions.

In a seemingly clandestine way, these ethics committees – comprised of medical and legal professionals – are empowering facilities to make life and death decisions independent of the family or a person’s own wishes.

The chilling stories we receive make it clear few citizens have any idea how vulnerable they are when it comes to judgments left in the hands of these ethics committees and facilities. And with the federal government now controlling our health care, there is no reason not to believe that these types of committees won’t become nationalized. Particularly when a health care system has been sabotaged by cost factors and quality of life judgments.

When our office receives phone calls from people fighting for their loved ones, I cannot help but look back and reflect on the courage of many individuals and groups who advocated on behalf of my sister.

As time has passed, however, many of those people, organizations and politicians – even many of our own friends – have fallen silent. Many who once ardently supported Terri’s life no longer actively educate or advocate for vulnerable patients.

With each troubling phone call from a frantic family, I am reminded there are countless other Terris in desperate need of our voice. Terri’s Foundation has been successful helping to save some, but sadly so many others have fallen victim.

I understand our nation faces many challenges today that may threaten our very existence. But how can we claim to be a just and honorable society, deserving of any blessing at all, if we richly reward hateful bigots while refusing to protect our weakest citizens?

Moreover, how did the tremendous courage and kindness we saw when we were fighting for Terri’s life have faded? How can any of us abandon this issue when all signs are that things are getting worse?

There are still many who support our efforts, who recognize the erosion of the value and dignity of the medically weak and who believe in protecting the life and liberty of all human beings.

The problem is their voices are often drowned out by the din of the pro-death lobby that claims death is the only dignified answer to a complicated problem.

Meanwhile the pro-death movement has not fallen silent. Rather, it has grown more vocal. The issue for them did not die with Terri. Indeed, their success in killing her seems to have only bolstered their determination to gain wider acceptance among the American people.

There will always be people with needs, there will always be others who work tirelessly to help them, and there will always be those who turn the other way; or worse – sit behind their drawing tables, disseminating cruel bigotry and hatred toward the disabled and vulnerable.

Until we all recognize that our inherit worth doesn’t change because of life’s circumstances, illness, disability or other events, we will continue to rob our most vulnerable of their right to fairness, justice and the ability to guide their own course in life.

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A “Duty to Die”? (townhall.com, 100511)

by Thomas Sowell

One of the many fashionable notions that have caught on among some of the intelligentsia is that old people have “a duty to die,” rather than become a burden to others.

This is more than just an idea discussed around a seminar table. Already the government-run medical system in Britain is restricting what medications or treatments it will authorize for the elderly. Moreover, it seems almost certain that similar attempts to contain runaway costs will lead to similar policies when American medical care is taken over by the government.

Make no mistake about it, letting old people die is a lot cheaper than spending the kind of money required to keep them alive and well. If a government-run medical system is going to save any serious amount of money, it is almost certain to do so by sacrificing the elderly.

There was a time— fortunately, now long past— when some desperately poor societies had to abandon old people to their fate, because there was just not enough margin for everyone to survive. Sometimes the elderly themselves would simply go off from their family and community to face their fate alone.

But is that where we are today?

Talk about “a duty to die” made me think back to my early childhood in the South, during the Great Depression of the 1930s. One day, I was told that an older lady— a relative of ours— was going to come and stay with us for a while, and I was told how to be polite and considerate towards her.

She was called “Aunt Nance Ann,” but I don’t know what her official name was or what her actual biological relationship to us was. Aunt Nance Ann had no home of her own. But she moved around from relative to relative, not spending enough time in any one home to be a real burden.

At that time, we didn’t have things like electricity or central heating or hot running water. But we had a roof over our heads and food on the table— and Aunt Nance Ann was welcome to both.

Poor as we were, I never heard anybody say, or even intimate, that Aunt Nance Ann had “a duty to die.”

I only began to hear that kind of talk decades later, from highly educated people in an affluent age, when even most families living below the official poverty level owned a car or truck and had air-conditioning.

It is today, in an age when homes have flat-panelled TVs, and most families eat in restaurants regularly or have pizzas and other meals delivered to their homes, that the elites— rather than the masses— have begun talking about “a duty to die.”

Back in the days of Aunt Nance Ann, nobody in our family had ever gone to college. Indeed, none had gone beyond elementary school. Apparently you need a lot of expensive education, sometimes including courses on ethics, before you can start talking about “a duty to die.”

Many years later, while going through a divorce, I told a friend that I was considering contesting child custody. She immediately urged me not to do it. Why? Because raising a child would interfere with my career.

But my son didn’t have a career. He was just a child who needed someone who understood him. I ended up with custody of my son and, although he was not a demanding child, raising him could not help impeding my career a little. But do you just abandon a child when it is inconvenient to raise him?

The lady who gave me this advice had a degree from the Harvard Law School. She had more years of education than my whole family had, back in the days of Aunt Nance Ann.

Much of what is taught in our schools and colleges today seeks to break down traditional values, and replace them with more fancy and fashionable notions, of which “a duty to die” is just one.

These efforts at changing values used to be called “values clarification,” though the name has had to be changed repeatedly over the years, as more and more parents caught on to what was going on and objected. The values that supposedly needed “clarification” had been clear enough to last for generations and nobody asked the schools and colleges for this “clarification.”

Nor are we better people because of it.

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Belgian euthanasia nurses ‘fail to get consent’ (Vancouver Sun, 100611)

Almost half of deaths by euthanasia in Belgium have involved patients who have not explicitly requested their lives to be ended by a doctor, a study has suggested.

A fifth of nurses interviewed by researchers admitted that they had been involved in the euthanasia of a patient based on the “assumption” they would want to die. Nearly half of the nurses - 120 of 248 - admitted they had taken part in “terminations without request or consent”.

Euthanasia has been legal in Belgium since 2002. It accounts for two per cent of all deaths annually. The law states that patient consent must be given and that doctors must carry out the procedure. But the study published in the Canadian Medical Association Journal shows that the rules are routinely flouted and shows how doctors often delegate the administering of fatal drugs to nurses.

The study states: “By administering the life-ending drugs in some of the cases of euthanasia, and in almost half of the cases without an explicit request from the patient, the nurses in our study operated beyond the legal margins of their profession.”

Dr Peter Saunders, of the anti-euthanasia charity Care Not Killing, said: “We should take warning from this that wherever you draw the line people will go up to it and beyond it.”

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Study Reveals How U.K. Doctors’ Faith Affects End-of-Life Care (Christian Post, 100827)

U.K. doctors who are not religious are more likely to take steps to help end a very sick patient’s life than doctors who are very religious, according to the findings of a new study.

The study, published in the Journal of Medical Ethics, surveyed more than 3,700 doctors in the United Kingdom across a wide range of specialties such as neurology, palliative care, and general practice.

Researchers asked doctors about the last patient whom they had worked with who had died. The doctors answered questions about their own religious beliefs and ethnic background, as well as end of life care - did they give continuous deep sedation until death to the last patient who had died? Did they discuss decisions with the patient that would likely shorten the patient’s life?

The study found that the strength of a doctor’s religious faith is related to the incidence of continuous deep sedation until death, confirming findings of previous research. Researchers also found that a doctor who reported being “very or extremely non-religious” had an increased likelihood of taking these kinds of decisions to end a patient’s life.

Furthermore, doctors who said they were very religious were found to be less willing to discuss decisions expected or partly intended to end life. This result corroborates what a 2007 New England Journal of Medicine study found – that more religious doctors are less likely to believe that they should give the patient information about procedures to which the doctors held moral objections.

Other findings from the study: Specialists in care of the elderly were somewhat more likely to be Hindu or Muslim than other doctors; palliative care specialists were somewhat more likely to be Christian, religious and “white” than others; and ethnicity was largely unrelated to rates of reporting ethically controversial decisions.

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Assisted Suicide Advocate Jack Kevorkian Dies at 83 (Fox News, 110603)

Dr. Jack Kevorkian, the Michigan pathologist who championed physician-assisted suicides, died early Friday after being hospitalized with kidney problems and pneumonia.

The 83-year-old Kevorkian, who said he helped some 130 people end their lives from 1990 to 1999, died about 2:30 a.m. at William Beaumont Hospital in Royal Oak, Mich., close friend and attorney Mayer Morganroth said.

An official cause of death had not been determined, but Morganroth said it likely will be pulmonary thrombosis.

“I had seen him earlier and he was conscious,” said Morganroth, who added that the two spoke about Kevorkian’s pending release from the hospital and planned start of rehabilitation. “Then I left and he took a turn for the worst and I went back.”

Nurses at the hospital played recordings of classical music by composer Johann Sebastian Bach for Kevorkian before he died, Morganroth said.

Kevorkian was freed in June 2007 after serving eight years of a 10- to 25-year sentence for second-degree murder. His lawyers had said he suffered from hepatitis C, diabetes and other problems, and he had promised in affidavits that he would not assist in a suicide if he was released.

In 2008, he ran for Congress as an independent, receiving just 2.7% of the vote in the suburban Detroit district. He said his experience showed the party system was “corrupt” and “has to be completely overhauled from the bottom up.”

His life story became the subject of the 2010 HBO movie, “You Don’t Know Jack,” which earned actor Al Pacino Emmy and Golden Globe Awards for his portrayal of Kevorkian. Pacino paid tribute to Kevorkian during his Emmy acceptance speech and recognized the world-famous former doctor, who sat smiling in the audience.

Pacino said during the speech that it was a pleasure to “try to portray someone as brilliant and interesting and unique” as Kevorkian and a “pleasure to know him.”

Kevorkian himself said he liked the movie and enjoyed the attention it generated, but told The Associated Press that he doubted it would inspire much action by a new generation of assisted-suicide advocates.

“You’ll hear people say, ‘Well, it’s in the news again, it’s time for discussing this further.’ No it isn’t. It’s been discussed to death,” he said. “There’s nothing new to say about it. It’s a legitimate ethical medical practice as it was in ancient Rome and Greece.”

Eleven years earlier, he was sentenced in the 1998 death of a Lou Gehrig’s disease patient — a videotaped death shown to a national television audience as Kevorkian challenged prosecutors to charge him.

“The issue’s got to be raised to the level where it is finally decided,” he said on the broadcast by CBS’ “60 Minutes.”

Nicknamed “Dr. Death” because of his fascination with death, Kevorkian catapulted into public consciousness in 1990 when he used his homemade “suicide machine” in his rusted Volkswagen van to inject lethal drugs into an Alzheimer’s patient who sought his help in dying.

For nearly a decade, he escaped authorities’ efforts to stop him. His first four trials, all on assisted suicide charges, resulted in three acquittals and one mistrial.

Murder charges in earlier cases were thrown out because Michigan at the time had no law against assisted suicide; the Legislature wrote one in response to Kevorkian. He also was stripped of his medical license.

People who died with his help suffered from cancer, Lou Gehrig’s disease, multiple sclerosis, paralysis. They died in their homes, an office, a Detroit island park, a remote cabin, the back of Kevorkian’s van.

Kevorkian likened himself to Martin Luther King and Gandhi and called prosecutors Nazis, his critics religious fanatics. He burned state orders against him, showed up at court in costume, called doctors who didn’t support him “hypocritic oafs” and challenged authorities to stop him or make his actions legal.

“Somebody has to do something for suffering humanity,” Kevorkian once said. “I put myself in my patients’ place. This is something I would want.”

Devotees filled courtrooms wearing “I Back Jack” buttons. But critics questioned his publicity-grabbing methods, aided by his flamboyant attorney Geoffrey Fieger until the two parted ways before his 1999 trial.

“I think Kevorkian played an enormous role in bringing the physician-assisted suicide debate to the forefront,” Susan Wolf, a professor of law and medicine at University of Minnesota Law School, said in 2000.

“It sometimes takes a very outrageous individual to put an issue on the public agenda,” she said, and the debate he engendered “in a way cleared public space for more reasonable voices to come in.”

Even so, few states have approved physician-assisted suicide. Laws went into effect in Oregon in 1997 and Washington state in 2009, and a 2009 Montana Supreme Court ruling effectively legalized the practice in that state.

In a rare televised interview from prison in 2005, Kevorkian told MSNBC he regretted “a little” the actions that put him there.

“It was disappointing because what I did turned out to be in vain. ... And my only regret was not having done it through the legal system, through legislation, possibly,” he said.

Kevorkian’s ultimate goal was to establish “obitoriums” where people would go to die. Doctors there could harvest organs and perform medical experiments during the suicide process. Such experiments would be “entirely ethical spinoffs” of suicide, he wrote in his 1991 book “Prescription: Medicide — The Goodness of Planned Death.”

His road to prison began in September 1998, when he videotaped himself injecting Thomas Youk, a 52-year-old Lou Gehrig’s disease patient, with lethal drugs. He gave the tape to “60 Minutes.”

Two months later, a national television audience watched Youk die and heard Kevorkian say of authorities: “I’ve got to force them to act.” Prosecutors quickly responded with a first-degree murder charge.

Kevorkian acted as his own attorney for most of the trial. He told the court his actions were “a medical service for an agonized human being.”

In his closing argument, Kevorkian told jurors that some acts “by sheer common sense are not crimes.”

“Just look at me,” he said. “Honestly now, do you see a criminal? Do you see a murderer?”

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B.C. court shoots down assisted suicide challenge (National Post, 110817)

VANCOUVER — A British Columbia group fighting for the right to die through assisted suicide has lost its battle in B.C. Supreme Court.

Justice Lynn Smith ruled Wednesday that the Farewell Foundation for the Right To Die — a New Westminster, B.C., organization seeking a legalization of “self-chosen death” — did not have a strong enough case to challenge the Criminal Code section that bans assisted suicide.

Justice Smith pointed specifically to anonymous individuals in the foundation’s case and stated that unnamed individuals do not have the power to challenge federal laws.

The foundation brought the case to B.C. Supreme Court in early August to fight for the right to both medically assisted and non-medically assisted suicide. According to their website, the organization wanted the right to open centres where non-medical practitioners and counsellors could help people end their own lives.

“The Farewell Foundation tried something new and today we learned that that is not possible,” foundation director Russel Ogden told reporters outside the courthouse Wednesday.

The court challenge comes nearly 20 years after the Supreme Court of Canada ruled that Sue Rodriguez — a Canadian woman dying from Lou Gehrig’s disease, a painful and fatal degenerative disorder — did not have the right to end her own life.

Mr. Ogden argued that times have changed since Rodriguez’s case — and sought a declaration that Section 241(b) of the Criminal Code — the section of the Code that identifies assisted suicide as punishable by a maximum of 14 years in prison — was unconstitutional.

“It’s a matter of a wider range of options for Canadians who are suffering at the end of life,” he said.

Despite the loss, the B.C. group’s fight for the right to die may not be over.

Following the court’s decision, Justice Smith invited the Farewell Foundation to seek “intervener status” in the B.C. Civil Liberties Association’s case to fight for assisted suicide rights for Gloria Taylor, a Kelowna, B.C., woman dying of Lou Gehrig’s disease. The disease is also known as Amyotrophic Lateral Sclerosis, or ALS.

Though the BCCLA case focuses on medically assisted suicide and will not pursue the right to non-medical assisted dying like the Farewell Foundation, Mr. Ogden said the chance to participate in the trial would allow his organization to continue to forward its interests in the court system.

“It’s not an overwhelming victory, but it’s an opportunity for us to move our interests forward and that’s what we always wanted to do,” he said. “There are thousands of Canadians that are suffering and we have an opportunity to advance the interests of those Canadians.”

Coquitlam, B.C.-based Farewell Foundation member Jim Preece also said that although the foundation’s case was unsuccessful, he hoped to see Canada’s assisted-suicide ban lifted.

“I think the time has come for this society to take a definite look at the ways in which people who have insurmountable pain can end their life the way they wish to,” he said.

According to Mr. Ogden, the Farewell Foundation has already begun the paperwork to apply for “intervener status” in the BCCLA’s trial, scheduled to begin in B.C. Supreme Court Nov. 15.

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Martin Green: Give patients ‘choice’ over when they die (Daily Telegraph, 110829)

Terminally ill patients who want to commit suicide should be able to receive medical help to die, a government adviser on care for the elderly has said.

Martin Green, a dementia expert for the Department of Health, said patients who were too frail to take their own lives were being denied “choice” and “autonomy” because assisted suicide is illegal in the UK.

In an interview with The Daily Telegraph, he urged ministers to review the law and suggested that a referendum or a free vote in Parliament should be called to settle policy on the issue.

“If you’re going to give people ‘choice’, it should extend to whether or not they want to die,” he said. “If people have got the capacity to make an informed choice then it is my view that they should be allowed to make the informed choice.”

His remarks were welcomed by campaigners for a change in the law but will fuel concerns among disability charities and Christian groups who fear that legalising assisted suicide would put elderly and disabled people under pressure to end their lives.

Mr Green, the chief executive of the English Community Care Association, which represents nursing and care home groups, is one of the country’s leading experts on support for the elderly and has advised ministers on a number of key dementia policies. [KH: do you want to stay in a nursing home operated under him?]

He is among the panel of experts that drafted new Department of Health guidelines on services for dementia patients, published in July, and has been one of the government’s three national dementia “champions” since 2009.

His intervention follows a series of high profile cases in which terminally ill patients have sought help from relatives to commit suicide, or have travelled to the Dignitas suicide clinic in Switzerland where doctors have supplied them with lethal poison.

Last year, the Director of Public Prosecutions published revised guidelines that detailed factors making the prosecution of family members who helped loved ones to die less likely. Chief among these was clear evidence that the suspect was motivated by compassion.

However, police investigate all cases and there is no legal protection for doctors or other professionals who assist a suicide, an offence which carries a potential sentence of 14 years in jail.

Mr Green said that while the NHS and social care systems were organised around the “mantra of choice and control”, this does not extend to terminally ill patients who want to end their suffering but are physically incapable of committing suicide.

Medical professionals and carers will ask patients where they want to die, what their “cultural needs” might be and how to support their family members.

“But if I come and say to you I want to die, that is not a choice that the system allows me to have,” he said. “In terms of people who have cognitive function, it seems to me to be wholly consistent to say, if you’re going to give people choice and control and autonomy, it should extend to whether or not they want to die.”

In other areas of life, disability discrimination laws mean that those who are physically unable to “engage in the activities of normal citizens” are entitled to support. Therefore, this support should extend to assistance from medical or legal professionals to die “because this is an element of choice that people are being denied because of their impairment”.

Mr Green warned that any change in the law would require “absolutely clear safeguards” to protect the vulnerable from medical intervention against their will. People can change their minds and patients with dementia can undergo major alterations to their personality, he said.

However, even with safeguards that seek to ensure patients remain genuinely committed to their decisions, it would be impossible to eliminate the danger of abuse entirely, he said.

“It might be a small minority but you will never ever be able to eliminate risk and you should never pretend you can,” he said.

Mr Green suggested that referendum or a free vote in Parliament could settle the issue for the next 60 years. “It is something which needs to be reviewed now, not least because there are going to be more people who are engaged in having a choice in their lives.”

Mr Green has given evidence to the Commission on Assisted Dying, an inquiry organised by the think-tank Demos and chaired by the former Labour Lord Chancellor, Lord Falconer.

Next month, the High Court is due to hear a test case in which a paralysed man with “locked in” syndrome is seeking permission for doctors and lawyers to help him to commit suicide.

Campaigners for a change in the law include the actor Sir Patrick Stewart and the authors Sir Terry Pratchett, who has Alzheimer’s disease, and Ian McEwan.

Jo Cartwright, from the Dignity in Dying campaign, said she believed “the vast majority of the public” would support a change in the law to allow terminally ill, mentally competent adults “the choice of an assisted death”.

“At present people who want such choice are either forced to travel abroad for help to die, or attempt to end their lives at home behind closed doors,” she said.

However, opponents of legal reform include the Church of England, most medical organisations, and the disability charity, Scope, which has warned that “a substantial majority” of disabled people fear that legalising assisted suicide could increase pressure on them to end their lives.

Dr Peter Saunders, campaign director at the Care Not Killing Alliance, said British parliamentarians had repeatedly rejected reforms over fears for vulnerable people who see themselves as a financial or emotional burden on their families.

“In a free, democratic society, we know that there are limits to personal choice,” he said. “Even with so-called safeguards, to allow people to choose to have help to kill themselves would be open to exploitation and abuse.”

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An ailing doctor’s decision to die (World Magazine, 110909)

Euthanasia and the “right to die” continue to be hot topics of debate here and around the world, in religious and secular circles. I recently wrote about a daughter who helped her mother die by allowing her to starve to death and then penned a book about it.

The following story addresses the topic from a unique perspective and with a different twist.

Three years ago, Dr. Eric Manheimer was diagnosed with squamous cell carcinoma of the throat that had spread to his lymph nodes. As a physician, Manheimer knew this was bad news. He also knew his illness was treatable with radiation and chemotherapy, and that with those treatments his chance of survival was 75%.

For 35 days in a row he was given 2,000 units of radiation, along with high doses of chemotherapy. In his own words, his world shrank “to a small, sterile, asteroidal universe between the interminable nausea and the chemobrain that left my head both empty and feverish, between survival and death.”

After what Manheimer describes as “one desperate hospitalization” where he had to be given blood transfusions and medication to stimulate his white blood cells, he decided he’d had enough. “I refused further radiation and chemotherapy. I lay in my bed . . . comfortable that I had made the correct decision. My doctors couldn’t override it or persuade me to change my mind, but, luckily, my wife, Diana, could and did.”

Manheimer is alive and well today, working as the medical director of Bellevue Hospital Center in New York. He wrote about his experience with cancer and his decision to die for The New York Times: “My dreams of dying were not the products of anxious moments of terror. The life force had simply slipped away and made me ready to die. It had also rendered me incapable of making the right decision for myself.”

He had lost the will to live. He was not thinking clearly. He was suffering terribly. And by his own admission that made him incapable of making the right decision on his own.

Thankfully his wife did.

And thankfully Dr. Manheimer reports that the “recognition of vulnerability” has helped make him a better doctor.

Dr. Eric Manheimer’s experience obviously doesn’t apply to all situations, but it provides powerful, personal testimony to the altered state of mind that illness—and grueling treatment regimens—can produce. I hope the medical establishment is listening.

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