TWO CHARGES AGAINST PRO-LIFE DOCTOR SET ASIDE

Doctors For Life International welcomes the progress made in defending Dr Jacques de Vos against the persecution he had to endure for advising that an unborn baby is a human being. Dr De Vos has been barred from continuing with his medical career for more than two years now and has been charged with unprofessional conduct by the HPCSA. His hearing has been delayed and rescheduled, and charges have been changed on more than one occasion. On 28 and 29 October 2019, Dr De Vos’ legal team argued among other things, that the delays render the hearing unfair and the charges are unlawful.

On 3 December 2019 the Disciplinary Committee made a ruling that counts 3 and 4 are set aside and that the hearing is to continue on counts 1 and 2 only. This means that the only charge now facing Dr De Vos is that he tried to convince a woman not to authorise a doctor to kill her healthy 19 week old unborn child.

Secondly, after some two years of linking their refusal to sign Dr De Vos off with the outstanding disciplinary proceedings, the Wynberg Military Hospital has now abandoned this position. (In this regard the Disciplinary Committee of the HPSCA in effect in its reasons delivered on Tuesday has confirmed this de-linking. Prior to this despite letters to the HPSCA requesting clarity on this, no response was forthcoming from the HPSCA.)

The hearing will continue on *9 December 2019* at the Southern Sun Hotel, Newlands, Cape Town. The parties will try and reach an agreement about the future conduct of this matter as regards to the single incident relating to the unborn child.

Dr De Vos, who is a member of Doctors For Life International (DFL) is supported by DFL and legal team (De Wet Wepener Attorneys and Adv Keith Matthee SC) on a pro bono basis.

For more information, please contact Martus De Wet at [email protected]

DR DE VOS UPDATE

26 November 2019

The Disciplinary committee must give their decision (together with reasons) whether to dismiss counts 3 and 4, and give their reasons for not dismissing counts 1 and 2.

Until then, Dr de Vos is not in a position to decide whether to apply to the High Court for review.

The next hearing date is 09 December 2019 at the Southern Sun, Newlands, Cape Town.

For more information contact: Martus De Wet of De Wet Wepener Attorneys at 057 004 0004 / Email: [email protected]

Marijuana Vaping Outbreak — Not Just a Black Market Issue

By Colton Grace

• 86 percent of the cases of illness and at least 2 deaths in this marijuana vaping outbreak have been connected to THC oils.

• At a time when we are investigating the causes of this rash of deaths and illnesses connected to marijuana oils and vapes, all marijuana legalization efforts and THC vaping oil sales should pause.

• This is not a black-market issue, it is the result of allowing Big Marijuana – an addiction- for-profit drug industry backed by Big Tobacco and companies like Juul – to mass produce these oils and vapes, along with candies, gummies, and other dangerously potent forms of the drug.

• Big Tobacco, E-Cigarette and Vaping Companies and the Marijuana industry share many of the same investors. The industries are connected by billions in investments.

FAQs:

Is the Vaping Crisis a reason to legalize marijuana?

No. Many “licensed, regulated” pot shops are selling the vapes at the center of this crisis, such as a confirmed case in Delaware and a death in Oregon. This crisis is an indication that a legalized marijuana industry will be just as difficult to regulate and as detrimental to public health as the tobacco industry (which is now invested in marijuana). All legalization efforts should pause given this crisis only 6 years into recreational legalization in Colorado and Washington State.

What’s more, researchers are still quite unclear as to the culprit responsible for the illness and death. The only unifying factor in the majority of cases is the presence of THC, the psychoactive chemical in marijuana. As such, no amount of “regulation” or “testing” can guarantee these devices are safe to use. The CDC and the FDA seem to agree, as they have urged Americans to avoid using any marijuana vaping device

Is the vaping crisis exclusively a black-market problem?

No. The CDC and FDA are asking the public to stop using all THC vapes, whether from the black market or “licensed” pot shops. Many “licensed, regulated” pot shops are selling the vapes at the center of this crisis, such as a confirmed case in Delaware and a death in Oregon. A recent study out of Colorado found that in cheap marijuana vaping devices, a soldering material may leak harmful heavy metals into vaping liquids when heated. This backs up a recent study by the Mayo Clinic finding several lung tissue samples from victims of the illness feature what resemble chemical burns, similar to the effects of mustard gas.

Logically, cheap vaping devices make greater targets for diversion to the black market, given the possibility of a greater profit margin. We have long known that the legal market fuels the illegal market and it was recently discovered that a marijuana vaping device producer in Californiawas supplying devices that couldn’t pass inspections to the black market.

Facts:

• At least 37 people have died from severe respiratory complications associated with vaping. At least 1,888 cases have been reported across the United States.i

• 84 percent of the deaths investigated have been associated with THC.ii

• Two of the deaths have been connected to marijuana products, one of which was associated with marijuana oil purchased at a legal dispensary in Oregon.iii No other states have released information about the kinds of vapes that were linked to the deaths.

• Reports link marijuana vapes to 86 percent of the lung illnesses being reported in the wake of the vaping epidemic.iv

• Though the marijuana industry blames illicit vaporizers exclusively for using Vitamin E acetate, one source working within the industry, Andrew Jones of Mr. Extractor, has said that 60 to 70 percent of all vapes contain Vitamin E acetate. Even still, no health official has pointed to any individual cause.v

• New York state has issued subpoenas to several vape companies as the investigation mounts.vi

• Medical marijuana users in Maryland have reported symptoms consistent with the lung illnesses resulting from vaping.vii

• According to the CDC, 36 percent of the victims of the vaping-related illnesses are 20 years old or younger.viii

• A recent study showed adolescents who vaped were 3.5 times as likely to smoke marijuana.ix

• Since Monitoring the Future (MTF) first began recording vaping trends among young people in 2017, the survey has demonstrated significant increases among key demographics. In 2017, 1.6 percent of 8th graders, 4.3 percent of 10th graders, and 4.9 percent of 12th graders reported past-month marijuana vaping use. In 2018 the numbers increased to 2.6 percent, 7 percent, and 7.5 percent respectively.x

• The MTF notes that “the doubling from 5.2% in 2017 to 10.9% in 2018 of 30-day prevalence of vaping marijuana among college students is among the largest one-year proportion increases for any substance” in 40 years.xi

• In Arizona, a survey of 50,000 10th and 12th graders found that one quarter (25%) of teens were using has used highly potent marijuana concentrates at least once.

PDF version of this article: https://learnaboutsam.org/wp-content/uploads/2019/10/11-01TP.pdf

References:

https://www.cdc.gov/media/releases/2019/p1028-first-analysis-lung-injury-deaths.html

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

https://www.usatoday.com/story/news/health/2019/09/05/vaping-death-oregon-man-dies-thc-vape-%20dispensary/2218501001/

https://www.nejm.org/doi/full/10.1056/NEJMoa1911614

https://www.inverse.com/article/59207-vitamin-e-acetate-thc-vapes

https://jamanetwork.com/journals/jamapediatrics/article-abstract/2748383

http://www.monitoringthefuture.org//pubs/monographs/mtf-vol2_2018.pdf

https://www.livescience.com/marijuana-concentrates-teen-use.html

PRO LIFE DR DE VOS HPCSA HEARING UPDATE RULINGS AND REASONS OF DISCIPLINARY COMMITTEE’S DECISION AWAITED APPLICATION FOR REVIEW TO HIGH COURT CONSIDERED

Media Release

The long-awaited professional conduct hearing of Dr De Vos, who allegedly advised a mother that her unborn baby is a human being, started on 27 and 28 October 2019 in Cape Town. Over two days, four grounds were argued as to why all the charges against Dr De Vos should be set aside. 

In essence, these grounds were: 

1. The HPSCA did not follow its own regulations before the decision to charge Dr De Vos and thus the hearing was a nullity. 

2. The charges were too vague to enable dr De Vos to prepare his defence. 

3. The length of time between when action was first taken against him, April 2017, and the eventual hearing on 29th October 2019, was excessive and for various reasons unfair. In this regard amongst other things the following was emphasized: All the delays were caused by the HPSCA, without any explanation a single charge was withdrawn in July 2018, only to be reinstated a few months later in November 2018, only to be replaced by four wholly new charges some 3 weeks before the first day of the hearing in August 2019, the severe ongoing prejudice to dr De Vos who as a result of the conduct of the HPSCA has not been able to practice as a doctor since June 2017 up to the present day, despite not yet having had a hearing. 

4. Bad faith by the HPSCA – numerous examples were given, including the changing of the charge sheets and the failure to give necessary information in terms of undertakings by it. 

Various decisions of the Constitutional Court and the Supreme Court of Appeal were relied on by Dr De Vos.

During the first day, the prosecutor for the first time provided some of the information sought by De Vos to prepare for the hearing (e.g. a medical report), and conceded that other crucial information is not in their possession (e.g. the text messages referred to in the charges, and the statement by the complainant (patient) in charges 1 & 2). 

At the end of the second day, after a short adjournment by the disciplinary committee of the HPSCA, it ruled that counts 1 and 2  “were properly before it” (which suggests it was thinking of the nullity argument) and could continue. Furthermore, it stated that it still had to decide about counts 3 and 4. No reasons were provided at the time of the ruling, and the Committee said it would give its reasons for its decision later.

Dr De Vos’s legal representative informed the committee that before they could decide on the way ahead, they needed a decision about counts 3 and 4 and the reasons for all their decisions. The main reason for wanting the reasons is so that a decision can be made as to whether the decision should be taken to the High Court on review. The disciplinary committee was also informed that a piecemeal approach, starting with counts 1 and 2 whilst they made a decision on counts 3 and 4, was impractical and ill advised.

What is of possible significance is that when it made its ruling the committee of the HPSCA stated that counts 1 and 2 were “properly” before it. This suggests that at this stage the committee had only addressed the nullity argument of Dr De Vos, and not the arguments as regards the vagueness of the charges, that a fair hearing was no longer possible and that the matter was driven by bad faith on the part of the HPSCA. When clarity was asked for in this regard, the chairperson stated that their ruling also took into account the other said points. This is one of the reasons why the reasons of the committee are so important – to enable the legal representatives of Dr De Vos to try and understand how the committee arrived at its decision, not least of all how it dealt with the cited decisions of the Constitutional Court and the Supreme Court of Appeal. This is crucial before the legal representatives advise Dr De Vos on the way ahead. 

Dr De Vos, who is a member of Doctors For Life International (DFL) is supported by DFL and legal team (De Wet Wepener Attorneys and Adv Keith Matthee SC) on a pro bono basis. For more information, please contact Doctors For Life International at 032 481 5550 or [email protected]

29 October 2019, DE VOS UPDATE:

The legal team for Dr De Vos argued that the case against him is a nullity and that it should be struck off the roll. Arguments continued until 16h30 and will continue today at 9h30.

Among other things, De Vos’ legal team argued that the charges are vague, the delay of almost three years is excessive, and that the HPCSA has not provided the prescribed information to De Vos’ legal team despite the ruling of the disciplinary committee on 27 August.

The HPCSA prosecutor argued that all information has been provided. This was disputed by De Vos’ legal team. Some additional information was then provided.

However, the committee must still rule on all the points raised by De Vos’ legal team.

Arguments will continue tomorrow at 9h30 at the Southern Sun Hotel, Newlands.

More more information contact Doctors For Life International at [email protected]

Kingsley Holgate heads to Zambezi Delta on ‘Vision Mission’

Kingsley Holgate’s crew have loaded up their expedition Land Rovers and headed for Mozambique with their sturdy ‘Ma Robert’ inflatable pontoon boat in tow, to assist the non-profit Doctors For Life International (DFL) team in conducting free, life-changing, cataract operations in the Zambezi Delta, as part of DFL’s Aid to Africa programme.

The Kingsley Holgate Foundation is taking its Mashozi’s Rite to Sight programme to a new level with this campaign, called ‘Vision Mission’.

In keeping with using adventure to improve lives, the Kingsley Holgate Foundation’s focus on helping those with poor eyesight was started more than a decade ago by Mashozi (Gill) Holgate. ‘I remember the day clearly,’ says Kingsley.

‘We were on our 23° 27 Capricorn round-the-world-by-Land-Rover Expedition, in South America close to the Piranha River, in the company of a team of rangers. They told us that they were about to evict an old man who had lived all his life in a local village because he was becoming a danger to himself and others – he’d nearly burned down his hut several times whilst trying to light his stove. We went with them to the old man’s hut and sure enough, there he was, fumbling with a box of matches. The problem was – he couldn’t see properly.

‘I don’t know what made Mashozi think of it, but she suddenly rummaged in her big expedition bag, brought out a pair of her own basic readers and popped them on the old man’s nose. Miraculously, they were the perfect strength. A look of complete surprise came over his face, followed by a big, toothy grin as for the first time in years, he could see clearly again. There were claps and cheers from the rangers as the old man confidently struck the match, lit his stove and made us each a cup of coffee. The rangers allowed him to stay in his home and that was the start of our Mashozi’s Rite to Sight programme, named in her honour. Since then, it’s gone from strength to strength; after careful eye tests, we’ve distributed over 200,000 pairs of reading glasses to poor-sighted, mostly elderly people in remote areas all over Africa and beyond. The instant gratitude from the recipients and the immediate difference it makes in their lives is heart-warming.’

DFL has performed 2,500 eye surgeries throughout Africa over the past decade, helping to reverse blindness and dramatically change lives. This Zambezi Delta Vision outreach is in response to a call for help to assist blind people in the Marromeu, Luabo and Chinde areas. DFL and the Kingsley Holgate Foundation are transporting two mobile operating theatres to Marromeu on the banks of the Zambezi River, along with a team of volunteer doctors and nurses from South Africa and eSwatini, with the aim of conducting at least 200 cataract surgeries during August.

‘We are incredibly honoured to be a part of this humanitarian mission,’ says expedition leader Ross Holgate. ‘We know the Zambezi River well and our role will be to provide ground support. Using our three Land Rovers and the ‘Ma Robert’ boat, we’ll be criss-crossing the Zambezi Delta, conducting our normal malaria prevention and Mashozi Rite to Sight spectacle-distribution work, and at the same time, assessing patients that need more stringent, corrective eye surgery. The DFL doctors will train our expedition team on what cataract symptoms to look for and we will transport patients and their family members by water and road to the operating theatres, and then return them home after their eye surgery. It’s going to be a lot of hard work in difficult conditions with tricky logistics; just the amount of expedition kit, including the bolt-together ‘Ma Robert’ boat and medical equipment that’s being transported 2,000 kilometres to the Delta, is quite unbelievable.’

Also supporting this humanitarian effort is the non-profit Mercy Air group, which recently played a vital role in providing emergency air support after Cyclone Idai devastated central Mozambique, rescuing hundreds of victims and transporting tonnes of food, drinking water, medical supplies and personnel to flood-stricken communities. For this Zambezi Delta mission, Mercy Air is providing a helicopter and aeroplane to transport cataract patients living in inaccessible villages to the operating theatres by air.

‘The capabilities of our tried-and-tested Land Rover Discoverys and faithful old Defender 130 are really going to be needed,’ continues Ross. ‘These are the same vehicles that took us safely to Africa’s extreme easterly point in dangerous Somalia in 2017 and completed the 17,000-kilometre transcontinental Cape Town to Kathmandu expedition last year, making short work of below-freezing, high-altitude and snow-filled mountain passes. Then in April this year, they delivered tonnes of malaria prevention supplies and clean drinking water to flooded communities near Gorongosa National Park that were badly affected by Cyclone Idai.’

Zambezi Vision Mission at a glance:

3 Expedition Land Rovers

2 Mercy Air aircraft

2 Doctors For Life mobile operating theatres

1 large, inflatable pontoon-type ‘Ma Robert’ boat and tender

22 personnel

10 tonnes of equipment

2,000Km of rough roads

230Km of coastline and 18,000Km² of swamps, floodplains and savannah in the Zambezi Delta

200+ cataract operations

1,000 recipients of Mashozi’s Rite to Sight eye-testing and spectacle distribution.

 

Text and images: Kingsely Holgate Foundation – Link to article

 

Link to article –

DFL member Dr de Vos takes a stand against abortion and then gets charged by HPCSA for misconduct.”

Please read the following articles about Dr de Vos:

SOWETAN LIVE

A hearing by the Health Professions Council of SA (HPCSA) against an anti-abortion doctor got off to a rocky start and had to be temporarily adjourned on Tuesday in Cape Town. Jacques de Vos, 32, is facing charges of unprofessional conduct and was prohibited from practising medicine due to his views on abortion. READ MORE

EYEWITNESS NEWS

A doctor, prohibited from practising medicine over his views on abortion, will face the Health Professions Council of South Africa (HPCSA) on Tuesday. Doctor Jacques de Vos reportedly believes abortion constitutes the killing of an unborn human being. De Vos was a medical intern at 2 Military Hospital in Wynberg when he made the utterance to a patient. He was then fired more than two years ago. READ MORE

IOL NEWS

An intern doctor and anti-abortionist appeared before a disciplinary hearing yesterday for allegedly dissuading a pregnant woman from terminating her pregnancy and likening it to the “killing of a human being”. READ MORE

ALGOA FM

A former military hospital doctor will appear before a disciplinary inquiry in Cape Town on Tuesday after being barred from practising as a doctor. Dr Jacques De Vos, who was a medical intern at 2 Military Hospital, was suspended two years ago after advising a patient that abortion is the killing of an unborn human being. READ MORE

DOCTOR CHARGED FOR ADVISING THAT UNBORN BABIES ARE HUMAN

Former Military Hospital doctor, Dr Jacques de Vos, has been charged by the Health Professions Council of South Africa (HPCSA) for advising that abortion is the killing of an unborn human being. Dr De Vos, who is a member of Doctors For Life International (DFL) will finally be able to respond to charges after waiting more than two years since being barred from practicing as a doctor.

Dr De Vos was a medical intern at 2 Military Hospital when he was suspended from the gynaecology rotation and refused to be signed off. As a result, Dr De Vos has also been prevented from commencing his community service year, effectively barring him from practicing medicine in South Africa for the past two years. Despite numerous efforts by Dr De Vos and his legal team, Dr De Vos has not received any assistance from the SA Military Health Service or the HPCSA to continue with his career.

Adv Keith Matthee SC, instructed by De Wet Wepener Attorneys, will represent Dr De Vos when he appears before a six-member panel disciplinary enquiry scheduled for 27 and 28 August 2019 in Cape Town. This case is likely to attract great interest in the medical community as healthcare practitioners such as Dr De Vos are often victimized and discriminated against for upholding the sanctity of life for unborn children and for advising women of the adverse effects of abortion on the mother of the unborn child.

The hearings are open to the public. The venue is yet to be confirmed by the HPCSA.

For more information, contact Martus de Wet of De Wet Wepener Attorneys at 057 004 0004 or [email protected]

12 Myths about Assisted Suicide and Medical Aid In Dying

Introduction In an age of “alternative facts”, it’s hard to sort out myth from reality when it comes to so-called ‘medical-aid-in-dying’ (MAID)—also called physician assisted suicide (PAS). By whatever label we attach to it, this practice involves a physician’s prescribing a lethal drug for a patient with a putatively terminal illness who is requesting this “service.” Some form of MAID/PAS is now legal in 5 states and the District of Columbia. People of good conscience, including many physicians, are sharply divided on the ethics of MAID/PAS. Unfortunately, much of the support for this practice is founded on several myths and misconceptions regarding existing MAID laws and practices. Here are 12 of the most common.

1. Everyone has a “right to die”, including a right to take one’s own life, acting alone or with assistance.

In contrast to “liberties”, rights entail the cooperation or assistance of others.1 Mentally competent people may be at liberty to end their own lives (i.e., will not be prosecuted), but there is no recognized right to suicide that involves the cooperation of others. In Washington v. Glucksberg [521 U.S. 702 (1997)], the US Supreme Court (USSC) denied that there is a constitutionally-protected “right to commit suicide” or a right to PAS. To rule otherwise, the majority held, would force them to “reverse centuries of legal doctrine and practice, and strike down the considered policy choice of almost every state.” That said, the USSC has held that all competent persons have the right to refuse unwanted or “heroic” measures that merely prolong the dying process.2 Similarly, in Vacco v. Quill [521 U.S. 793(1997)], the USSC held that there is a legal difference between withdrawal of care and provision of a lethal intervention; i.e., everyone has a right to refuse medical care, but no one has a “right” to receive a lethal means of ending one’s life.

2. People who request “medical aid in dying” usually do so because they are experiencing severe, intractable pain and suffering.

Most requests for medical-aid-in-dying are not made by patients experiencing “untreatable pain or suffering”, as data from Oregon have shown; rather, the most common reasons for requesting medical aid in dying were loss of autonomy (97.2{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4}), inability to engage in enjoyable activities (88.9{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4}), and loss of dignity (75.0{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4}).3 Many patients who request assisted suicide are clinically depressed and could be successfully treated, once properly diagnosed.

3. In states such as Oregon and Washington, where PAS is legal, there are adequate safeguards in place to ensure proper application of the PAS law.

In Oregon, reporting to the state is done solely by the physician prescribing the lethal drugs, who has a vested interest in minimizing problems. Moreover, if a physician was negligent in making the initial diagnosis or prognosis, there is no way to track this, since, by law, all death certificates will state that the person died of the putative underlying disease. At the same time, the physician is rarely present at the time the patient ingests the lethal drug, so the possibility of abuse—e.g., by coercive family members—cannot be adequately assessed. The Oregon department of human services has said it has no authority to investigate individual death-with-dignity cases,4 and Oregon has acknowledged that its law does not adequately protect all people with mental illness from receiving lethal prescriptions.5 Thus, it is nearly impossible to determine cases in which, for example, terminally ill patients were pressured to end their lives by family members. A study in the Michigan Law Review (2008) found that “seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented…[and that]…the Oregon Public Health Division (OPHD), which is charged with monitoring the law…does not collect the information it would need to effectively monitor the law…OPHD…acts as the defender of the law rather than as the protector of the welfare of terminally ill patients.”6 Kenneth R. Stevens, Jr., MD, and William I. Toffler, MD, both of the Oregon Health & Science University, point to other actual or potential abuses in PAS-permissive states, including “physician shopping” to get around safeguards; nurse-assisted suicide without orders from a physician; and economic pressures to use PAS, such as Oregon Medicaid patients being denied cancer treatment but offered coverage for assisted suicide.7 Furthermore, an investigative piece by the Des Moines Register revealed that mandatory reporting requirements were not followed by hundreds of doctors in states where MAID/PAS is legal.8

4. In the US, only people with terminal or incurable illnesses are eligible for PAS.

Most PAS legislation applies to an adult with a terminal illness or condition predicted to have less than 6 months to live. In Oregon and Washington State, nearly identical criteria are interpreted to mean less than 6 months to live—specifically, without treatment. Thus, a healthy 20-year-old with insulin-dependent diabetes could be deemed “terminal” for the purpose of Oregon’s “Death with Dignity Act.” So, too, patients refusing appropriate treatment may be deemed “terminal” under current interpretation of the Oregon law. Thus, a patient with anorexia nervosa who refused treatment could be eligible for PAS under Oregon law, even though she could recover with intensive therapy. As Swedish investigator Fabian Stahle observes, “This is in fact an alteration of the traditional meaning of the concept of ‘incurable.’”9

5. “Slippery slope” arguments against PAS are overblown. In European countries that allow PAS, there is no evidence that patients are being euthanized improperly.

People with non-terminal illnesses have been legally euthanized at their own request in several countries for nearly 15 years. This has included certain eligible patients who have only psychiatric disorders. In 2002, Belgium, the Netherlands, and Luxembourg removed any distinctions between terminal and non-terminal conditions—and between physical suffering and mental suffering—for legally permitted PAS. Between 2008 and 2014, more than 200 psychiatric patients were euthanized by their own request in the Netherlands (1{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} of all euthanasia in that country). Among them, 52{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} had a diagnosis of personality disorder, 56{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} refused 1 or more offered treatments, and 20{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} had never even had an inpatient stay (1 indication of previous treatment intensity). When asked the primary reason for seeking PAS/euthanasia, 66{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} cited “social isolation and loneliness.” Despite the legal requirement for agreement between outside consultants, for 24{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} of psychiatric patients euthanized, at least 1 outside consultant disagreed.10-12 The US has not been immune to the slippery slope, either. For example, in Oregon, a psychiatrist opened a fee-for-service death clinic, where for $5,000, “terminally ill patients who are eligible to take advantage of…Oregon’s suicide law can book a death that might look a lot like a wedding package.”13

6. The method of “assisted dying” now used in Oregon and other PAS-states assures the patient of a quick, peaceful death, without serious complications.

A peaceful death is by no means guaranteed using current methods of PAS, as a recent piece by Lo pointed out: 14 “Physicians who support PAD need to consider how to address the potential for adverse outcomes, including longer time to death than expected (up to 24 hours or more), awakening from unconsciousness, nausea, vomiting, and gasping.” Data collected between 1998-2015 showed that the time between ingestion of lethal drugs and death ranged from 1 minute to more than 4 days. During this same period (1998-2015), 27 cases (out of 994) involved difficulty ingesting or regurgitating the drugs, and there were 6 known instances in which patients regained consciousness after ingesting the drugs. However, it is difficult to know the actual rate of drug-induced complications, since in the majority (54{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4}) of cases between1998-2015, no health care professional was present to attend and observe the patient’s death.15

7. “Death with Dignity” all comes down to the patient’s autonomy, and the right of patients to end life on their terms.

In the first place, under current legislation permitting so-called medical aid in dying, the patient is completely dependent on the judgment, authorization, and prescriptive power of the physician—hardly a state of autonomy.1 Moreover, autonomy is only 1 of the 4 ‘cornerstones’ of medical ethics; the others are beneficence, non-malfeasance and justice. As Desai and Grossberg observe in their textbook on long-term care: “The pre-eminence of autonomy as an ethical principle in the United States can sometimes lead health care providers to disregard other moral considerations and common sense when making clinical decisions…we strongly feel that the role of the medical profession is to understand but not to support such wishes [for physician-assisted death]. Every person’s life is valuable, irrespective of one’s physical and mental state, even when that person has ceased to deem life valuable.”16

8. Doctors who conscientiously oppose PAS are perfectly free to refuse participation in it.

In theory, the California guidelines state that “A healthcare provider who refuses to participate in activities under the act on the basis of conscience, morality or ethics cannot be subject to censure, discipline … or other penalty by a healthcare provider, professional association or organization,” the guidelines say.17 However, prior to its PAS law being declared unconstitutional, physicians in California could be compelled to participate in PAS, under certain circumstances. California’s health department regulation requires a state facility to provide PAS. If the request is denied, the patient has a right to a judicial hearing on the matter. If the court determines the patient is qualified, the attending physician must write a prescription for lethal drugs.18 Moreover, there is evidence that physicians are sometimes pressured or intimidated by patients to assist in suicide.7

9. Terminally ill people who request MAID are not suicidal and don’t commit suicide. They are dying, and simply want “hastening” of an inevitable death. In contrast, genuinely suicidal people are not dying of a terminal condition, yet they want to die.

This argument plays fast and loose with language, logic, and law. In fact, it turns ordinary language on its head, thereby eliminating suicide by linguistic fiat. As the American Nursing Association states, “suicide is the act of taking one’s own life,”19 regardless of the act’s context. There may indeed be different psychological profiles that distinguish suicide in the context of terminal illness from suicide in other contexts, but that does not overturn the ordinary language meaning of suicide. Thus, when a terminally ill patient (or any other person) knowingly and intentionally ingests a lethal drug, that act is, incontrovertibly, suicide. Most suicides occur in the context of serious psychiatric illness. Yet patients who express suicidal ideation in the context of a condition such as major depression rarely want to die; rather, as numerous suicide prevention websites note, “Most suicidal people do not want to die. They are experiencing severe emotional pain, and are desperate for the pain to go away.” 20

10. People requesting PAS are carefully screened by mental health professionals to rule out depression.

Most PAS statutes modeled after the Oregon Death with Dignity statute do not require examination by a mental health professional, except when the participating physician is concerned and decides to do so. Specifically, “The patient is referred to a psychologist or psychiatrist if concern exists that the patient has a psychiatric disorder including depression that may impair judgment.”21 A study of the Oregon law concluded that “Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.”21 In Oregon, 204 patients were prescribed lethal drugs in 2016 under the “Death with Dignity” statute, yet only 5 patients were referred for psychiatric or psychological evaluation.22

11. Doctors who participate in PAS are almost always comfortable doing so and rarely regret their decision.

Many doctors who have participated in euthanasia and/or PAS are adversely affected— emotionally and psychologically—by their experiences. In a structured, in-depth telephone interview survey of 38 US oncologists who reported participating in euthanasia or PAS, nearly a quarter of the physicians regretted their actions. Another 16{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.23 For example, one physician felt so “burned out” that he moved from the city in which he was practicing to a small town. Similarly, reactions among European doctors suggest that PAS and euthanasia often provoke strong negative feelings.24

12. For terminally ill patients, the only means of achieving “death with dignity” is by taking a lethal drug prescribed by one’s doctor.

Only a small minority of persons with a terminal disease seek a physician’s prescription for a lethal drug. It is not clear why self-poisoning confers more dignity to one’s death than more traditional and much more common ways of dying. Many people who are dying choose to “bear with” their pain. Some seek hospice care and—in cases of severe, intractable pain—merit palliative sedation.25 Some choose voluntary stopping of eating and drinking (VSED), which, according to one study involving hospice nurses, results in a more satisfactory death than seen with PAS. In fact, “as compared with patients who died by physician-assisted suicide, those who stopped eating and drinking were rated by hospice nurses as suffering less and being more at peace in the last two weeks of life.”26 A form of VSED called ‘sallekhana’ has been practiced in the Jain religion for centuries and is regarded as an ethical and dignified means of achieving a “natural” death.27

Conclusion

The case for physician-assisted suicide legislation rests on a number of misconceptions, as regards the adequacy, safety, and application of existing PAS statutes. The best available evidence suggests that current practices under PAS statutes are not adequately monitored and do not adequately protect vulnerable populations, such as patients with clinical depression. The American College of Physicians,28 the American Medical Association, the World Medical Association and the American Nurses Association have all registered opposition to physician-assisted suicide. It is critical that physicians inform themselves as regards the actual nature and function—or dysfunction—of medical aid in dying legislation. The first step is to recognize and challenge the many myths that surround these well-intended but misguided laws.

Acknowledgments

The authors wish to recognize the important contributions of Dr. Mark Komrad and Mr. Alex Schadenberg to the discussion of physician-assisted suicide. Ronald W. Pies, MD is Professor Emeritus of Psychiatry and Lecturer on Bioethics at SUNY Upstate Medical University, Syracuse, NY; and Clinical Professor of Psychiatry, Tufts U. School of Medicine, Boston. Annette Hanson, MD, is Director of the Forensic Psychiatry Fellowship Program, and Clinical Assistant Professor, Department of Psychiatry, University of Maryland School of Medicine.

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