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.

References

1. Szasz T: Fatal Freedom. Syracuse University Press, 1995. 2.  https://constitutioncenter.org/blog/does-the-constitution-protect-a-right-to-die 3. Loggers ET, Starks H, Shannon-Dudley M et al. Implementing a Death with Dignity program at a comprehensive cancer center. N Engl J Med. 2013 Apr 11;368(15):1417-24. https://www.nejm.org/doi/full/10.1056/NEJMsa1213398 4. Oregon board investigates failed assisted suicide. Jun 20, 2005 http://www.drugtopics.com/community-pharmacy/oregon-board-investigates-failed-assisted-suicide 5. The Oregon Death With Dignity Act: A Guidebook for Healthcare Providers, page 43. Accessed at: http://www.ohsu.edu/xd/education/continuing-education/center-for-ethics/ethics-outreach/upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf 6. Hendin H, Foley K.  Physician-Assisted Suicide in Oregon: A Medical Perspective, Mich. L. Rev. 106; 1613 (2008). Available at: https://repository.law.umich.edu/mlr/vol106/iss8/7 7. Stevens KR, Toffler WI. Euthanasia and physician-assisted suicide. JAMA, 2016;316(15): 1599 https://jamanetwork.com/journals/jama/article-abstract/2569774 8. Suicide with a helping hand worries Iowans on both sides of ‘right to die’. Desmoine Register, 2016 Nov 25 https://www.desmoinesregister.com/story/news/investigations/2016/11/25/too-weak-kill-herself-assistance-legal/92407392/ 9. Stahle F. Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model. https://www.masscitizensforlife.org/oregon-health-authority-reveals-hidden-problems-with-the-oregon-assisted-suicide-model 10. Kim SYH, De Vries RG, Peteet JR. Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016;73(4):362-368 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530592/ 11. Komrad MS. APA Position on Medical Euthanasia. Psychiatric Times. Feb. 25,c 2017.  http://www.psychiatrictimes.com/suicide/apa-position-medical-euthanasia 12. https://fatalflawsfilm.com 13. https://abcnews.go.com/Health/MindMoodNews/oregon-doctor-opens-death-clinic-physician-assisted-suicide/story?id=10994210 14. Lo B. Beyond Legalization — Dilemmas Physicians Confront Regarding Aid in Dying.”  N Engl J Med. 2018; 378(22):2060-2062 https://www.nejm.org/doi/10.1056/NEJMp1802218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4}3dwww.ncbi.nlm.nih.gov 15. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year19.pdf 16. Desai AK, Grossberg GT.  Psychiatric Consultation in Long-Term Care, Johns Hopkins University Press, 2010, p. 262. 17. McGreevy P. Guidelines issued for California’s assisted suicide law http://www.latimes.com/politics/la-pol-sac-guidelines-california-assisted-suicide-law-20160120-story.html 18. California Code of Regulations. § 4601. Petitions to the Superior Court and Access to the End of Life Option Act. http://www.dsh.ca.gov/Publications/docs/Regulations/2016_10_31_End_of_Life_ISOR.pdf 19. American Nurses Association. Position Statement. Euthanasia, Assisted Suicide, and Aid in Dying. April 24, 2013 https://www.nursingworld.org/~4af287/globalassets/docs/ana/ethics/euthanasia-assisted-suicideaid-in-dying_ps042513.pdf 20.  https://medicine.umich.edu/sites/default/files/content/downloads/macomb-county-cmh-holding-on-to-life-toolkit.pdf 21. Ganzini L, Goy ER, Dobscha SK. Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey BMJ 2008; 337:a1682 https://www.bmj.com/content/337/bmj.a1682 22. https://www.oregon.gov/oha/ph/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf 23. Emanuel EJ, Daniels ER, Fairclough DL, Clarridge BR. The Practice of Euthanasia and Physician-Assisted Suicide in the United States. Adherence to Proposed Safeguards and Effects on Physicians. JAMA. 1998;280(6):507–513. doi:10.1001/jama.280.6.507 https://jamanetwork.com/journals/jama/article-abstract/187854 24. Stevens KR Jr. Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians. Issues Law Med. 2006 Spring; 21(3):187-200. https://www.ncbi.nlm.nih.gov/pubmed/16676767 25. Statement on Palliative Sedation. Approved by the AAHPM Board of Directors on December 5, 2014 http://aahpm.org/positions/palliative-sedation 26. Ganzini L, Goy ER, Miller LL et al. Nurses’ experiences with hospice patients who refuse food and fluids to hasten death. N Engl J Med. 2003 Jul 24;349(4):359-65. https://www.nejm.org/doi/full/10.1056/NEJMsa035086 27. Tukol JTK. Sallekhana. https://www.jainworld.com/education/seniors/senles15.htm 28. Sulmasy LS, Mueller PS. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. 2017;167(8):576-578.  http://annals.org/aim/fullarticle/2654458/ethics-legalization-physician-assisted-suicide-american-college-physicians-position-paper
Disclaimer: the views and opinions expressed in this article do not necessarily reflect those of Doctors for Life International]]>

Mozambique Medical Outreach May 2018

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Aid to Africa Mozambique Medical Outreach Update

In total we did 67 cataract eye surgeries on the first 2 days of the outreach being May the 14th and 15th. Two ladies told me that they had lost hope of ever seeing again after they had become blind. But this morning their sight was restored. It was a wonderful opportunity for us to share the gospel with them! At the end of the third day (May 16) we had completed 112 cataract surgeries. We were at the hospital from 7am until 6:15pm. By Gods grace all went well with the operations but not without a few challenges: Two of our medical machines, a keratometer and statim sterilizer packed up but thankfully the work can continue. We also ran out of some medical consumables but managed to procure more to finish our work. We had a blessed meeting with the Directorate of Health for the Inhambane province in the afternoon who expressed their appreciation for our work. They said the people are poor and needy and that we bring them hope. The country and health sector is in need of finances and resources and the outreach has already been broadcast on Mozambique national television. Mario Rocha said that after the devotion with the patients that many of them said see Gods hand in receiving their sight back. All glory to God. Today (May 17) we had two special surgery cases: a 1 year and a 4 year old child who were completely blind from cataracts. Children can be born with cataracts for various reasons. It is vitally important to remove them as soon as possible or the child could remain permanently blind. The outcome of these kinds of operations can be somewhat uncertain due to the child developing lazy eyes etc. We are thankful we could do these surgeries to give them a chance to see. Both eyes of both children were operated on. Thankfully Dr Pons brought a few special lenses along on the outreach without which these two surgeries would not have been possible! We have another child scheduled for tomorrow May 18. The good news is that Pieter Bos managed to get the Statim instrument sterilizer working again. We are aiming to do about 38 cases today and TV Mozambique came to do more interviews and filming in theatre for broadcasting. [su_custom_gallery source="media: 4619,4618,4617,4616,4615,4614,4613,4612,4611,4610,4609,4608,4607,4606,4605,4604,4603,4602,4601,4600,4599" limit="100" link="lightbox" width="150" height="150" class="lb_gal_thumbs"]  ]]>

Angola Medical Outreaches

Photos from various medical outreaches to Angola by Doctors For Life

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Mozambique Medical Outreaches

Photos from various medical outreaches to Mozambique by Doctors For Life

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South Africa Medical Outreaches

Photos from various medical outreaches in South Africa by Doctors For Life

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Malawi Medical Outreaches

Photos from various medical outreaches to Malawi by Doctors For Life

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Botswana Medical Outreaches

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Doctors For Life April 2018 Newsletter

From the CEO’s desk Friends are at the heart of everything that’s done at Doctors for Life. There is an African proverb which says that one person’s arms cannot encompass a Baobab tree. We at DFL know it so well. It is impossible for us to accomplish everything by ourselves. We want to use this opportunity to thank everybody who contributed to our legal costs concerning the ‘Dagga’ case. Everything has been paid. We value our friends who make this ministry possible. Thank you so much for your prayers and support. May the Lord “meet all your needs according to the riches of his glory in Christ Jesus” (Phil. 4:19).

Dr Albu van Eeden

Our Legal Corner

When reading newspaper articles pertaining to the use of dagga in South Africa, it is often difficult to understand the equality and discrimination debate in terms of the constitution as it relates to the dagga trial. To add to this difficulty, the daily proceedings during the trial in the High Court was streamed on the internet and many who watched them found it difficult to understand what was really happening in Court. Chapter Two of the Constitution contains the so-called Bill of Rights. In terms of its provisions, the State must respect, protect, promote and fulfil the rights in the Bill of Rights which include issues such as equality, freedom of speech, freedom of religion and others. The Plaintiffs in the so-called “dagga trial” are claiming, inter alia, for an order declaring that the legislative prohibition against the possession and use of Cannabis (Dagga) by adults is inconsistent with the Constitution and therefore invalid. The South African Constitution is the supreme law of the Republic and any law or conduct inconsistent with it is invalid and the obligations imposed by it must be fulfilled. Allow me to deal with only one of the issues referred to by the Plaintiffs in their claim. In terms of Section 9 of the Bill of Rights everyone is equal before the law and has the right to equal protection and benefit of the law, including the full and equal enjoyment of all rights and freedoms. In terms of section 9, the state or any person may not unfairly discriminate directly or indirectly against anyone on one or any unspecified grounds, including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth. The equality clause distinguishes between two forms of unfair discrimination: discrimination on the specified grounds, for example, race, gender, disability and religion; and discrimination on those grounds which are not specified. In relation to the former, section 9 provides that prima facie proof of discrimination will create a rebuttable presumption that such discrimination is unfair. An applicant who alleges that he or she is discriminated against on an unspecified ground is not assisted by such a presumption. It is also of great importance to take note of the provisions of section 9(5): “Discrimination on one or more of the grounds listed in subsection (3) is unfair unless it is established that the discrimination is fair”. What then will be required of a Plaintiff who is of the opinion that the provisions of a particular law impose burdens, obligations and disadvantages on him beyond those applicable to other persons? What if he feels that he is unfairly discriminated against, notwithstanding the provisions of section 9 of the Constitution, and finds himself to be not equally protected before the law? To give an answer, one has to enquire as to the following: (1) Does the provision differentiate between people or categories of people? If so, does the differentiation bear a rational connection to a legitimate governmental purpose? If it does not, then there is a violation of section 9. Even if it does bear a rational connection, it might nevertheless amount to discrimination. (2) Does the differentiation amount to unfair discrimination? To answer the last question, does the differentiation amount to unfair discrimination, a two-staged analysis is required:
  1. Firstly, does the differentiation amount to “discrimination”? If it is on a specified ground, then discrimination will have been established. If it is not on a specified ground, then whether or not there was discrimination would depend upon whether, objectively, the ground was based on attributes and characteristics which have the potential to impair the fundamental human dignity of persons as human beings or to affect them adversely in a comparably serious manner.
  2. If the differentiation amounts to “discrimination”, did it amount to “unfair discrimination”? If it had been found to have been on a specified ground, unfairness would be presumed. If on an unspecified ground, unfairness would have to be established by the complainant. The test of unfairness focuses primarily on the impact of the discrimination on the complainant and others in his or her situation. If the differentiation was found not to be unfair, there would be no violation of section 9.
  3. If the discrimination is found to be unfair then a determination would have to be made as to whether the provision could be justified under the limitations clause, section 36 of the constitution.
Where does it leave us in the dagga issue? Now it is for Doctor’s for Life, the 8th Defendant in the case, to provide the Court with expert medical evidence which will outweigh any findings of unfair discrimination or unequal treatment. Through presenting scientific evidence, DFL hopes to convince the court that cannabis is a “gateway drug” with all its negative consequences. That cannabis in itself is harmful enough to justify keeping it an illegal substance.

Addiction – there is hope

Drug addiction is a reality that we can no longer ignore. It affects the parts of the brain that are involved in learning and memory, rewards and motivation and has control over behaviour. The DSM-5 classifies addiction as a Substance Use Disorder and is thus seen as a disease that affects both brain and behaviour. Because it is a disease it can be treated but it is not that simple. The main aim of treatment must be to assist the addict to not only stop using drugs, but to remain drug-free and become a productive community and family member. According to the National Institute of Drug Abuse (NIDA) the following principles must be adhered to when treating drug addicts:
  1. One must bear in mind that drug abuse affects the brain and for that reason drug abusers are at risk for relapse even after long periods of abstinence.
  2. People are different and no single treatment is appropriate for everyone.
  3. Treatment must be readily available because potential patients can be lost if they are emotionally ready to receive treatment but it is not immediately available.
  4. Treatment must tend to the multiple needs of the individual and not just the drug abuse.
  5. The patient must ideally remain in treatment for an adequate period of time.
  6. Behaviour therapies – including individual, family and group counselling are common forms of treatment for addiction.
  7. Treatment plans must be assessed regularly and modified to accommodate the patients changing needs.
  8. Many drug-addicted individuals also have other mental disorders and must be assessed for that as well. They must also be tested for HIV/AIDS, hepatitis B and C and tuberculosis. All the diagnosed disorders and diseases must be treated.
  9. Detoxification is only the first stage of addiction treatment but does not change the long-term abuse.
  10. Drug use should really be monitored throughout the treatment as lapses may occur during treatment. In South Africa there are relatively few government facilities for the treatment of addiction. The bulk of the burden at this stage is carried by the private sector which includes many faith based facilities.
https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment

LifeChild

The first week of January was a great start to this new year! A volunteer from England was eager to spend some time with our children. We visited centres and played different fun games with the children which really put a smile on their faces! It was a special time even for us to be around the children just showing them love and being interactive with them. Our volunteer taught the children some sewing skills after fixing the broken machine and they made little skirts together for the three year-old twin girls going to crèche this year. We were very grateful to have had a donation to purchase new school uniforms for our older teens along with new shoes, new school bags and stationary! We are very excited to see the garden at our centre growing so well and yielding some of the biggest eggplants and cabbages we have ever seen! The garden also has tomatoes, beetroot and butternut that are growing very well. This is great news for us because it means we will spend less on food for the centre and be able to concentrate on some other needs at the centre. For example, one of the buildings where we feed the children has been damaged by heavy rains and has since been put together using mud and wood. It is our desire to build a more stable unit to continue feeding the orphans in the Esifuleni area.

Prostitution

Feedback from the Prostitution Exit Program

We would like to thank you for praying for our project. God provided new cupboards for the bedroom we accommodate our ladies in. Thank God for sending donors from Switzerland to carry the costs of these cupboards. We are also very blessed with donations of clothes that come from time to time. We still need small sizes skirts (32, 34, 36) or material that we can make skirts from. The donors from Switzerland also bought us an over-locker machine and we have also have a standard sewing machine available to do sewing. The one ex-prostitute lady who stayed at our safe house passed her matric exams last year. Please continue to pray for the project. Ever since it started in the early 2000’s the project never stopped and we still do outreaches on Fridays to Durban and Pietermaritzburg.

Soli Deo Gloria

Abortion

In the USA we are so grateful for our new president Donald Trump. Yes, he is brash and sometimes talks like a ruffian but he is truly defending Christianity and the unborn. We often joke that he has the personality of a junkyard dog but a very brave and smart one. This year, at our annual March for life in January, Trump addressed the crowd. This is extremely rare. He also just launched a new Human Health Services (HHS) branch dedicated to protecting medical doctors and nurses who are opposed to abortion and are being coerced to perform them. We also have a petition running by Personhood Alliance that has already gained thousands of signatures asking Trump to make an executive order that directs all federal agencies to recognize the personhood of all children in the womb. When the petition was first posted it gained 700 signatures within the first half an hour. It is now in the thousands. During the election we had the slogan “Time to Drain the Swamp.” This refers to the corruption that has been so prevalent in our federal government and we often refer to Washington D.C. as the swamp. It takes a brave and determined man to “Drain the Swamp!”

By Professor Pat McEwen – DFL Volunteer USA

Aid to Africa

Personal Testimonies

Taxi accident near DFL’s Zavora/Sihane Clinic

“One Saturday someone came running to tell us that there had been a taxi accident and that the people were at the clinic door, waiting for help. Onlookers who were also standing by shouted, ‘there are more coming’! Cars brought more wounded people and family members as well as other people from the village who simply wanted to see what was going on. The taxi’s that pass by the hospital easily transport up to 20-30 people sitting on a back of an open pickup truck (bakkie) and so when an accident happens, there are often many people involved. It was difficult trying to keep focus because everyone was speaking, everyone wanted to be helped first and children were crying. Two of our co-workers who had heard what happened came to the hospital to help their friend Ester who was there for a visit and Elke Epp. Elke is a nurse from Germany who feels a calling to work at the new DFL clinic in Chikuluma in Malawi which is in the process of registration. She currently lives there with her husband. Mario Rocha, the manager of our Sihane clinic and Joy Smith were called as well. We commenced triage to identify those who were most badly wounded to take them to hospital first. Many of the patients needed advanced help that we could not supply at the clinic. “In the beginning I didn’t really think it was so serious” said Esther. “I had never seen anything like it, except on TV or in the news. I had never seen people up close that were so badly wounded. It was chaotic and the many onlookers made things so much more difficult “she explained. The people in general were all frightened because wherever one looked you saw blood and wounds. Even our visitor helped to take care of the wounded and we split up to take better care of the patients. We checked for vital signs and monitored the children. There was nobody free to help with the driving but after a lot of searching and persuading we found someone willing to take the last patients to Inharrime, 25 km away. One of the drivers, whose name we don’t have, was asked to help transport the patients to the nearest hospital and had this to say about the incident; “My sister-in-law was also in the vehicle involved in the accident and my brother called me to come to the hospital. She was the one with the broken collar bone. When I came to the clinic I felt compassion for the people. When I was asked if I could help to transport some people to the hospital at Inharrime, I hesitated because I was afraid of getting into trouble with the authorities, but then I decided to help them anyway.” All together we had 17 wounded people of which 3 were severely wounded, 8 of them were taken to the nearest hospital of which 3 were transferred to another hospital. We thank God that everybody survived.

By Alex Andrade – DFL Volunteer Germany

Outreaches to remote Mozambique villages

“I am so thankful to the Lord that I can still go on some Aid to Africa outreaches even though I have cancer. Although I cannot go as often as I originally did, each one that I am able to be a part of is a blessing. On a field outreach to some needy villages in Mozambique, Benerio Mazivilla, (who works in the DFL Sihane Clinic) helped me, both as an aid and an interpreter. I serve in testing and distributing glasses to those who are in need. Two doctors were also present to examine and treat patients with general and dental care. The areas are pretty remote and people cannot just go to an optometrist in a city to get testing and glasses. Later I spotted a lady who was an albino, in the cue. I asked Benerio to bring her in for a pair of sunglasses because the African sun often blinds the albino. After giving her the glasses I examined her and found that she already had severe vision loss. She could only count fingers at about 4 feet, even with a –10 lens, the strongest we can test for. I could not help her and was feeling so sorry that we had nothing to help her severe problem. She was almost blind. Prayerfully I looked through our glasses just in case. By God’s grace I found a –15 pair that also were very dark sunglass. When I took away the original sunglasses her face fell but when I placed the new pair on her face she burst into laughter as she could see. Our motto is “so the blind might see” and it means both physical and spiritual sight. She, like most of our patients, listened intently to the Gospel message and left with a tract in her native language clutched tightly to her chest. There is no joy like seeing someone’s eyes open to the Gospel.” Professor Pat McEwen has been going on medical outreaches with DFL since 2009.

By Professor Pat McEwen – DFL Volunteer USA

Devotion

Luke Chapter 9 Verse 57 -62

Luke 9:v57. As they were going along the road someone said to him, “I will follow you wherever you go”. Luke 9:v58. And Jesus said to him, “Foxes have holes and birds of the air have nests but the son of man has nowhere to lay his head”. Luke 9:v59. To another he said, “Follow me” but he said “Lord let me first go and bury my father”. Luke 9:v60. And Jesus said to him “Leave the dead to bury their own dead but as for you go and proclaim the Kingdom of God”. Luke 9:v61. Yet another said, “I will follow you Lord but let me first say farewell to those at home”. Luke 9:v62. Jesus said to him “No one who puts his hand to the plough and looks back is fit for the Kingdom of god”. Here we find three different ways that people get to follow Christ. The first person was not invited but felt urged to follow the Lord. Some people may decide to follow Christ because they have a romantic notion about how it’s going to be. Here’s this man with His disciples moving around the country and it’s all so wonderful. But the Lord immediately brought him down to reality by telling him how harsh it would be to follow Him. The second man was actually called by Jesus. Such a person may feel the calling of the Lord. But he felt a moral obligation to bury his father, a basic duty of decency. But the Lord said to him, “Leave the dead to bury their own dead but as for you go and proclaim the Kingdom of God”. There may be some things we consider to be moral, the right thing to do, the decent thing to do. But when Christ comes he changes that. And sometimes it sets us free because we may be carrying all kinds of moral burdens around God doesn’t expect of us. The third man said, “I will follow you but let me first say farewell to those at home”. This man was like the first; he took his own initiative to tell Jesus he would follow him. But he had preconditions – “Lord I will follow you but….” Jesus said to him “No one who puts his hand to the plough and looks back is fit for the Kingdom of god”. People who constantly look back become a burden in God’s work because even after being encouraged, they can’t stop looking back. What a challenge! What a judgement if Jesus says we are not fit for the Kingdom of God if we put our hand to the plough and then look back. These verses tell us that if we decide to follow Christ that it must be with total surrender. It must be without any preconditions and we must be willing to experience discomfort and humiliation.

By Dr. Albu van Eeden


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Special Life Alert: USA – Yale data: Cancer patients relying on unproven alternative treatments likely to die two and a half times sooner

a July article by several Yale physicians is the most-discussed paper ever published in the Journal of the National Cancer Institute (JNCI). The title of this blockbuster: “Use of Alternative Medicine for Cancer and Its Impact on Survival.” “It struck a chord,” said senior author James Yu, MD, MHS, Associate Professor of Therapeutic Radiology. The Yale researchers used the U.S. National Cancer Database to collect information on patients with breast, lung, colon, and prostate cancer from 2004 to 2013. They looked for people who reported using only unproven alternative treatments instead of conventional medical therapies such as surgery, radiation, and chemotherapy. The researchers found 280 such people and then compared their outcomes after 5½ years to 560 people with the same cancer, diagnosis, age, and race who had received conventional treatment. The results were clear. Patients who initially relied on unproven alternatives were, on average, 250{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} times more likely to die within the 5½ year window. Within particular cancers, the risk associated with alternative medicine was often much worse—almost 600{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} higher for patients with breast cancer, 400{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} for colon cancer and 200{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} for lung cancer. The researchers have some theories about this seeming conundrum. Dr. Johnson mentions the Dunning-Kruger effect, in which people overestimate their knowledge, in part by relying on the Internet. Could this be true? Skyler Johnson, MD, Resident in Therapeutic Radiology and the paper’s lead author thinks the discrepancy in survival rates would be even more alarming if the patients had been followed for longer than five years to take into account slow-growing cancers such as prostate cancer. He also calls the 280 people identified as using only alternative medicine “a huge underestimate” because the researchers excluded a large group of patients who had been coded as having refused treatment, with no reason given. Dr. Johnson suspects that many of them chose an alternative therapy first but did not report it to their physicians. Another interesting finding from the paper was that people who preferred alternative treatments tended to have had more formal education, and higher incomes. Dr. Yu speculates that people with higher incomes can afford more types of healthcare and know how to seek them out, such as clinical trials. “But in this case it’s wishful thinking,” he said. “These alternatives don’t necessarily cause harm, but they’re placebos, and placebos don’t cure cancer, but they can delay real cancer care.” Co-author Cary P. Gross, MD, Professor of Medicine and of Epidemiology, wasn’t that surprised by the demographic finding, citing increased scepticism about science and conventional medicine that has driven things such as the anti-vaccination movement. “And just as the Internet and social media have fuelled discord in the political process,” he added, “they also have enabled conspiracy theories about medicine and health to spread rapidly and wildly.” The researchers also believe, based on their own patients that the number of people choosing alternative treatments over conventional ones is increasing. “I understand the human impulse to think there’s got to be something else,” said Dr. Yu. “And when the answer is ‘no, there isn’t’, then there’s the opportunity for someone to say, ‘Just rub these crystals or sit in a salt bath or eat special food.’” All of the researchers noted that the problem should not be pinned only on patients and providers of alternative medicine. “Physicians need to shoulder some of the blame as well,” said Dr. Johnson. “We need to take the time to really listen to patients’ concerns and explain things more clearly. That builds a relation of trust, and makes them more willing to believe the data.” Dr. Yu agrees. “We need to bring these conversations about alternative therapies to the forefront,” he said, “and because of this study we now have the data to help us.” The researchers also noted that their work focused on alternative medicine, when patients choose not to receive conventional medical therapies, rather than “complementary medicine,” in which patients undergo conventional cancer treatment as well as additional therapies from disciplines that are not part of traditional Western medicine. The researchers know that facts and data won’t be enough to persuade everyone, a common symptom of our time, but their paper is a start. They hope it convinces a few people to reconsider relying on alternative treatments, or prompts someone to insist that a loved one see an oncologist. “That’s why we do research,” said Dr. Johnson. “We try to help people one at a time, and hopefully our research can help patients and families to make more informed decisions.” http://www.newswise.com/articles/view/688151 Disclaimer: the views and opinions expressed in this article do not necessarily reflect those of Doctors for Life International]]>

Daring South Africa to give hope instead of abortion as a death sentence!

Embargo: Immediate release Enquiries: Doctors For Life Int. Date: 30 January 2018 Telephone: 032 481 5550 Doctors for Life International (DFL) commends the Office of Civil Rights (OCR) division of Health and Human Services (HHS) of the USA for setting the ultimate example for countries to follow! According to the OCR website health care workers can now file complaints when they experience coercion or discrimination of any sort, for refusing to participate in any procedure related to abortion, euthanasia or gender reassignment. Even though DFL agrees that there are indeed complicated situations that could cause a pregnant woman to consider having an abortion, and that these circumstances could be extremely difficult, the morality of abortion being seen as the solution to these problems is not straight forward and is evidently wrong. We simply cannot take the lives of human beings to solve social problems, no matter how serious they may seem to be. Everyone in this day and age is morally obliged to understand that alternative options and solutions are readily available without needlessly having to abort a child. Women who have had abortions are not the only ones who eventually regret their decisions. Doctors and nurses who have performed abortions have also had a change of heart.

  • Dr. Kathi Aultman a board certified obstetrician and gynaecologist used to perform abortions but after she saw how it affected her patients – she realized that she could no longer continue performing abortions.
  • Dr. Anthony Levatino is another gynecologist who changed his mind about abortion. He is renowned for highlighting the horrific abortion procedures and negative health implications on the women who have had abortions globally.
  • Ally Bowlin struggled for six years, trying to suppress emotions of grief and suicidal tendencies after having had an abortion which did not alleviate her social problems. She also now testifies from experience as to how abortion did not empower or help her as per the abortion clinics spurious claims. Indeed, she experienced quite the opposite of these pro choice organizations advertised claims.
Many references can be quoted from which demonstrate the brutal horror of abortion on the babies who get poisoned or ripped from the womb. Notwithstanding that the impact on the mothers who decide to end the life of their baby can result in psychological problems such as Post Abortion Syndrome. We should not forget to include the doctors who have had to take the lives of these babies. South Africa can still turn things around and provide hope instead of willingly handing out death sentences to our littlest and most innocent of South Africans! https://www.bioedge.org/bioethics/trump-administration-moves-to-defend-conscience-rights/12567 https://www.hhs.gov/conscience/conscience-protections/index.html Doctors for Life International represents more than 1500 medical doctors and specialists, three-quarters of whom practice in South Africa. Since 1991 DFL has been actively promoting sound science in the medical profession and health care that is safe and efficient for all South Africans. For more information visit: http://www.doctorsforlife.co.za]]>