LIFEalerts – Euthanasia


Belgium – Investigates alleged illegal euthanasia deaths

Belgium officials are investigating around ten euthanasia cases which may not have murder. In an anonymous letter to the public prosecutor, they say: “Our family member passed away two years ago, and we were told that euthanasia was presumed to have been carried out without the doctors informing us or following the necessary procedure. This is a very traumatic experience for us.” Two doctors were named in the letter. Belgium’s chief euthanasia overseer says that not every case of euthanasia gets reported to the committee, as it should, and doctors freely admit that. Potential for abuse was the among the concerns of euthanasia opponents and cases like these prove their concerns were right about the slippery slope. More

South Africa – New legal challenge attempts to legalise euthanasia

A new legal challenge was instituted in the Johannesburg High Court in August 2017 in an attempt to legalise physician assisted suicide (PAS) and active voluntary euthanasia (PAE). Currently, South African law deems these acts are prohibited and are treated either as murder or culpable homicide. The new case is expected to proceed to trial in early 2021 and Cause For Justice (CFJ) will be contributing to the case by legal arguments. CFJ’s main concern is that legalized euthanasia will result in a “cultural shift and slippery slope towards acceptance of death as a solution to human pain and suffering” (which has been the case in countries that have legalized it). See Fatal Flaws Documentary. More, Fatal Flaws.

Netherlands – Doctors can sedate dementia patients before euthanizing them

Doctor no longer have to agree with a patient on the time or manner in which euthanasia will be given, sedation is permissible if a patient is unable to communicate or becomes disturbed, agitated or aggressive in cases of severe dementia. Family members no longer need to be consulted either. This came when a doctor sedated a 74-year-old patient without her knowledge before killing her, was cleared of wrongdoing. Dutch euthanasia doctor Bert Keizer admitted that “those who embark on euthanasia venture down a slippery slope along which you irrevocably slide down to the random killing of defenceless sick people”. More

LIFEalerts – Euthanasia


South Africa – Dignity SA lies to Minister of Health about Euthanasia

DignitySA (DSA) is a group that advocates for physician assisted suicide on patients that seek to end their life. DSA makes their case about “intolerable suffering” which should be the reason for anyone to choose to die by euthanasia. In a petition to the Minister of Health, DSA states that “Twenty-five years of incontestable data prove that the safeguards to protect the vulnerable in Oregon have never been breached.” A recent study from Oregon however, shows that most Americans do not choose euthanasia because of pain and suffering, but rather that they choose euthanasia because they fear pain and suffering. Dr Benoit Beuselinck MD, PhD, Oncologist, from Belgium says that “We can manage All pain with palliative care, including palliative sedation where we can manage all symptoms.” The American Medical Association, American College of Physicians, The World Medical Association, all reject Doctor Assisted Suicide. There is no reason for South Africa to believe killing someone at their lowest point in life should constitute the right to die, bottom line is, pain can be managed.

Evidence suggests that in countries where euthanasia was legalized, so-called safeguards indeed were breached for example; In Canada, a wife lost a lawsuit to prevent her husband’s death by euthanasia, another incident described a psychiatrist in Oregon who determined that an elderly woman with dementia was mentally unable to consent to assisted suicide, and believed her daughter was pushing for it, but it happened anyway. In USA, Texas a disabled, 46-year old African American man named Michael Hickson, was euthanized without his consent or that of his wife. The doctor said it was better to euthanize Michael because he is paralyzed and not like “walking and talking people.” In Belgium, nurses admitted to euthanizing patients without their consent. Safeguards were breached wherever euthanasia was legalized, South Africa can expect the same result when learning from those countries who have gone before us. DignitySA, wife looses lawsuit to prevent husbands euthanasia, doctors didn’t try to save a black covid-19 patient who was paralyzed, Belgian euthanasia nurses admit to killing without consent.

UK – Over 50 palliative care doctors resist introducing assisted suicide

In a letter to media group called The Times, over fifty palliative care doctors called attention to a recent British Medical Association survey on assisted suicide which shows that 84% of doctors in palliative medicine would not be willing to perform euthanasia on a patient should the law ever change. The doctors pointed out that “Every legislature that allows ‘safeguarded’ assisted dying has seen its safeguards breached, starkly illustrating the gap between principle and practice.” In the Netherlands, for example, reports indicate that the requirement for explicit consent is frequently ignored, as is the required reporting of all instances of euthanasia. Motivations for assisted suicide as seen in countries that have already legalised the practice, are social and not medical. more

UK – Committing Suicide is reason enough to travel abroad

Britain has entered a second period of hard lockdown to avert a wave of Covid-19 patients swamping hospitals. Holiday travel overseas is banned. However, Health Secretary Matt Hancock has said that visiting the Swiss assisted suicide clinic Dignitas will be permitted, as an exception. This forces people who need hope not suicide to believe that life is better if we’re dead. It is heart breaking to see how governments dismiss their citizens in desperate situations by affirming their misguided beliefs of being better off dead. This is no positive solution to any problem. Read more

Canada – Assisted Suicide saves money PBO Report suggests

Since Canada’s laws on euthanasia and assisted suicide became legal in 2016, health-care costs have dropped millions of dollars, according to a Parliamentary Budget Officer (PBO) report. Although this could sound grotesquely utilitarian, it stresses that these savings should “in no way be interpreted” to suggest that assisted dying be used to reduce health-care costs. But it does, and it sends a message to the elderly and disabled, or terminally ill, that being alive any longer would mean that they are costing their families money. In Belgium, deaths rose from 0.2% of all deaths to 2.4% in 16 years. Canada expects a rise from 0.3% to 2.6% in just five years. Read more

Canada – Euthanasia in prisons slammed by ombudsman

Canada’s prison ombudsman has recommended an absolute ban on providing euthanasia inside a federal penitentiary. Ivan Zinger acknowledged there have been three known cases of doctor-assisted death in federal prisons. The first case involved a “non-violent recidivist” serving a two-year sentence. It would seem that this man ‘chose’ euthanasia not because that was his ‘wish,’ but rather because every other option had been denied, extinguished or not even contemplated. Hopelessness, despair, lack of choice and alternatives are issues magnified in prison. Seeking euthanasia in the community and providing euthanasia behind prison walls is not the same and Zinger suggests that the government should set up an expert committee to consider the ethical and practical concerns in providing euthanasia in prisons. Read more

UK – Leading Palliative Care doctor opposes euthanasia

In a letter to The Times, Dr Carol Davis, Lead Consultant of Palliative Medicine at the University Hospital Southampton NHS Foundation Trust, criticised the conflation of assisted suicide and palliative care. She said that “most patients do ‘let go quietly’, dying peacefully of their illness. Their doctors know they have a duty of care to provide effective symptom control and care as life ends. But that’s a completely different matter from giving dying patients lethal drugs”. She emphasised that good “clinical care is a partnership between patient and doctor”, where they cannot simply impose demands on each other, adding: “Doctor-patient dialogue isn’t just another customer-supplier relationship”. Earlier this month, a survey revealed that a majority of doctors in the British Medical Association (BMA) do not want to give patients life-ending drugs. Read more

LIFEalerts – Euthanasia


World – Assisted dying round-up

In New Zealand the public will vote on voluntary euthanasia on October 17. In nine US states and the District of Columbia assisted suicide is legal. Some political observers believe that the Bay State could become the tenth. In Portugal earlier this year the parliament passed measures to permit euthanasia but got held up by an appeal for a referendum and will be worked out in October. In Austria four people are challenging the Constitutional Court on the euthanasia ban, the court will decide before the end of the year. In Ireland the issue of legalizing euthanasia is being debated but currently delayed until next year to grant time to parliament to study the issue. In Tasmania, the parliament of the Australian state is also still debating the merits of euthanasia. The suggested bill is the fourth in ten years. Previous bills failed in 2010, 2013 and 2017.

Let’s take a look at what happens when euthanasia is legalized; Argentine mother seeks to euthanize son who has cerebral palsy because she’s exhausted and fed up with caring for him. In the Netherlands, a woman seeking help with post-traumatic stress disorder was told she met the criteria to be euthanized on her first appointment. She was angry at this offer and said Yes, I’m broken, but I want to become whole again. I’m asking for help to get better, not for death!”. In Canada, a wife lost a lawsuit to prevent her husband’s death by euthanasia, another incident described a psychiatrist in Oregon who determined that an elderly woman with dementia was mentally unable to consent to assisted suicide, and believed her daughter was pushing for it, but it happened anyway. In USA, Texas a disabled, 46-year old African American man named Michael Hickson, was euthanized without his consent or that of his wife. The doctor said it was better to euthanize Michael because he is paralyzed and not like “walking and talking people.” In Belgium, nurses admitted to euthanizing patients without their consent. The future for many citizens in a country that legalizes euthanasia looks very grim when one considers the above accounts of ordinary people. Read extracts taken from: BioEdge, NewsBreak, National review, NY Post, Christian Post UK, Daily Mail

Netherlands – Seeks to extend euthanasia to children

The Netherlands Minister of Health, Hugo de Jonge, announced that their government will amend or re-interpret the euthanasia law to permit child euthanasia to help terminally ill sick children between one and twelve. Currently, Netherlands euthanasia law permits euthanasia for children as young as 12, when parents or guardians consent; and for disabled newborns. People over the age of 16 are considered adults and can therefore provide consent to euthanasia. The recommendation comes as experts found that a small group of children may be suffering because doctors fear the consequences of actions to hasten their deaths. A petition by citizenGo is circulating in opposition to this and has gathered over 20,000 signatures. Read more

Belgium – The ‘downside’ to euthanasia is swept under the rug

Three children euthanized in Belgium, one being an 11 year-old with cystic fibrosis (CF). This congenital respiratory disease is incurable and fatal, but modern treatments enable many patients to enjoy high quality of life well into their 30s or even beyond. A member of the euthanasia commission resigned in protest because it refused to recommend prosecution when a woman with dementia who had not requested euthanasia was nevertheless put to death at her family’s request. Since then, 360 Belgian doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients. While debating assisted suicide legislation in the UK, one sponsor of the assisted suicide bill watched Fatal Flaws (a film that questions the so-called compassion around euthanasia) and had a change of mind. The next day he stood up in the legislature and said that he changed his mind after watching Fatal Flaws. Guernsey then defeated the assisted suicide bill by 24 to 14.

Sadly, under-reporting of euthanasia and euthanasia without request is common in Belgium. Lethally injecting people without request are considered criminal acts in every jurisdiction in the world, but under the banner of assisted death these acts becomes a difficult but necessary part of protecting the “human right” to kill in a post-post-modern society. (this article was written in 2018) Read more, Watch Fatal Flaws

LIFEalerts – Euthanasia


Australia – Assisted dying explodes in Victoria

In Victoria, a progress report from the Voluntary Assisted Dying Review Board, shows that ten times more people than expected have chosen to end their lives in the first full year of 2017. According to the report people seeking euthanasia were aged between 32 and 100, with an average of 71-44% being female, and 55% male. Unbearable pain was not a major factor amongst the reasons for requesting assisted dying. In fact, the word “pain” was only mentioned once, and no percentages were given. The common reasons for euthanasia includes being less able to engage in activities that make life enjoyable, losing control of body functions, and loss of dignity. Such reports show how euthanasia increasingly cultivates a culture where anything goes and people can commit suicide for any reason. Read more

Argentine – Argentine mother seeks to euthanize son who has cerebral palsy

These are two examples of how euthanasia can be used for the wrong reasons. Argentine woman Brinocoli is asking to be allowed to kill her 22- year old son who has cerebral palsy even though he is not dying or terminally ill. She says she’s exhausted and fed up with caring for Adrian. Another parent from Canada murdered his daughter Tracy because she had cerebral palsy, claiming that she was suffering in pain and misery, even though she was known to have been a cheerful, happy girl who lived games, parties, and pets. After killing his daughter, Latimer was given, in essence, a slap on the wrist, and is seen by many as a hero in Canada for ending Tracy’s “suffering”. Many people in society believe life with disability is not worth living. A parent who kills their disabled child is portrayed as a martyr, while one who kills a healthy child is rightly portrayed as a murderer. Read more

Netherlands – Dutch MD Euthanized Dementia Patient Despite Being Told ‘No’

Marinou Arend, a Dutch doctor euthanized a woman with dementia struggling to stay alive. First she drugged her patient’s coffee and then, when the woman awakened and fought against being killed, she had the family hold the patient down while administering the lethal injection. Not only was she exonerated, but she was even praised by the judge. The patient told Arends that she did not want to be euthanized! Not once, not twice, but three times. This is not the first time people are euthanized without their consent. Read more

Netherlands – Dutch doctor minimizes disastrous effect of legalized euthanasia 

Dutch Dr Bert Keizer, who recently wrote in the Dutch Medical Association Journal, does not think this is a disaster. He agrees that euthanasia has become a slippery slope where legalized, but suggests that it should be embraced and viewed as ‘gradual erosion of boundaries’ instead of a slippery slope that leading to disaster. But imagine your spouse is being euthanized because he is disabled and you have no say over it because the doctor says so, or your daughter wants treatment for her depression and the doctor tells her that her only solution is to be euthanized. She eventually considers it because the doctor gives her no hope despite significant and continuous developments in medicine for depression. Both scenarios actually happened in the USA and in the Netherlands. Moreover, nurses in Belgium admitted to euthanizing patients without their consent. Read more: bioedge, NYpost, Christian post UK

Netherlands –  Dutch mental health patient angry at euthanasia offer

A Dutch mental health patient has shared how she was “overwhelmed and angry” when her new psychiatrist offered her euthanasia during their first appointment. Manon, who was seeking help for post-traumatic stress disorder, was told she met the criteria to be euthanized. The doctor said Manon had already done “everything humanly possible” to get treatment for her condition, which made Manon feel like she didn’t “deserve” to continue living.  “Yes, I’m broken, but I want to become whole again. I’m asking for help to get better, not for death!”. Read more

USA – Compassion & Choice show their true colors

According to the Public News Service, Californian people of color rarely commit assisted suicide. The new report from the state also found big difference in who actually uses the law. The patients are 87% white, just over 1% are Black. 4% are Hispanic. And 6.4% are Asian American. But the Compassion and Choice (C&C) believing there’s never enough assisted suicides continue to run “public service” advert to increase the number of suicides by people of color. By this statement the C&C shows their true colors for euthanizing ethnic groups. Read more

LifeAlerts – Euthanasia


USA – Euthanasia polling data may fail to capture people’s considered views

A new paper in The American Journal of Geriatric Psychiatry find that public attitudes to euthanasia for patients with dementia change when they are presented with case studies of individuals with severe dementia who have made an advanced request for euthanasia. An online survey of 1700 US-based participants show 54% supported legalized euthanasia and 22.6% were unsure, but after reading the ethical and practical complexities of the scenarios, support decreased. The study authors say that it is not enough to ask whether advanced request for euthanasia should be legal following a description of life with dementia because it may fail to capture the public’s considered views. Rather, it is important that the public is given insight into the complexities of illnesses like dementia to avoid clouded public views. Read Bioedge, ajgponline

Canada – Wife Loses Lawsuit to Prevent Husband’s Euthanasia

According to Wesley J. Smith, euthanasia destroys the family bond. Imagine your spouse wants to be euthanized and you have no say over it, or if your depressed brother decides to be euthanized and you beg doctors not to kill him, to no avail. Both cases happened in Canada. One involving a wife trying to prevent her husband’s death by euthanasia but lost because the benefit of the doubt goes to death once euthanasia becomes legal. In Oregon a psychiatrist determined that an elderly woman with dementia was mentally unable to consent to assisted suicide, and believed her daughter was pushing for it, but it happened anyway. Read more

New Zealand – Underfunding no argument for assisted dying

In an upcoming referendum a vote on Euthanasia will be done. Pro-euthanasia, unsupported claims have been promoted in the media. Specialist doctor Sinead Donnelly is trained in palliative medicine, who decries the move to make underfunding and overworked staff the reason to euthanize the old and dying. Dr Donnelly says it’s a little like arguing that the car needs a clean so we should push it off a cliff. This “End of Life Choice Act” gives no choice for the patient but to die. The Royal New Zealand College of General Practitioners told Parliament they won’t be able to detect coercion or pressure in all cases with this test, and that there will be wrongful deaths under this law.

“Lawyers for Vulnerable New Zealanders advised that: “… under the Act a person could be dead within only a matter of days after being diagnosed, and without needing to tell any loved ones. There’s no mandatory cooling-off period between a request and the lethal prescription. That’s a serious flaw because terminally ill people can go through a whole range of emotions from day to day. If they’re caught in a moment of weakness and have the wrong people around them they could be dead within 72 hours”.

Every week as doctors we see cases where patients with advanced illnesses with limited prognosis who are also disabled, sick or mentally ill will, at their most vulnerable point, contemplate suicide. With the right care and medicine, the vast majority are brought out of this vulnerable state to a place of health. Under the proposed Act, those same people could be dead within 72 hours.” Read more

Canada – Organ donation increases after euthanasia

In 2016, Canada legalized euthanasia or Medical Aid in dying (MAiD), but since euthanasia was legalized organ donations increased. The CEO, Ronnie Gavsie, of the organization called Trillium insists that euthanasia is totally separate from organ donation and that they only provide the information to the dying patient and wait for them to decide. Yet there is a subtle sense of coercion since in the very next breath Ronnie says “it’s the right thing to do for those no the wait list.” Organs donated by euthanized patients are often of better quality than organs harvested from accident victims. There is more time to test them and find a match with potential recipients.

Wesley J. Smith commented in the National Review saying “The clear message being sent to suicidal, ill, and disabled Canadians – with the active support of the organ transplant community – is that their deaths can have greater value to Canada than their lives.” “Someday, Canada will probably dispense with the euthanasia part altogether and go straight to killing by organ harvesting—already being proposed bioethics and medical journals. Read more

Spain – Legalized euthanasia pressures elderly to die

According to an article by Francisco José Contreras, a lecturer in legal philosophy, Euthanasia once legalized will pressure the sick elderly to die. Francisco said that it will be easy to convince the elderly that the final stretch of their life, along with all the difficulties, is not worth being lived and that it is dignified not to impose one’s decay on others – exactly what the Nazi legislation used to justify the extermination of the deficient. In both The Netherlands and Belgium, once euthanasia became legal, the interpretation became increasingly lax. They have evolved from killing only terminally ill patients, to those with chronic illnesses; from killing people with physical illnesses, to people with psychological illnesses; from voluntary cases to killing people without their express permission. Read more

Belgium – Court clears Doctors for murder

A Belgian court has cleared three doctors accused of murder in the country’s first criminal case concerning euthanasia. The doctors were alleged to have unlawfully poisoned 38-year-old Tine Nys in April 2010 because she did not fulfil the conditions to be euthanized. The deceased’s family said that Nys did not have an incurable mental disorder. Belgian law allows adults to request euthanasia if they are facing unbearable physical or mental suffering resulting from a serious and incurable disorder. In the Netherlands, a doctor was cleared in a trial after being accused of failing to secure proper consent from a woman who had Alzheimer’s disease. Read more

Netherlands – Euthanasia now kills patients who could receive healing and hope

According to a file analysis by the Euthanasia Expertise Center requested by the Ministry of Public Health, Men turn to euthanasia more often because they suffer from addiction problems, and women more often suffered from mood disorders. The average age of women in this study is 50 years, of the men 49. A depressive mood disorder was the most common disorder across the board. Bullying, sexual abuse, or trauma played a role with relatively many patients. Many of these lives could have turned out differently if they had sought out counselling and support. Another example of how euthanasia has crossed the lines and become a slippery slope. Read more

Canada – No one talks about the cons of euthanasia

Hendrik van der Breggen, PhD, retired last year as Associate Professor of Philosophy at Providence University College, Manitoba, Canada. He feels that there are more cons to euthanasia that are often dismissed. For example; with the acceptance and expansion of euthanasia, our society will see suicide as a legitimate way of solving an individual’s problems. Life will no longer be seen as society’s default position. the elderly, terminally ill, disabled, and whoever else is suffering—must justify the continuation of their lives. Why should we spend so much money on healthcare for them? This may not be stated explicitly, but will be an unspoken assumption. Law professor Carter Snead correctly points out, a “subtle coercion.” Adding insult to injury. To those becoming handicapped or infirm we insult them as the most vulnerable with euthanasia by saying: We would rather be dead than be like you! If that isn’t an insult, what is?

If the choice or autonomy of the sufferer constitutes acceptable personal and legal grounds for euthanasia, then will suicide interveners have to add to their script some directions as to where euthanasia is available? Will National Suicide Prevention Week include some Suicide Promotion Days? Will suicide intervention or counselling against suicide become grounds for a lawsuit against the intervener or counsellor? If we kiss good-bye the above portion of the Hippocratic Oath, then we invite a deep change of character to the practice of medicine. Healers will be asked to be killers. Health care becomes careful killing. And those conscientious persons who refuse to kill will be discouraged from practicing medicine.

In conclusion: Ideas have consequences—and sometimes the consequences of bad ideas can be disastrous.

In view of the above cons, it would be wise for Canadians not to embrace euthanasia. Instead, we should do a better job of providing excellent palliative care—pain relief and life-enhancing dignity—for all who suffer. We should embrace a culture of life, not a culture of death. Read more

Germany – Death on demand comes to Germany

German people now have the right to kill themselves at any time and for any reason. The right to a self-determined death is not limited to situations defined by external causes like serious or incurable illnesses, nor does it only apply in certain stages of life or illness. Rather, this right is guaranteed in all stages of a person’s existence. One radical court ruling leads to another. The right to commit suicide could soon become a right to be killed. Since Germany’s absolute right to assist in suicide is open-ended and not limited to doctors, why not permit friends to kill friends? How can the state now restrict the taking and selling of addicting drugs? Drugs may be harmful, but if an autonomous person chooses to spend their days high, how can the state gainsay that decision or inhibit the commercial providers who supply the fixes? A culture that has lost its faith in life cannot comprehend why it should be endured.” If we don’t change our current cultural trajectory, we will become “Germany” too. Read more

UK – Academics says euthanasia saves money

Academics have argued how killing patients through assisted suicide in the United Kingdom would save money and provide organs for transplantation in a new report published in the journal of Clinical Ethics. Dr Gordon Macdonald, Chief Executive of Care Not Killing said that this report “exposes the real agenda” of assisted suicide and demonstrates the dangers of legalising assisted suicide and euthanasia. While the authors may not believe money is a motivation for assisted suicide there are some people who do. In the US states of Oregon and Washington the majority of those ending their lives cite fear of being a burden on their families and finances.”  Read more at Lifesitenews, Sagepubjournals

Texas – Disabled man euthanized without his consent

In Texas, a disabled, 46-year old African American man named Michael Hickson, was euthanized without his consent or that of his wife. Michael contracted COVID-19 and was admitted to hospital. Melissa, his wife, was given no choice over whether he lived or died. Melissa recorded her conversation with the doctor who said it was better to euthanize Michael because he is paralyzed and not like “walking and talking people.” Giving her husband food, water, oxygen and medicine would not have been a burdensome treatment, and the hospital had plenty of space. The doctor made clear that the issue was his disability. The National Council on Disability is calling for an investigation into the hospital for violating Michaels civil rights. Read more

USA – Girl kills herself with the help of assisted suicide website

Shawn Shatto who was dealing with depression and anxiety for years and seeing a therapist. A website provided Shawn with lethal directions and encouraged her to die by suicide through cheering her on by telling her what kind of drugs to mix in order to kill herself, and by wishing her ‘good luck and ‘safe travels.’ Shawn’s mom has been advocating for “Shawn’s Law” Which “strengthens penalties against anyone who assists in a suicide, especially anyone under the age of 18 or has a mental disability. Shawn’s Law has passed the House, and is now in the Senate. Read more

Death on Demand comes to Germany

by Wesley J. Smith

Editor’s note. This first appeared at First Things and is reposted with the author’s permission.

The 1973 dystopian film Soylent Green featured several shocking moments, including overpopulation riots and men calling women “the furniture” required for sex. But the most disturbing scene showed Edward G. Robinson entering a euthanasia clinic, choosing to be put down rather than live with his existential anguish. What was once fiction is becoming reality. Assisted suicide, unthinkable then, is popular now. Since the movie was released, many have come to view human existence as a relative, rather than absolute, good. The sanctity of life ethic has been replaced by the drive to eliminate suffering, even if this requires eliminating the sufferer. And the raw power of this logic has led directly to suicide clinics and a right to death on demand—since no one can judge what another person considers to be unbearable torment.

Assisted suicide activists insist that euthanasia is only for the seriously ill, and offer vacuous promises of strict guidelines to protect the vulnerable. Such bromides have never made sense to me. If there is indeed a “right to die,” if the most important good is “choice” rather than “life,” how can the right to commit suicide remain limited to the seriously ill? After all, many people suffer more intensely and for a longer time than the sick. Once one accepts the moral propriety of euthanasia, the logic eventually leads to death on demand for anyone who desires to die.

Still, even I never expected full-bore death on demand to arrive in the West for another decade. I was too optimistic. A recent ruling from Germany’s highest court has cast right-to-die incrementalism aside and conjured a fundamental right both to commit suicide and to receive assistance in doing it. Moreover, the decision has explicitly rejected limiting the right to people diagnosed with illnesses or disabilities. As a matter of protecting “the right of personality,” the court decreed that “self-determined death” is a virtually unlimited fundamental liberty that the government must guarantee to protect “autonomy.” In other words, the German people now have the right to kill themselves at any time and for any reason. From the decision (published English version, my emphasis):

The right to a self-determined death is not limited to situations defined by external causes like serious or incurable illnesses, nor does it only apply in certain stages of life or illness. Rather, this right is guaranteed in all stages of a person’s existence. . . . The individual’s decision to end their own life, based on how they personally define quality of life and a meaningful existence, eludes any evaluation on the basis of general values, religious dogmas, societal norms for dealing with life and death, or consideration of objective rationality. It is thus not incumbent upon the individual to further explain or justify their decision; rather their decision must, in principle, be respected by state and society as an act of self-determination.

The court wasn’t done. The right to suicide also includes a right to assist suicide:

The right to take one’s own life also encompasses the freedom to seek and, if offered, utilize assistance provided by third parties for this purpose. . . . Therefore, the constitutional guarantee of the right to suicide corresponds to equally far-reaching constitutional protection extended to the acts carried out by persons rendering suicide assistance.

The court also opined that Germany’s drug laws might have to be changed to facilitate the absolute right to die that “the state must guarantee”:

Sufficient space must remain in practice for the individual to exercise the right to depart this life and, based on their free will and with the support of third parties, to carry out this decision on their own terms. This not only requires legislative coherence in the design of the legal framework applicable to the medical profession and pharmacists but potentially also requires adjustments of the law on controlled substances.

This is stunning and appalling: In Germany, autonomous people now have the absolute right to commit suicide and receive assistance in doing so for any reason or no identifiable reason at all. The court’s ruling is so encompassing that it seems to apply even to children capable of making autonomous decisions, since being underage is a “stage of existence.” While the court stated that minor restrictions such as waiting periods might pass legal muster—the government may also prohibit “particularly dangerous forms of suicide assistance” (whatever that means)—the German constitution now requires, literally, death on demand.

That will not be the end of it, either. One radical court ruling leads to another. The right to commit suicide could soon become a right to be killed outright. After all, everyone isn’t physically or emotionally capable of committing suicide, and homicide can achieve death more swiftly and with less discomfort than a do-it-yourself demise. Since Germany’s absolute right to assist in suicide is open-ended and not limited to doctors, why not permit friends to kill friends?

The ruling also opens the gates to social anarchy. How can the state now restrict the taking and selling of addicting drugs? Drugs may be harmful, but if an autonomous person chooses to spend their days high, how can the state gainsay that decision or inhibit the commercial providers who supply the fixes? How can the state restrict any surgical or chemical sex changes? And on what basis can the state prohibit people who identify as “transabled” (people who have body identity integrity disorder) from amputating their healthy limbs or severing their healthy spinal cords? If suicide is no longer a harm the state has a duty to prevent, how can the state thwart a person’s desire to destroy his bodily functions? Indeed, how can the state restrain any personal behavior or vice, so long as the desired autonomous act does not directly harm an unwilling other?

I am reminded of Canadian journalist Andrew Coyne’s prophetic words more than twenty years ago. Reacting to his country’s strong public support for a father who murdered his disabled daughter as a supposed act of compassion, he wrote: “A society that believes in nothing can offer no argument even against death. A culture that has lost its faith in life cannot comprehend why it should be endured.” If we don’t change our current cultural trajectory, we will become “Germany” too. Wesley J. Smith is a senior fellow at the Discovery Institute. His latest book is Culture of Death: The Age of “Do Harm” Medicine


Adopted by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019

The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide.

For the purpose of this declaration, euthanasia is defined as a physician deliberately administering a lethal substance or carrying out an intervention to cause the death of a patient with decision-making capacity at the patient’s own voluntary request. Physician-assisted suicide refers to cases in which, at the voluntary request of a patient with decision-making capacity, a physician deliberately enables a patient to end his or her own life by prescribing or providing medical substances with the intent to bring about death.

No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.

Separately, the physician who respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care, even if respecting such a wish results in the death of the patient.


John Kelly’s Testimony Opposing New Jersey Assisted Suicide Bill A2451

published on the Not Dead Yet website on September 6, 2016. [Editor’s Note: John Kelly lived in New Jersey in his younger years and traveled back there to testify on October 6, 2016 in opposition to the latest assisted suicide bill, A2451. His oral testimony is below, and his full written testimony is here.] Chair Burzichelli, Vice Chair Lagana, Members of the Committee: My name is John Kelly, and I am the New England Regional Director for Not Dead Yet, the national disability rights group that has long opposed euthanasia and assisted suicide. I am also the director of Second Thoughts Massachusetts, Not Dead Yet’s Massachusetts affiliate. We are concerned that this bill is before the Appropriations Committee. It suggests that cost-containment really is a major factor behind the push for assisted suicide laws. So when in the state of Oregon, Barbara Wagner and Randy Stroup received letters from Oregon Medicaid denying coverage for prescribed chemotherapy. The letters did, however, offer to cover the negligible cost of assisted suicide. Because assisted suicide will always be the cheapest treatment, its availability will inevitably affect medical decision-making. This will actually end up constraining choice. A2451 threatens you, every single resident of New Jersey, because all of us are vulnerable to misdiagnosis. “Terminally ill” is defined as: “Terminally ill” means that the patient is in the terminal stage of an irreversibly fatal illness, disease, or condition with a prognosis, based upon reasonable medical certainty, of a life expectancy of six months or less.” When it comes to life and death, there is no such thing as “reasonable medical certainty.” Of the millions of misdiagnoses every year, many are terminal misdiagnoses. We know this because of the thousands of people who “graduate” from hospice each year. Every year in Oregon, people have lived longer than their six-month terminal diagnosis. Every year in New Jersey, it is estimated that 1/10 people over the age of 60 are abused, almost always by adult children and caregivers. Although “self-administration” is touted as one of the key “safeguards”, in about half of Oregon program deaths, there is no evidence of consent or self-administration in the death. If the drugs were administered by others without consent, no one would know. The request form constitutes a virtual blanket of legal immunity covering all participants in the process. Assisted suicide laws inevitably take the lives of innocent people through mistakes, coercion, and abuse. Please reject this bill.{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4}26+Information+Website&utm_campaign=f1894f7f9b-Euthanasia_Deception_documentary_counter10_7_2016&utm_medium=email&utm_term=0_b9d6bb980e-f1894f7f9b-198483333&m=1  ]]>

The Proposed Bill on Euthanasia and Comments by Doctors For Life (in Italics):

The bill is quite different to the July press release by the Law Commission. We have found the Law Commission to be less than honest when they stated in the press release that “As regards to active voluntary euthanasia, the Commission does not make any specific recommendation”. We find the recommended legislation under Option 2 to be very specific indeed. This deviousness, which is most obvious in section 5, seems to indicate an attempt by the Law Commission to dupe the media and the public as to the real intentions of the euthanasia bill. This euthanasia bill is based on the same principles as the German T4 program, which was condemned as a crime against humanity at Nuremberg: 1) They also allowed active euthanasia if the patient himself shall “earnestly and expressly” ask for it. 2) They also allowed his “nearer relatives” to ask for it “in case the patient is no longer able to express his desire”. 3) They also allowed it for “incurable” (terminal) conditions but 4) They even demanded a second opinion by two experts (the South African legislation only demands one) who would carefully trace the history of the case and personally examine the patient. The bill legalizes Physician Assisted Suicide (PAS) and active euthanasia. Even if the clauses legalizing active euthanasia and PAS would be removed, there are numerous loopholes built into the legislation starting right from the beginning with the definitions. The South African Law Commission (SALC) has also re-defined traditional concepts in medical practice and given it a completely new meaning. BILL: To regulate end of life decisions and to provide for matters incidental thereto. To be introduced by the Minister of Justice BE IT ENACTED by the Parliament of the Republic of South Africa, as follows: Definitions (1) In this Act, unless the context otherwise indicates- ‘competent witness’ means a person of the age of 18 years or over who at the time he witnesses the directive or power of attorney is not incompetent to give evidence in a court of law and for whom the death of the maker of the directive or power of attorney holds no benefit; ‘court’ means a provincial or local division of the High Court of South Africa within whose jurisdiction the matter falls; ‘family member’ in relation to any person, means that person’s spouse, parent, child, brother or sister; ‘intractable and unbearable illness’ means an illness, injury or other physical or mental condition, but excluding a terminal illness, that- The term “intractable and unbearable” is ridiculously inclusive and vague. (a) offers no reasonable prospect of being cured; and (b) causes severe physical or mental suffering of a nature and degree not reasonable to be endured. This is a very broad definition. It covers all incurable illnesses such as manic-depressive illness, schizophrenia and intractable depression. It says that mental suffering equals physical suffering. Diabetes or hypertension qualifies, since they are not curable. How much suffering is “not reasonable to be endured”? Whose yardstick of “not reasonable to be endured” is used – the patient’s, the doctor’s, the family’s and/or society’s? It is so idiosyncratic as to be useless. One cannot believe somebody could expect this to help anyone care for patients appropriately and the potential for abuse is astronomical! ‘lawyer’ means an attorney as defined in section 1 of the Attorney’s Act, 1979 (Act 53 of 1979) and an advocate as defined in section 1 of the Admission of Advocates Act, 1964 (Act 74 of 1964); ‘life-sustaining medical treatment’ includes the maintenance of artificial feeding; What is “artificial feeding”? Does this mean “artificially administered nutrition”? If the patient can’t feed themselves orally, is that artificial feeding? Food and water (hydration and nutrition) does not fall under medical treatment. Even healthy people need food and water. We do not believe there is the danger of, artificially keeping a terminally ill patient alive indefinitely, simply by providing food and water. (With this we are not referring to intravenous food and nutrition but food and nutrition via a naso-gastric tube or gastrostomy). Would the conscience clause in section 10 also apply here? ‘medical practitioner’ means a medical practitioner registered as such in terms of the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act 56 of 1974); ‘nurse’ means a nurse registered as such in terms of the Nursing Act 50 of 1978 and authorized as a prescriber in terms of section 31(14) (b) of the proposed [South African Medicines and Medical Devices Regulatory Authority Bill]; Could this possibly also include Traditional Healers with the new developments which are being considered by the Health Professionals Council and which may also register them as “medical practitioners”? ‘palliative care’ means treatment and care of a terminally ill patient with the object of relieving physical, emotional and psycho-social suffering and of maintaining personal hygiene; It should be stated clearly that palliative care does not include active euthanasia and PAS. The reason being that some people have lately been redefining the term “palliative care” to include PAS and active euthanasia. ‘spouse’ includes a person with whom one lives as if they were married or with whom one habitually cohabits; ‘terminal illness’ means an illness, injury or other physical or mental condition that- (a) in reasonable medical judgment, will inevitably cause the untimely death of the patient concerned and which is causing the patient extreme suffering; or This has been poorly defined. Many chronic diseases will also “inevitably cause untimely death” – e.g. diabetes, coronary heart disease, hypertension etc. The definition of “untimely” is open to all sorts of interpretations. “Extreme suffering” – what does that mean? Is that the doctor’s opinion or the patient’s opinion? Is it physical or mental suffering? “extreme suffering” has nothing to do with determining a terminal illness and, not having some time frame for the “untimely” death is ridiculous. This is amongst the vaguest and broad language used in euthanasia legislation. (b) causes a persistent and irreversible vegetative condition with the result that no meaningful existence is possible for the patient. The definition of “Persistent Vegetative State/condition” (PVS) as a terminal illness is a major departure from medical understanding and practice. To call them terminally ill opens the door to the wholesale termination of lives. Conduct of a medical practitioner in the event of clinical death 2.(1) For the purposes of this Act, a person is considered to be dead when two medical practitioners agree and confirm in writing that a person is clinically dead according to the following criteria for determining death, namely – (a) the irreversible absence of spontaneous respiratory and circulatory functions; or (b) the persistent clinical absence of brain-stem function. “Brain-stem function” – This is the liberal definition of death and follows British practice only. The rest of the world prefers the “whole brain” definition because it is possible for a patient to have a severe brain stem infarct (a stroke involving the brain stem) with the preservation of some cortical function. (2) Should a person be considered to be dead according to the provisions of sub-section (1), the medical practitioner responsible for the treatment of such person may withdraw or order the withdrawal of all forms of treatment. Mentally competent person may refuse treatment 3.(1) Every person – (a) above the age of 18 years and of sound mind, or (b) above the age of 14 years, of sound mind and assisted by his or her parents or guardian, is competent to refuse any life-sustaining medical treatment or the continuation of such treatment with regard to any specific illness from which he or she may be suffering. More vague language. How is a 14-year-old “assisted by his or her parents”? Does this mean the parents make the decision alone or must both agree? Who has the legal right to refuse treatment? (2) Should it be clear to the medical practitioner under whose treatment or care the person who is refusing treatment as contemplated in subsection (1) is, that such a person’s refusal is based on the free and considered exercise of his or her own will, he or she shall give effect to such a person’s refusal even though it may cause the death or the hastening of death of such a person. There is not enough clarity whether the conscience clause at the end of the law would also apply to this part of the legislation. It should at least have been repeated here to make sure that the doctor is protected against being coerced into taking part in a suicide. (3) Care should be taken when taking a decision as to the competency of a person, that an individual who is not able to express him or herself verbally or adequately, should not be classified as incompetent unless expert attempts have been made to communicate with that person whose responses may be by means other than verbal. (4) Where a medical practitioner as contemplated in subsection (2) does not share or understand the first language of the patient, an interpreter fluent in the language used by the patient must be present in order to facilitate discussion when decisions regarding the treatment of the patient are made. Conduct of medical practitioner in relieving distress 4.(1) Should it be clear to a medical practitioner or a nurse responsible for the treatment of a patient who has been diagnosed by a medical practitioner as suffering from a terminal illness that the dosage of medication that the patient is currently receiving is not adequately alleviating the patient’s pain or distress, he or she shall – (a) with the object to provide relief of severe pain or distress; and (b) with no intention to kill increase the dosage of medication (whether analgesics or sedatives) to be given to the patient until relief is obtained, even if the secondary effect of this action may be to shorten the life of the patient. (2) A medical practitioner or nurse who treats a patient as contemplated in subsection (1) shall record in writing his or her findings regarding the condition of the patient and his or her conduct in treating the patient, which record will be documented and filed in and become part of the medical record of the patient concerned. We are a bit concerned about this clause. It is very important not to leave any loop holes in the wording. One usually does not have to remind a brain surgeon that a double-effect risk of brain surgery could be the death of the patient. When double effect is spelled out in this manner for doctors interested in euthanasia, in other words interested in accomplishing the second effect – death, the implicit purpose appears to be to encourage them to practice “terminal sedation” as spelled out by the US euthanasia advocacy group “Concern for Dying”. Secondly, in practice this (the second effect of killing a patient when trying to relieve pain) never happens if it is done properly. The permissible practice is to titrate up the dosage of the drug to try to achieve pain relief. In the words of Dr. Gary Lee, expert in pain control: “We don’t see respiratory depression in patients not on the brink of death already, unless the intent is to cause respiratory depression. Where it becomes euthanasia is when one causes these effects earlier than when they would occur in the natural process”. An example of the loophole that this piece of legislation offers, happened in America where a doctor ordered the nurse to “titrate to effect”, the pain medication in a patient that was not having pain. When she refused, he simply wrote in the chart that the patient was having pain and incrementally increased the dosage of the morphine till the patient stopped breathing in order to cover his tracks as he killed the patient. The same could happen under this law in South Africa and who would know? Looking at the chart it would look like good pain care and unfortunately a double effect. The whole law is based on the supposition that ALL doctors will act honorably and competently (not make any fatal mistakes) both of which have odds somewhere along the likely hood of Durban getting half a meter snow in the middle of December. Active voluntary euthanasia Option 1: No legislative enactment Option 2: Cessation of life Nowhere in the world has euthanasia been controlled successfully through legislation. As was shown earlier, the German T4 program also started off with certain criteria which had to be adhered to. These safeguards did not help however. It was doctors who started and ran the program. Within a short time, the second doctor was rubber stamping as many as 100 applications and hour. Within a short while they emptied two third of the beds in mental institutions. They first used injections, but when it was to slow they built gas chambers. The first gas chamber to be used by the Nazis some years later, was dissembled at a mental hospital and re-assembled at a prison camp. 1939 were killing disabled soldiers. They had gone from killing the suffering and terminally ill (1920) to killing criminals (1933) to killing the mentally ill, the aged and disabled “weaklings”(1935) to genocide (1939). Neither did similar safeguards help in Holland. Holland went from active voluntary euthanasia for the terminally ill (1973) to active voluntary euthanasia for the chronically ill (1982) to Non-voluntary euthanasia of people in old age homes (1985) to infanticide of new born children with Down’s syndrome (1989) to euthanasia for mental suffering (1994) to no penalty for not sticking to the criteria/safeguards (1997) and are now considering voluntary euthanasia for minors above 12 years of age. Safeguards are also not working in Oregon. At first Oregonians were promised that euthanasia would only be practiced within a long-term, meaningful relationship between a doctor and the suicidal patient. The family doctors of the very first two women to be euthanized in the USA refused to do it. The general practitioner of the one woman actually diagnosed her as suffering from depression. The women called the Hemlock Society, which simply referred them to doctors who were willing to administer the lethal drugs, despite having had no long-term relationship with the patient. What her personal doctor diagnosed as depression, the medical Director of Compassion in Dying dismissed as mere frustration. Coercion into euthanasia is too subtle to control. The Santa Rosa Press Democrat reported an interview with an 84-year-old woman who said the following: “when I started losing my hearing about three years ago, it irritated my daughter. She began to question me about financial matters and apparently feels I won’t leave much of an estate to her¼. She became very rude¼ Then one evening (she)said she thought it was okay for older people to commit suicide¼ So I sit, day after day, knowing what I am expected to do”  5. (1) Should a medical practitioner be requested by a patient to make an end to the patient’s suffering, or to enable the patient to make an end to his or her suffering by way of administering or providing some or other lethal agent, the medical practitioner shall give effect to the request if he or she is satisfied that- This section again has no conscience clause. It needs to be clearly stated that a physician who cannot morally or ethically participate in these actions has to be able to refuse. There cannot be any obligation for anyone to go along with this. The patient is suffering from a terminal or intractable and unbearable illness; As mentioned before, this safeguard was also used in Germany – they called it an “incurable” disease. (b) the patient is over the age of 18 years and mentally competent; (c) the patient has been adequately informed in regard to the illness from which he or she is suffering, the prognosis of his or her condition and of any treatment or care that may be available; (d) the request of the patient is based on a free and considered decision; Cliff jumpers also make “free” and “considered” decisions, that does however not change the fact that they, like the suicidal patient, are displaying emotional trauma. (e) the request has been repeated without self-contradiction by the patient on two separate occasions at least seven days apart, the last of which is no more that 72 hours before the medical practitioner gives effect to the request; This is the shortest waiting period we are aware of. Both Oregon and Holland require at least 14 days. (f) the patient, or a person acting on the patient’s behalf in accordance with subsection (6), has signed a completed certificate of request asking the medical practitioner to assist the patient to end the patient’s life; (g) the medical practitioner has witnessed the patient’s signature on the certificate of request or that of the person who signed on behalf of the patient; Who has the right to sign on behalf of the patient? (h) an interpreter fluent in the language used by the patient is present in order to facilitate communication when decisions regarding the treatment of the patient are made where the medical practitioner as contemplated in this section does not share or understand the first language of the patient; Ending the life of the patient or assisting the patient to end his or her life, is the only way for the patient to be released from his or her suffering. The only way out in whose opinion? The doctor who is killing the patient, the patient’s or other doctors’? The cliff jumper thinks theirs is the only way too, that does not mean it is so. Obviously, before the law goes into effect, people with the same illnesses who are under palliative care (hospice) and not euthanized prove that euthanasia is not the only way. We do not believe that there is ever a situation where euthanasia is the only way out. (2) No medical practitioner to whom the request to make an end to a patient’s suffering is addressed as contemplated in subsection (1), shall give effect to such a request, even though he or she may be convinced of the facts as stated in that subsection, unless he or she has conferred with an independent medical practitioner who is knowledgeable with regard to the terminal illness from which the patient is suffering and who has personally checked the patient’s medical history and examined the patient and who has confirmed the facts as contemplated in subsection (1)(a), (b) and (i). Experience in Holland has shown that the doctor simply chooses another doctor whom he/she knows is in favor of euthanasia, as the second independent practitioner. This clause is a reason for grave concern if you look at what subsection (1)(a), (b) and (I) say. This does not even say that the first medical practitioner must tell the other that euthanasia is being considered. It does not say when the consultation has to take place. If the patient has seen any other doctor for a chronic illness who may not even agree that the patient is incompetent but just says that there “is nothing more we can do” for any of the symptoms (paresthesia in a diabetic’s legs, chronic intermittent angina, intermittent severe migraines which are resistant to therapy) then, with the vague wording of this section, the patient would qualify for euthanasia. (3) A medical practitioner who gives effect to a request as contemplated in sub-section (1), shall record in writing his or her findings regarding the facts as contemplated in that subsection and the name and address of the medical practitioner with whom he or she has conferred as contemplated in subsection (2) and the last-mentioned medical practitioner shall record in writing his or her findings regarding the facts as contemplated in subsection (2). (4) The termination of a patient’s life on his or her request in order to release him or her from suffering may not be effected by any person other than a medical practitioner. (5) A medical practitioner who gives effect to a patient’s request to be released from suffering as contemplated in this section shall not suffer any civil, criminal or disciplinary liability with regard to such an act provided that all due procedural measures have been complied with. Holland has proven the folly of holding killing doctors to “procedure”. What this says is that if the paperwork is okay, the doctor is totally absolved. He could miss the diagnosis and the patient is not terminally ill. He could botch the euthanasia and leave the patient with another disability and he couldn’t be prosecuted. The family could say the patient was depressed and treatable but they could not sue for wrongful death or damages. The doctor gets to serve as both judge and executioner. This law strips the medical licensure of their right to cancel licenses even if Dr. Kevorkian moves to S.A. and opens a clinic. Dr. Kevorkian couldn’t be terminated from membership or have his privileges withdrawn by any medical society or facility as long as he followed the “procedure” correctly. With good paperwork, nothing else is considered. An article in the Australian medical journal recently reported that in Holland, doctors form “consulting pairs” where, in over 90{01b0879e117dd7326006b2e84bcaac7e8fa1509c5c67baf2c9eb498fe06caff4} of the cases, the second doctor agrees that the patient should be killed. If a doctor sends patients to a doctor that frequently disagrees with them on the diagnosis or treatment course they think is the right course, what does the doctor do? Of course, he starts sending his patients to a doctor that agrees with him/her. (6) If a patient who has orally requested his or her medical practitioner to assist the patient to end the patient’s life is physically unable to sign the certificate of request, any person who has attained the age of 18 years, other than the medical practitioner referred to in subsection (2) above may, at the patient’s request and in the presence of the patient and both the medical practitioners, sign the certificate on behalf of the patient. There seems to be a real possibility that the witness and the two doctors could conspire to kill the patient without his consent. If the law requires two witnesses to formulate an advance directive, why does it not require two here as well? The two doctors are likely to speak as one and one can imagine situations where there may be secondary gain for them to be able to kill patients as they please. Two physicians could certainly find a witness who would agree to “witness” the request if they could benefit from the patient’s death. (7) (a) Notwithstanding anything in this Act, a patient may rescind a request for assistance under this Act at any time and in any manner without regard to his or her mental state. (b) Where a patient rescinds a request, the patient’s medical practitioner shall, as soon as practicable, destroy the certificate of request and note that fact on the patient’s medical record. (8) The following shall be documented and filed in and become part of the medical record of the patient who has been assisted under this Act: (a) a note of the oral request of the patient for such assistance; (b) the certificate of request; (c) a record of the opinion of the patient’s medical practitioner that the patient’s decision to end his or her life was made freely, voluntarily and after due consideration; (d) the report of the medical practitioner referred to in subsection (2) above; (e) a note by the patient’s medical practitioner indicating that all requirements under this Act have been met and indicating the steps taken to carry out the request, including a notation of the substance prescribed. Option 3: Decision by panel or committee Cessation of life 5.(1) Euthanasia may be performed by a medical practitioner only, and then only where the request for the euthanasia of the patient has been approved by an ethics committee constituted for that purpose and consisting of five persons as follows:

  1. a) two medical practitioners other than the practitioner attending to the patient;
  2. b) one lawyer;
  3. c) one member sharing the home language of the patient;
  4. d) one member from the multi-disciplinary team; and
  5. e) one family member.
(2) In considering and in order to approve a request as contemplated in subsection (1) the Committee has to certify in writing that:
  1. a) in its opinion the request for euthanasia by the patient is a free, considered and sustained request;
  2. b) the patient is suffering from a terminal or intractable and unbearable illness;
  3. c) euthanasia is the only way for the patient to be released from his or her suffering.
(3) A request for euthanasia must be heard within three weeks of it being received by the Committee. (4) (a) The Committee which, under subsection (2), grants authority for euthanasia must, in the prescribed manner and within the prescribed period after euthanasia has been performed, report confidentially to the Director-General of Health, by registered post, the granting of such authority and set forth – (i) the personal particulars of the patient concerned; (ii) the place and date where the euthanasia was performed and the reasons therefore; (iii) the names and qualifications of the members of the committee who issued the certificates in terms of the above sections; and (iv) the name of the medical practitioner who performed the euthanasia. (b) The Director-General may call upon the members of the Committee required to make a report in terms of subsection (4) or a medical practitioner referred to in subsection (1) to furnish such additional information as he may require. (5) The following shall be documented and filed and become part of the medical record of the patient who has been assisted under this Act: (a) full particulars regarding the request made by the patient; (b) a copy of the certificate issued in terms of subsection (2); (c) a copy of the report made in terms of subsection (4). This third option appears to be more vague than the others. Does it take a majority vote of the committee, a unanimous opinion or what? Where does the committee come from – who chooses them? It is called an “ethics committee” but who convenes it – the healthcare facility, the doctor who wants to euthanize the patient, the family or the patient him/herself? If the committee says “no”, then what? Can the patient re-apply? Is there an appeal process? Who runs the committee? Who pays them? Are they volunteers? Do they only serve for that one case or are they a standing committee who rotates family members onto the committee? In short, having a panel decide appears to be a vain attempt to introduce further safeguards that won’t really make any difference. All it really does is to introduce a (probable) rubber stamp into the process without significantly affecting the outcome. Directives as to the treatment of a terminally ill person Living-wills/advanced directives are supposed to be a positive antidote to overzealous doctors keeping a patient alive by rendering undesired treatment. In principle we cannot find any fault with that. One wonders whether, with the present financial climate of the country and the workload of health professionals, the danger is not greater that desired treatment will be withheld. The only choice discussed here, is the termination or withholding of life-saving treatment. This is a common trend. (Some living wills may offer the option of demanding life-saving treatment, but makes it more difficult e.g. If your decision is to fight for life it gets complicated and often you must create your own detailed treatment instructions. If on the other hand your choice is non-treatment one only need to tick in a box on the page.) The option for accepting care should however also be made available and easily accessible. The patient may well request that all appropriate medical treatment be given and such a directive should be followed just as closely as one limiting medical treatment. Take note also, that the power to withhold treatment is not restricted to withholding “extraordinary care”, such as ventilators to assist with breathing, but “to any medical treatment” – from not treating a curable bacterial infection to withdrawing food and fluids. Experience in the United States have also shown that Health Professionals often appear to be confused about the legalities of a living will leading to the denial of care for people with treatable conditions as in the tragic case of Martha Musgrave.  6.(1) Every person above the age of 18 years who is of sound mind shall be competent to issue a written directive declaring that if he or she should ever suffer from a terminal illness and would as a result be unable to make or communicate decisions concerning his or her medical treatment or its cessation, medical treatment should not be instituted or any medical treatment which he or she may receive should be discontinued and that only palliative care should be administered. This is a very concrete promise! This implies that a young person with a recent high spinal cord injury which requires ventilation support, will not even have a trial of vent support for several weeks to make sure he/she is not depressed and to help him/her learn what the rehab potential is, before making an irreversible decision. It has happened in the USA that patient’s/family members wanted to change living wills after an accident/sickness, but were considered incompetent and starved to death. (2) A person as contemplated in subsection (1) shall be competent to entrust any decision-making regarding the treatment as contemplated in that subsection or the cessation of such treatment to a competent agent by way of a written power of attorney, and such power of attorney shall take effect and remain in force if the principal becomes terminally ill and as a result is unable to make or communicate decisions concerning his or her medical treatment or the cessation thereof. (3) A directive contemplated in subsection (1) and a power of attorney contemplated in subsection (2) and any amendment thereof, shall be signed by the person giving the directive or power of attorney in the presence of two competent witnesses who shall sign the document in the presence of the said person and in each other’s presence. (4) When a person who is under guardianship, or in respect of whom a curator of the person has been appointed, becomes terminally ill and no instructions as contemplated in subsection (1) or (2) regarding his medical treatment or the cessation thereof have been issued, the decision-making regarding such treatment or the cessation thereof shall, in the absence of any court order or the provisions of any other Act, vest in such guardian or curator. This is the start of third-party euthanasia. It accepts the “standard of substituted judgment”, where the family or guardian can decide as they/he would have expected the patient to decide. This principle has not held in American courts. The only time when a relative or guardian can decide is when the patient him/herself has explicitly stated before what their wishes would be under such circumstances. What about cases where the family member/guardian has a vested interest in the death of the patient, like being able to inherit from the patient? Conduct in compliance with directives by or on behalf of terminally ill persons 7.(1) No medical practitioner shall give effect to a directive regarding the refusal or cessation of medical treatment or the administering of palliative care which may contribute to the hastening of a patient’s death, unless- (a) the medical practitioner is satisfied that the patient concerned is suffering from a terminal illness and is therefore unable to make or communicate considered decisions concerning his or her medical treatment or the cessation thereof; and Terminal illness does not equate with mental competency but that is what 7. (a) says. The “therefore” should not be there. Secondly, the right to refuse medical intervention should not be based on whether the patient is terminally ill. The bio-ethical principle is based on the right of autonomy. In other words, if I say I don’t want penicillin for my pneumonia and my doctor forces it on me, that is assault whether the doctor injures me or not. It would be no different than me kidnapping someone and bringing them to South Africa, even if it was for a vacation. I don’t have the right to force someone to do something against their will unless I have been given that authority by law (e.g. a government drafting men into the army, a policeman arresting someone for breaking the law, etc.) (b) the condition of the patient concerned, as contemplated in paragraph (a), has been confirmed by at least one other medical practitioner who is not directly involved in the treatment of the patient concerned, but who is competent to express a professional opinion on the patient’s condition because of his expert knowledge of the patient’s illness and his or her examination of the patient concerned. (2) Before a medical practitioner gives effect to a directive as contemplated in subsection (1) he shall satisfy himself, in so far as this is reasonably possible, of the authenticity of the directive and of the competency of the person issuing the directive. (3) Before giving effect to a directive as contemplated in subsection (1), a medical practitioner shall inform the interested family members of the patient of his or her findings, that of the other medical practitioner contemplated in paragraph (b) of subsection (1), and of the existence and content of the directive of the patient concerned. What will the doctor do if one family member disagrees? Does this mean that there must be a unanimous vote? Who would qualify as “interested members? Are they spouse, children, grandchildren, cousins, uncles, aunts, patents or who? (4) If a medical practitioner is uncertain as to the authenticity as regard to the directive or its legality, he shall treat the patient concerned in accordance with the provisions set out in section 8 below. (5) (a) A medical practitioner who gives effect to a directive as contemplated in subsection (1) shall record in writing his or her findings regarding the condition of the patient and the manner in which he or she implemented the directive. (b) A medical practitioner as contemplated in paragraph (b) of subsection (1) shall record in writing his or her findings regarding the condition of the patient concerned. (6) A directive concerning the refusal or cessation of medical treatment as contemplated in sub-section (1) and (2) shall not be invalid and the withholding or cessation of medical treatment in accordance with such a directive, shall, in so far as it is performed in accordance with this Act, not be unlawful even though performance of the directive might hasten the moment of death of the patient concerned. Conduct of a medical practitioner in the absence of a directive 8.(1) If a medical practitioner responsible for the treatment of a patient in a hospital, clinic or similar institution where a patient is being cared for, is of the opinion that the patient is in a state of terminal illness as contemplated in this Act and unable to make or communicate decisions concerning his or her medical treatment or its cessation, and his or her opinion is confirmed in writing by at least one other medical practitioner who has not treated the person concerned as a patient, but who has examined him or her and who is competent to submit a professional opinion regarding the patient’s condition on account of his or her expertise regarding the illness of the patient concerned, the first-mentioned medical practitioner may, in the absence of any directive as contemplated in section 6(1) and (2) or a court order as contemplated in section 9, grant written authorisation for the cessation of all further life-sustaining medical treatment and the administering of palliative care only. (2) A medical practitioner as contemplated in subsection (1) shall not act as contemplated in subsection (1) if such conduct would be contrary to the wishes of the interested family members of the patient, unless authorised thereto by a court order. (3) A medical practitioner as contemplated in subsection (1) shall record in writing his or her findings regarding the patient’s condition and any steps taken by him or her in respect thereof. (4) The cessation of medical treatment as contemplated in subsection (1) shall not be unlawful merely because it contributes to causing the patient’s death. This is one of the most frightening sections. It allows for unilateral decision making by physicians, without requiring consent for withhold or withdraw actions! The mild caution in 8. (2) is ridiculously inadequate to prevent abuse (“if such conduct would be contrary to the wishes” is pitifully weak) This places WAY too much independent power in the hand of physicians who may not always be acting in the patient’s best interest, particularly in a society that may be recognizing killing as an acceptable part of medical care! Once again, there is a presumption that killing the patient (or allowing him to die) is the right thing to do UNLESS EVIDENCE EXISTS TO THE CONTRARY! Powers of the court
  1. (1) In the absence of a directive by or on behalf of a terminally ill person as contemplated in section 6, a court may, if satisfied that a patient is in a state of terminal illness and unable to make or communicate decisions concerning his or her medical treatment or its cessation, on application by any interested person, order the cessation of medical treatment.
According to the definition of “medical treatment”, given at the beginning, the court will have the right to starve a patient to death. This section states that the court (the arm of the state) can override the wishes of the family and withdraw care from the terminally ill patient (which is not well defined because all of us are “terminally ill” if there is no time limit). If the patient is in a coma and has an ill-defined “terminal illness”, the state can withdraw medical support/treatment even if the family refuses permission. Since South Africa has a socialized medical system, isn’t there a conflict in interest here? It would be like having medical insurance companies decide whether a patient’s medical support should continue. Doesn’t the payer have every reason to withdraw care in order to save funds? How do you hold the government liable? One can’t hold the doctor liable with this law because he is only an “agent of the government”.  It seems as if SA is trying to find any option that would authorize a radical change. In medical practice. It is particularly troubling when there seems to be a presumption that the decision should be to limit care or to kill the patient. In the court section, the family gets the “opportunity” to “be heard” by the court, but seems to be placed in the position of having to defend a decision to continue treatment. This is not so subtle coercion! (2) A court shall not make an order as contemplated in subsection (1) without the interested family members having been given the opportunity to be heard by the court. (3) A court shall not make an order as contemplated in subsection (1) unless it is convinced of the facts as contemplated in that subsection on the evidence of at least two medical practitioners who have expert knowledge of the patient’s condition and who have treated the patient personally or have informed themselves of the patient’s medical history and have personally examined the patient. (4) A medical practitioner who gives effect to an order of court as contemplated in this section shall not thereby incur any civil, criminal or other liability whatsoever. Interpretation
  1. The provisions of this Act shall not be interpreted so as to oblige a medical practitioner to do anything that would be in conflict with his or her conscience or any ethical code to which he or she feels himself or herself bound.
Finally, in section 10 we seem to find the necessary conscience clause! It is almost buried in the short title section and only if someone has the strength to wade through all the illogical. What about nurses? Would they be forced to participate? What about pharmacists? Would they be obliged to assist e.g. by supplying drugs with which to commit suicide? Short title
  1. This Act shall be called the End of Life Decisions Act 1999
  1. A waiting period of only 7 days as compared to the 14 days of Oregon.
  2. Does not define mentally competent.
  3. No safeguards against coercion by a family member, doctor, health facility personnel or third party payer.
  4. No reporting or oversight requirements and no listing of penalties for failure to comply. Who is going to know if this new law works or not?
  5. Allows active voluntary euthanasia. Even Oregon does not go this far.
  6. Allows court mandated active non-voluntary euthanasia for incompetent patient’s if any “interested” person requests it. What a great way to open up needed beds in old age home facilities!
Like Oregon:
  1. It does not require a psychiatric exam to rule out depression.
  2. It does not require family notification.
  3. The doctor just has to have perfect paper work. He is indemnified from all liability even if he misses the diagnosis or messes up the suicide. The family cannot sue the doctor who kills their loved one. He just has to write in the chart that the patient requested it, get another doctor to agree (In Holland, doctors find doctors who will agree with them and refer these cases to them) and document it. The patient is dead and the family has no recourse even if the doctor coerced the patient into it.
In summary: The law appears to indicate that the writers presume that (1) patients want to die and to die quickly (2) society wants them to do so as well (3) even if they don’t recognize that they really do want to die, we know that they really do want to (or at least ought to want to!) and (4) al physicians will agree with this presumption! The supposed safeguards are inadequate and dangerous. Each is subject to interpretation (e.g. terminal illness, competent, prognosis, considered decision etc.) There is no specific addressing of depression, though some would argue that it is presumed under “competent”. Yet it is so prevalent, so easily overlooked and so treatable. It should also be repeated that the following associations have rejected active euthanasia: The British Medical Association, The American Medical Association, The Nursing Association of America and the American Psychiatric Association.  ]]>