Let’s stop calling medical aid in dying ‘suicide’

By Kenneth Norton

The New Hampshire legislature is considering a bill to join our Maine and Vermont neighbors to allow New Hampshire residents with a terminal illness, in consultation with two medical providers, the option of ending their suffering and having a peaceful death. As a Licensed Independent Clinical Social Worker who has spent over four decades working to prevent suicide at the local, state, national and international level, I think it is time to look closely at the differences between the two, and stop referring to medical aid in dying as suicide.

Legally, in the 10 states and Washington D.C. where medical aid in dying is allowed, the death is not counted as a suicide death. Medical Examiners and Coroners list the underlying terminal illness, which the person was diagnosed with, as the cause of death on the death certificate of patients who utilize medical aid in dying.

People who die by suicide, for whatever reason, no longer wish to live and feel that they have no other option than death. The person who chooses medical aid in dying wants to live yet has been diagnosed with a terminal illness that will end their life, and may cause intense suffering before they die. They are fully informed of other options including palliative care, hospice, and comfort measures. This is not a decision they are allowed to take lightly or at the spur of the moment. It requires thoughtful controls and two medical opinions in support of specific terminal illness.

A high correlation exists between suicide and mental illness. The person who dies by suicide may or may not be rational, or even competent in that moment. Research shows that many suicide deaths are impulsive. Although the person may have contemplated suicide for some time, it may only be a matter of minutes between making the decision to die and then taking their life. By contrast, in medical aid in dying, people go through a formal process with two medical professionals that includes: an assessment of their mental capability, a determination about their terminal illness, an informed consent process including a review of available options, and a mandatory waiting period

People who die by suicide die alone, and often die by violent means. In New Hampshire, over 75% of suicides involve firearms or hanging. Nationally, over 75% of suicide deaths occur in a home or primary residence. These violent deaths result in trauma for their loved ones who return home to find their loved one dead. The scene, shock, and aftermath are so distressing that many people are no longer able to continue to live in their homes. Suicide deaths can also be traumatizing and contribute to PTSD in first responders who are called to the scene.

Family, friends, and loved ones of a person who dies by suicide can experience intense emotions including shock, guilt, anger, shame, regret, and despair as they try to come to terms with the suddenness of the death, and make sense of the often-unanswerable question: “why?” People who are bereaved by suicide may experience suicidal thoughts and are statistically at higher risk themselves for suicide. Suicide deaths are often devasting and life altering for family and friends resulting in a long and complicated grief process that may last years. It is said the person who dies by suicide dies a single death, but their family/friends are left to die a thousand deaths.

By contrast, the person who goes through the medical aid in dying process, frequently includes loved ones in their decision. Most die in their home, surrounded by their family and friends. The death is planned, and peaceful. Family and friends are left at peace knowing that this was their choice and their suffering is over. To be clear, this does not stop those close people from grieving the death, but it eliminates the “whys” and “what ifs” as well as the trauma from a sudden suicide.

Despite our best efforts, there is still considerable shame and stigma associated with, and experienced by family and friends after a suicide. We should be careful not to contribute to that stigma by extending it to medical aid in dying. Whether you support or are opposed to medical aid in dying, we should acknowledge there are significant differences between the two, and we should stop labeling medical aid in dying as suicide.

Complete Article HERE!

Terminally ill Connecticut woman ends her life on her own terms, in Vermont

— A Connecticut woman who pushed for expanded access to Vermont’s law that allows people who are terminally ill to end their lives has died in Vermont

Lynda Bluestein

By LISA RATHKE

A Connecticut woman who pushed for expanded access to Vermont’s law that allows people who are terminally ill to receive lethal medication to end their lives died in Vermont on Thursday, an event her husband called “comfortable and peaceful,” just like she wanted.

Lynda Bluestein, who had terminal cancer, ended her life by taking prescribed medication.

Her last words were ‘I’m so happy I don’t have to do this (suffer) anymore,'” her husband Paul wrote in an email on Thursday to the group Compassion & Choices, which was shared with The Associated Press.

The organization filed a lawsuit against Vermont in 2022 on behalf of Bluestein, of Bridgeport, Connecticut, and Diana Barnard, a physician from Middlebury. The suit claimed Vermont’s residency requirement in its so-called patient choice and control at end of life law violated the U.S. Constitution’s commerce, equal protection, and privileges and immunities clauses.

The state agreed to a settlement last March that allowed Bluestein, who is not a Vermont resident, to use the law to die in Vermont. And two months later, Vermont made such accommodations available to anyone in similar circumstances, becoming the first state in the country to change its law to allow terminally ill people from out of state to take advantage of it to end their lives.

“Lynda was an advocate all the way through, and she wanted access to this law and she had it, but she and everybody deserves to have access much closer to home because the need to travel and to make arrangements around the scheduling to come to Vermont is not something that we wish for people to have, ” Barnard said.

Barnard said it’s a sad day because her life came to an end, “But more than a silver lining is the beauty and the peace that came from Lynda having a say in what happened at the very end of her life.”

Ten states allow medically assisted suicide but before Vermont changed its law only one state — Oregon — allowed non-residents to do it, by not enforcing the residency requirement as part of a court settlement. Oregon went on to remove that requirement this past summer.

Vermont’s law, in effect since 2013, allows physicians to prescribe lethal medication to people with an incurable illness that is expected to kill them within six months.

Supporters say the law has stringent safeguards, including a requirement that those who seek to use it be capable of making and communicating their health care decision to a physician. Patients are required to make two requests orally to the physician over a certain timeframe and then submit a written request, signed in the presence of two or more witnesses who aren’t interested parties. The witnesses must sign and affirm that patients appeared to understand the nature of the document and were free from duress or undue influence at the time.

Others express moral opposition to assisted suicide and say there are no safeguards to protect vulnerable patients from coercion.

Bluestein, a lifelong activist, who advocated for similar legislation to be passed in Connecticut and New York, which has not happened, wanted to make sure she didn’t die like her mother, in a hospital bed after a prolonged illness. She told The Associated Press last year that she wanted to pass away surrounded by her husband, children, grandchildren, wonderful neighbors, friends and dog.

“I wanted to have a death that was meaningful, but that it didn’t take forever … for me to die,” she said.

“I want to live the way I always have, and I want my death to be in keeping with the way I wanted my life to be always,” Bluestein said. “I wanted to have agency over when cancer had taken so much for me that I could no longer bear it. That’s my choice.”

I Promised My Sister I Would Write About How She Chose to Die

By Steven Petrow

On the day before my sister Julie died, I lay down on her bed and held her gingerly in my arms, afraid that any pressure would hurt her. She had lost so much weight that she looked like a stick figure I might have drawn when we were kids. As her body had wasted, her tumors had grown — now several of them bigger than baseballs. Her abdomen looked like the lunar landscape, with protrusions everywhere, the sources of her pain plainly visible.

Two and a half months earlier, her oncologist explained that these tumors might soon block the liver’s ability to drain properly, resulting in liver failure, usually a fast and painless death. “It will be as though you’re going to sleep,” I remember him telling us on a Zoom call.

That had not happened. Those tumors continued to grow. No matter the doses of fentanyl and morphine, Julie cried out in pain, the only time during her long illness that she suffered like that.

On the bed, Julie and I said little as I smelled her hair, rubbed her back and told her how much I’d miss her. Born five years apart (I am the elder), we were a pair of matching bookends — from our teenage years, when we’d go to our respective queer bars, to later in life, when each of us faced a cancer diagnosis. I asked if we had anything unresolved between us, as my therapist had suggested. “Nope,” my sister replied. “I don’t want to leave you all, but it’s time.”

A few hours later, she joined the rest of the family for our last supper together. I don’t remember much of the evening; either I failed to capture that memory or I’ve erased it, too painful to keep. I do recall Julie had one bite of a friend’s homemade Key lime pie. Apparently, a sweet tooth never dies, even if you are about to. Before bed, Julie hugged and kissed each of us: her wife and two daughters; my brother, Jay, and his wife; and me. Tucked in under the covers, I pulled out my iPhone to continue a ritual I’d recently begun with my siblings. From the guest couch, I texted:

Steven: Good night, sibs
Jay: Good night 😘
Julie: Good night to the best big brothers in the whole world 💚💙❤️
Jay: Love you to the moon and back!!
Steven: And to the bestest sister ever

Two months earlier, I joined a conversation my sister and her wife were having with a social worker, a new member of their hospice care team. They kept discussing “the MAID,” which I soon came to understand is the acronym for the New Jersey law referred to as Medical Aid in Dying. It allows New Jersey residents with terminal illnesses to choose to end their lives by taking a cocktail of life-ending medications.

This important piece of legislation was enacted in 2019, and as of last year, 186 people had chosen to die this way. (That’s a very small percentage of annual New Jersey deaths.) Julie, a lawyer, had done her research and had told me that the Garden State is one of only 11 jurisdictions (10 states and the District of Columbia) that allow medical aid in dying, also known as death with dignity and end-of-life options.

If you live in one of the other 40 states, you must wait for the Grim Reaper to pay a visit, no matter how much pain and suffering that entails. Nor can you pack up and move to New Jersey (or most other states where MAID is legal), because you must be a resident to qualify, which, at best, can take time. Time is usually not readily on hand for those who are terminally ill.

In late 2017, Julie learned she had advanced ovarian cancer. Since then, she’d endured one nine-hour surgery, six rounds of chemo, three recurrences and two clinical trials. “Enough,” my sister told her oncologist a few days before her 61st birthday, in April of this year. “I’ve decided to end treatment,” she added, to make sure he understood, and then sang, off-key, the famous Carol Burnett song, “I’m So Glad We Had This Time Together.” She asked, “How much time do I have left?” His reply: “Two or three months, at the most.”

My sister understood from Day 1 that she’d most likely die from this cancer, which, when advanced, has a mortality rate of 80 to 85 percent, according to Dr. Jason Konner, a gynecologic oncologist in New Jersey. One by one, women she had befriended in an online support group died, their last weeks and days often made awful by what Julie called “Hail Mary” treatments — drugs, many with harsh side effects, often used out of desperation or denial.

“I do not want to die like that,” my sister told me repeatedly. “This is about me taking control of my life.” She added, “I want you to write about this after I’m gone, because not enough people know about this option, even when it’s available.”

She was right. Few of our friends knew of this option, even those living in New Jersey. Kim Callinan, the chief executive of Compassion and Choices, a nonprofit that led the effort to pass New Jersey’s MAID legislation, told me these “laws are meaningless if patients are not aware they exist, which is why we focus on public education during the first five to 10 years after a jurisdiction has authorized medical aid in dying.”

The doctor’s sobering “two to three months” estimate easily qualified Julie for MAID. But that was about all that was straightforward. To hear opponents of the right to die talk, you’d think it was easy to obtain the life-ending medications. New Jersey and most other states where MAID is legal require a patient to be a mentally capable adult resident diagnosed as being terminally ill by two doctors. Julie had to request the drugs twice verbally, with a minimum of 15 days in between each request. At the time of the second ask, she had to be given the opportunity to rescind her directive. The law also required her to sign a written request in the presence of two witnesses, one of whom could have no financial interest in her death.

Julie persisted.

In recent months, lawmakers in at least nine other states have introduced MAID legislation, but opponents remain adamant. As recently as last year, Pope Francis condemned assisted suicide, saying, “We must accompany death, not provoke death or help any kind of suicide.” Other objections come from advocacy groups like the National Council on Disability, an independent federal agency that advises on government policies affecting people with disabilities; the council fears the potential exploitation of vulnerable people, especially if they feel they are a burden to family members. Julie was well aware of these concerns, but she believed MAID’s built-in safeguards prevented such exploitation.

***

With the MAID request approved, Maddy, Julie’s spouse of 35 years, picked up the prescription from a local pharmacy. The price: $900, which is not covered by Medicare, the Department of Veterans Affairs or many private insurance plans. A study published in The Journal of the American Geriatrics Society last year found that 96 percent of people who died by medical aid in dying were white and 72 percent had at least some college education. “The reality is that communities of color, for a wide variety of reasons, also are more likely to utilize aggressive care and less likely to use other end-of-life care options, such as hospice and palliative care,” explained Ms. Callinan. People without the resources to pursue MAID may be forced to make a different choice: suffer through a painful death or take matters into their own hands. “Be sure to include these statistics when you write about this,” my sister directed me.

With her pain unabated, my sister’s next task was to choose the day she would die. Our entire family supported Julie’s decision; still, we did not want to say goodbye. We made silly excuses for why certain days were inconvenient. “I have an invitation to my friends’ 35th anniversary in Provincetown the third week of June,” I blurted out. One of Julie’s daughters said, “I’ve committed to a writing workshop starting July 4.” Julie’s best friend, Jenny, had plans to travel, too. “Please don’t let Julie schedule it before the 25th!” Jenny texted me.

Julie chose Friday, June 30. She gave us four days’ notice, which allowed for time to complete her obituary, finalize the guest list for her memorial and create the program. The day before, my brother handed me a draft of the program for one last copy edit. I’d expected her date of death to be left blank; after all, we could fill it in later. Or maybe I still hoped for a miracle that would make all this preparation unnecessary. But right there, on the program’s cover, I saw dates for the first and last days of her life, her death foretold.

Julie never wavered in her decision, which proved a godsend for the rest of us. That final morning, my sister got up early to write letters to her three girls: her wife and their two daughters. Then she called the insurance company to argue with them about a payment, trying to take one thing off Maddy’s list of to-dos. I heard her say, “I’m doing MAID at noon. I need you to get back to me before then.” That is — was — my sister.

With the sun creeping toward its zenith, Julie took one last walk in her garden, blossoming with hydrangeas, zinnias and some faded irises. Then we twice watched the video Jay had put together for her service — a lifetime of memories condensed into 14 minutes. We took one last family photo, the bookend to hundreds of others, most of them with our Julie in the center. I was confounded by how to pose — a big smile, a little smile, a frown? In looking at the photo now, I think my face looked blank, which was pretty much how I felt.

Before heading upstairs with her wife and daughters, Julie cried for a moment and said softly, “I don’t want to leave you.” A few minutes later, my sister made herself comfortable on the Ultrasuede sofa in her office. Maddy prepared the medications, and after they all recited the Serenity Prayer, my sister gulped it in one shot. Within minutes, she was unconscious, in a liminal state between life and death. Maddy gently laid her wife down on the sofa and then asked Jay and me to come upstairs. I stroked her face; I whispered to her how courageous she was to have made this decision. (After all, it’s commonly said that we lose our sense of hearing last.)

I also vowed to keep my promise to tell this story, a brother’s last act of devotion to a sister he loved beyond all measure.

Complete Article HERE!

Death by Doctor May Soon Be Available for the Mentally Ill in Canada

— The country is divided over a law that would allow patients suffering from mental health illnesses to apply for assisted death.

Jason French has undergone years of treatment for his depression without any improvement. He says he wants access to assisted death so he can die on his own terms.

By Vjosa Isai

Canada already has one of the most liberal assisted death laws in the world, offering the practice to terminally and chronically ill Canadians.

But under a law scheduled to take effect in March assisted dying would also become accessible to people whose only medical condition is mental illness, making Canada one of about half a dozen countries to permit the procedure for that category of people.

That move has divided Canadians, some of whom view it as a sign that the country’s public health care system is not offering adequate psychiatric care, which is notoriously underfunded and in high demand.

The government of Prime Minister Justin Trudeau, which has been criticized for its rollout of the policy, has defended its actions by pointing to a 2019 court decision in Quebec that officials say mandates the expansion.

Members of the Conservative Party have accused the government of promoting a “culture of death.” There has also been opposition from politicians on the left who would like the government to focus its health policy on expanding mental health care.

Jason French is among those building a case for why a doctor should help him die.

With copies of a document describing his troubled mental health history tucked in his backpack, he attended an event in Toronto to lobby for making assisted dying available to people like him.

He has severe depression and has tried twice to end his own life, he said.

“My goal from the start was to get better,” said Mr. French, of Toronto, who agreed to share his name, but not his age because so many in his life don’t know about his illness. “Unfortunately, I’m resistant to all these treatments and the bottom line is, I can’t keep suffering. I can’t keep living my life like this.”

But Dr. John Maher, a psychiatrist in Barrie, Ontario, who specializes in treating complex cases that often take years to improve said he was concerned that hopeless patients will opt for assisted death instead.

“I’m trying to keep my patients alive,” he said. “What does it mean for the role of the physician, as healer, as bringer of hope, to be offering death? And what does it mean in practice?”

Canada’s existing assisted death law applies only to people who are terminally ill or living with physical disabilities or chronic, incurable conditions. The country’s Supreme Court decriminalized assisted death in 2015 and ruled that forcing Canadians to cope with intolerable suffering infringes on fundamental rights to liberty and security.

About 13,200 Canadians had an assisted death last year, a 31 percent increase over 2021 according to a report by the federal health ministry. Of those, 463 people, or 3.5 percent, were not terminally ill, but had other medical conditions. Patients who are approved have the option to end their lives using lethal drugs administered by a physician or nurse, or by taking drugs prescribed to them.

There is still uncertainty and debate over whether assisted death will become available to the mentally ill early next year as scheduled. Amid concerns over how to implement it, Parliament has delayed putting it into place for the past three years and could delay it again.

Clinical guidelines were released to address those concerns last March, but some people involved in providing mental health care say they are insufficient.

A person wearing a dark jacket and an orange top stands near a body of water.
Lisa Marr, a paramedic diagnosed with post-traumatic stress disorder, said the wait for the assisted dying law to take effect has been grueling.

But supporters say denying mentally ill people access to the same humane option to end their suffering amounts to discrimination.

“I have a very deep empathy for patients who suffer deeply,” said Dr. Alexandra McPherson, a psychiatry professor at the University of Alberta and assisted death provider. She said she treats a small number of patients “with severe disabling mental health disorders who suffer equally to the patients that I see in cancer care.”

Lisa Marr, a former paramedic diagnosed with post-traumatic stress disorder who lives in Nova Scotia, said she was desperate to take advantage of the new law. She has bipolar disorder, depression and excoriation disorder, or skin picking, from anxiety and has made, she estimates, 15 attempts on her life but “always managed to pull myself out.”

A person covered by a blanket sits on a couch. A cat is nearby.
Ms. Marr at home with her support cat, Fig. “All the medications I take just barely keep me together,” she said.

Canada amended its criminal code to legalize assisted death for the terminally ill in 2016, and in 2021, responding to the court ruling in Quebec, the country loosened the law to add other severely ill people experiencing “grievous and irremediable” conditions.

Eligible patients must wait 90 days before receiving an assisted death and be approved based on the assessments of two independent physicians. One of the assessors must be a specialist in the patient’s illness or have consulted with a specialist.

A panel of experts and a special parliamentary committee have worked to address concerns from the public and medical community, by laying out practice standards and advising clinicians and regulators.

The government has also funded the development of a training program for physicians and nurses who assess patients for assisted death.

“The work has been done,” Dr. Mona Gupta, the chair of a government-appointed expert panel — who is a psychiatrist and bioethics researcher at the University of Montreal — told a special parliamentary committee in November. “We are ready.”

Anyone in Canada seeking assisted death must be deemed by the physicians or nurse practitioners who assess them as not impulsive and not suicidal, and those who are mentally ill would need to be evaluated to show that their condition is “irremediable.”

But even some psychiatrists worry that they may not always be able to determine if someone seeking an assisted death could actually get better or not.

“The research that we have shows psychiatrists are no better at identifying who’s not going to get better,” said Dr. Maher, the psychiatrist in Ontario. “The challenge for us is it’s not a short term process. When people have been sick for years, healing takes years.”

The Centre for Addiction and Mental Health, Canada’s largest teaching hospital for psychiatric care and research, has said that clinicians need more guidance to assist them in assessing who is acutely suicidal or capable of making a rational choice to end their lives.

“We’ve been clear that we have concerns about expansion at this time,” said Dr. Sanjeev Sockalingam, chief medical officer at the center, which has convened several professional groups to assist physicians in preparing for March.

A man in a suit leans against a pole looking out the window.
Dr. Sanjeev Sockalingam is the chief medical officer at the Centre for Addiction and Mental Health, Canada’s largest teaching hospital for psychiatric care and research.

Ms. Marr, the paramedic, said the wait for the law to take effect has been grueling. She takes eight psychiatric drugs every day. “All the medications I take just barely keep me together,” said Ms. Marr, who is on disability leave and spends most days in her room, leaving home only for therapy.

Her father had an assisted death after being diagnosed with prostate cancer, and her mother died shortly after, all while she was juggling her job as a paramedic.

“Then, my mental health started to rear its ugly head,” she said.

The uncertainty over whether the mentally ill would be allowed assisted death motivated Mr. French to leave his home after work, something his depression rarely allows him, to attend a screening of a documentary financed by Dying With Dignity, a charity promoting assisted death.

He went with several copies of a five-page document he created explaining his case, hoping to give it to medical experts at the screening.

Death doesn’t scare him.

“My biggest fear is surviving,” he said.

He said he’s not suicidal. But, he added, “I don’t want to have to die terrified and alone, and have someone find me somewhere. I want to do it with a doctor. I want to die within a few minutes, peacefully.”

A person in a hooded sits on a bench facing a playground.
“My biggest fear is surviving,” Mr. French said.

Both Canada and the United States have a three-digit suicide and crisis hotline: 988. If you are having thoughts of suicide, call or text 988 and visit 988.ca (Canada) or 988lifeline.org (United States) for a list of additional resources. This service offers bilingual crisis support in each country, 24 hours a day, seven days a week.

Complete Article HERE!

‘What is it about life that’s sacred?’

— Harriet Walter backs change in law on assisted dying

Harriet Walter at the 2023 Bafta Television Awards at the Royal Festival Hall in London on 14 May, 2023.

The actor, who has played characters on both sides of the debate, says the UK needs a conversation about euthanasia and assisted suicide

By

About a decade ago, Dame Harriet Walter, the 73-year-old star of stage and screen, decided to make a living will. The will, also known as an advance decision, informs family, carers and doctors of a person’s wish to refuse specific treatments should they become too ill to communicate those choices. (It stops short of requesting help with end of life; euthanasia and assisted suicide remain illegal in the UK.) But, when it came to actually completing the details of her living will, Walter always found something else to do.

“I had the will sitting in my filing cabinet for about three or four years before I got round to it,” says Walter, who made her name in the theatre but has recently had eye-catching roles in the TV shows Succession, Killing Eve and Ted Lasso. “It’s not something you really want to look at, it’s not something you want to think about. But it will be good to know that there’s something in place that you could use when the time comes. Then you close that filing cabinet.”

Walter’s reluctance is common. It came up earlier this month in the Observer in Rachael Stirling’s heartbreaking account of caring for her mother, Diana Rigg, in the final months before her death from cancer in September 2020. “As a nation we never talk about dying, or what it really looks like,” Stirling wrote, “even though it is one thing we’ve all got in the post.”

Stirling’s article has prompted renewed calls to change the law on assisted dying. The debate was picked up by the 83-year-old TV presenter Esther Rantzen, who is undergoing treatment for stage-four lung cancer and has joined the Swiss clinic Dignitas. Rantzen would like to see a free vote in parliament on assisted dying, telling the BBC it is “important that the law catches up with what the country wants”.

Walter, who has not previously spoken on the subject, first started thinking about assisted dying when she made the 2009 BBC film A Short Stay in Switzerland. The drama was based on the true story of Anne Turner (played by Julie Walters), a British doctor who had an incurable brain disease, progressive supranuclear palsy, and in 2006 became the 42nd Briton to end their life with the help of Dignitas. Walter played Clare, a fictional friend of Turner; her character vehemently opposed Turner’s decision because of her religious conviction that life is sacred.

“I found it really difficult to get behind that as an actress,” admits Walter. “And it did make me think: what is it that’s sacred about life? Does it continue to be sacred when it’s absolutely agonising and hopeless? And you’re in the last six months of your life anyway? You are just hurrying on something that’s going to happen anyway.”

Walter with Ralph Fiennes in Ivanov at the Almeida Theatre, London, in 1997.
Walter with Ralph Fiennes in Ivanov at the Almeida Theatre, London, in 1997.

Walter returned to assisted dying in the 2020 Sky Atlantic satirical drama The End. This time, though, her character was on the other side of the fence: a passionate supporter of the right to die. “I hasten to add that it’s easy to act something, it is very different when you come to face it in real life,” says Walter. “But one of the things that came out of these dramas I was involved in is that knowing the possibility is there doesn’t necessarily mean you’re going to use it. It’s just a comfort to know that you could. And it’s long overdue to have a proper conversation about this, a national conversation.”

The last time there was a vote in the Commons on assisted dying was in 2015, when MPs overwhelmingly rejected a change in the law by 330 votes to 118. More recent polls, though, seem to suggest a shift in public attitudes: According to an Ipsos Mori poll in July, 65% of people in the UK believe it should become legal for a doctor to assist an adult of sound mind with less than six months to live to voluntarily end their own life, subject to high court confirmation. Advocates point to demographic changes, with a quarter of the UK’s population estimated to be 65 years or over by 2050. “I feel that the legal and political system needs to catch up with the public mood,” says Walter, “because people are increasingly aware of, or have connections with, people who are in this position.”

Eventually Walter, who lives with her husband, the American actor Guy Paul, in west London, couldn’t put off filling in her living will any longer. “There’s a certain point at which I wouldn’t want to be revived,” she says. “And I just said that if I could no longer communicate then I wouldn’t want to go on. Loss of speech yes, but blinking or any form of communication. If I couldn’t make my feelings known, I wouldn’t want to live.”

It wasn’t easy, Walter recalls, but she feels a sense of relief that she faced it down. “We’ve got to think about it, because it could happen to any of us,” she reasons. “And if we saw that there was a law that helped, I think people would mostly feel less frightened in the end rather than more.”

Complete Article HERE!

Third of patients given lethal drugs under right-to-die laws ‘do not take them’

By Michael Searles

More than a third of suicidal patients who are prescribed lethal drugs under right-to-die laws do not take them, data show.

Just 1,905 of the 2,895 people prescribed assisted dying pills in Oregon, US, between 1998 and 2021 took them, according to the state’s public health data.

The figures are mirrored in the neighbouring state of California, where in 2021, 286 of the 772 people prescribed a fatal dose ultimately decided against using it.

Even in Canada, where medically-assisted deaths are the most pervasive and accepted in the world, around 13,000 people of the 15,500 with lethal drug prescriptions in 2022 used them – and around 300 people changed their mind.

Experts consider the Oregon model, whereby a doctor specialising in end-of-life care prescribes a deadly drug to be taken at home by a patient, as the best option for Britain, should MPs vote for a change in the law.

They said having the autonomy to take a lethal drug to end one’s own life is like an “insurance policy”, if a terminal illness becomes “intolerable”.

Oregon was one of the first places in the world, and the first state in the US, to legalise assisted dying under a Death with Dignity Act in 1997.

Inquiry into assisted dying

It is also where MPs from the cross-party health select committee visited as part of their inquiry into assisted dying and suicide earlier this year in order to understand more about the practice and what it may look like in the UK. A full report is due in the new year.

Calls for a free vote on the issue have intensified this week, with Dame Esther Rantzen revealing she was considering using Dignitas, in Switzerland, following her diagnosis with lung cancer.

Sir Keir Starmer, the leader of the Labour Party, voted for a change to the law in a defeated motion in 2015. This week he restated that there were “grounds for changing the law” but it should be through a free vote because of the “divided and strong views”.

An expert working group from the University of Essex, made up of two consultants in palliative medicine, two lawyers, and two philosophy professors, said that nowhere that had legalised the practice had voted to go back on it.

Most notably, a 2011 referendum in Zurich, Switzerland, where assisted dying has been legal since 1941 and the home of “suicide tourism” clinics like Dignitas, voted overwhelming to reject proposals to overturn the law.

Around 85 per cent of 278,000 voters opposed the ban on assisted suicide and 78 per cent rejected a motion to outlaw it for foreigners.

About 200 people travel to Zurich to use its assisted suicide services each year – an estimated 350 Brits have taken their lives there.

Prof Wayne Martin, director of the Autonomy Project and professor of philosophy at the University of Essex, said the law had never been repealed anywhere because “there is no political force sufficiently strong to reverse the tide”.

“If anything the tendency is for access to assisted dying to be progressively expanded over time,” he said.

‘Time and place of their own choosing’

“Public records in Oregon consistently show that many of those prescriptions are never actually used,” he said.

Prof Martin added that the system used in Oregon was preferred because it lets people take the lethal dose at a “time and place of their own choosing”.

“Public records in Oregon consistently show that many of those prescriptions are never actually used,” he said. “Many Oregonians who apply for assistance in dying do not actually want assistance in dying. What they seek from that prescription is an insurance policy that will protect them from being trapped in a life they find intolerable. What they want is autonomy.”

Around 200 million people have access to assisted dying around the world, and this number is only growing.

It is an option for the terminally ill in nine US states, Canada, eight European countries, and all Australian territories except the Northern Territory and the Australian Capital Territory.

It has in the last couple of years been legalised to some extent in Spain, Portugal, Germany and New Zealand, and is being considered in France.

The drug prescribed is usually a short-acting barbiturate, which is a type of sedative taken at a high dose so that it completely suppresses the central nervous system, inducing death.

Complete Article HERE!

Assisted dying around the world

— Where and when it is allowed

Esther Rantzen has joined Dignitas, a Swiss organisation that provides physician-assisted suicide.

In light of UK broadcaster Esther Rantzen’s revelation that she has considered assisted dying, we look at the policies of other countries

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The broadcaster and Silver Line founder Esther Rantzen has said she has considered the option of assisted dying if her ongoing lung cancer treatment does not improve her condition, adding that she had joined the Swiss organisation Dignitas, which offers physician-assisted suicide. Here we take a look at the policies of other countries.

Canada

Doctors are permitted to prescribe drugs for self-administration and they have been able to administer them since 2021 to those who ask to die and have a grievous and irremediable medical condition. A ban on assisted dying was liberalised after a 2015 supreme court ruling that prohibiting a physician’s assistance in terminating life infringed on the constitutional right to life, liberty and the security of the person who required such help.

Netherlands

The Termination of Life on Request and Assisted Suicide Act 2001 permits doctors to prescribe drugs for self-administration and to administer where it can be shown that the individual concerned is experiencing unbearable suffering and is making an informed choice to die. The individual involved must be at least 12 years old and parental consent is required for those aged 12-16.
Switzerland

The Swiss Criminal Code of 1942 permitted adults to assist in another’s suicide as long as the motive for doing so was not “selfish”. Doctors are permitted to prescribe drugs for self-administration and to administer. Organisations providing assisted suicide have been providing services under certain regulations since 1985. Assisted suicide is lawful irrespective of the condition of the person who requests it.

Germany

Lawmakers are struggling to agree on new legislation after a 2020 federal constitutional court ruling that a ban on assisted suicide violated the rights of citizens to determine the circumstances of their death by restricting their ability to seek assistance from a third party.

US

Medically assisted dying for adults is legal in 11 of the 50 states. In Washington DC, the Death With Dignity Act 2016 permits doctors to prescribe drugs for self-administration. Legislation was passed this year to allow more types of healthcare providers in the district to sign off on requests for a medically assisted death, and allow the drugs to be mailed to patients instead of collected in person.

Australia

Thousands of heart-shaped cards in shades of blue and yellow, each with a message from someone who supports voluntary assisted dying laws, lay behind the lawns at Parliament House in Sydney, Australia
The charity Dying with Dignity NSW has planted more than 3,000 hearts, each bearing a message from someone who supports voluntary assisted dying laws, behind the lawns at Parliament House in Sydney, Australia.

In Victoria, Western Australia, Tasmania, South Australia, Queensland, and New South Wales, doctors are able to prescribe drugs to adults for self-administration and, in cases where an individual is physically unable to self-administer, to administer the drugs. Assisted dying remains illegal in the Northern Territory and the Australian Capital Territory (ACT). A bill to legalise voluntary assisted dying in the ACT was introduced to the legislative assembly in October.

Belgium

For the past 20 years under Belgian law, patients have qualified for medically assisted dying if they have an incurable illness and experience constant and intolerable suffering that cannot be alleviated. Unlike in many other countries with liberal legal systems, euthanasia for people who are not terminally ill, such as those with psychiatric disorders or dementia, is also legal. Since 2014 there have been no age restrictions; parental consent is required for under-18s.

France

This year, President Emmanuel Macron instructed the government to look at whether euthanasia or assisted dying should be permitted in France. The law, in effect since 2016, allows medical personnel to place someone close to death and in intolerable pain under permanent sedation but stops short of authorising them to administer or supply a lethal substance.

Japan

According to Japan’s penal code, solicitation of suicide (the act of intentionally killing oneself), assistance in suicide, commissioned murder and consensual homicide are illegal. No laws or official guidelines govern voluntary assisted dying.

Complete Article HERE!