Treatment Concerns – Definitions / Living Wills / Palliative Care / Terminal or Excessive Sedation / Organ Donation / DCD or NHBD / Hospice / POLST / DNR

DCD – Donors after Circulatory Death
NHBD – Non Heart Beating Donation
POLST – Physician Orders for Life Sustaining Treatment
DNR – Do Not Resuscitate

Frisco Hospice Owner Urged Nurses to Overdose Patients So They Would Die Quicker, FBI Says

Comment: Note this quote from the article: “‘Aggregator cap’. Health care providers do not necessarily make more money for longer hospice stays. That’s because hospices are subject to an ‘aggregator cap’, which limits Medicare and Medicaid payments based on the yearly average hospice stay, the FBI said. If patients live longer than that, the provider can be forced to pay back part of their payments to the government. ‘Hence, hospice providers have an incentive to enroll patients whose hospice stays will be short relative to the cap’, an agent wrote in the affidavit.” [N. Valko RN, 17 May 2016] The owner of a Frisco medical company regularly directed nurses to overdose hospice patients with drugs such as morphine to speed up their deaths and maximize profits and sent text messages like, “You need to make this patient go bye-bye,” an FBI agent wrote in an affidavit for a search warrant obtained by NBC 5. The executive, Brad Harris, founded the company, Novus Health Care Services Inc., in July 2012, according to state records. Novus’ office is on Dallas Parkway in Frisco. No charges have been filed against Novus or Harris. Harris, 34, did not return messages left with a receptionist and at his Frisco home. Harris, an accountant, told a nurse to overdose three patients and directed another employee to increase a patient’s medication to four times the maximum allowed, the FBI said. In the first case, the employee refused to follow the alleged instructions, the agent wrote in the affidavit. The document does not say whether the other three patients were actually harmed. Harris also told other health...

Journal of Palliative Medicine: ‘Clinical Criteria for Physician Aid in Dying’ (aka: physician-assisted suicide)

[Comment: Unfortunately, some groups and individuals against physician-assisted suicide still cite hospice as the simple solution to physician-assisted suicide while some of us who have experience in hospice have warned for years about the progression of corrupting changes in hospice philosophy and practice promoted by well-funded groups like Compassion and Choices and individuals like George Soros. For example, note the first line of the article’s abstract: “More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID.”     How many people are aware that Dr. Quill first became famous in 1991 when he wrote a medical journal article “”Death and Dignity — A Case of Individualized Decision Making” before becoming a plaintiff in the 1997 US Supreme Court case Vacco v. Quill on the constitutionality of physician-assisted suicide. He became president of the American Academy of Hospice and Palliative Medicine from 2012-2013 and now the Academy has a position on physician-assisted suicide described as “studied neutrality”. Currently, we see our fears becoming reality. With the crucial help of the mainstream media, the public, the legal system and even medical organizations are being seduced into accepting that the so-called “right to die” must now include the “right” to be killed with medical assistance. It is not a coincidence that over 90% of assisted suicides victims in Oregon and Washington were enrolled in hospice. With California legalizing assisted suicide, I fear that it is only a matter of time before we see the US Supreme Court given the opportunity to follow...

Amending Medicare: Concerns About the Proposed Advance Care Planning AspectsRule

Comments on the Proposed Rule to Amend Various Aspects of Medicare re: Reimbursing Medicare Providers for Advance Care Planning Counseling Sessions Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue SW Washington, DC 20201 Attn: CMS-1625-P …we respectfully submit the following comments on the Proposed Rule to amend various aspects of the Medicare program. 80 Fed. Reg. 39840 (July 10, 2015). Our comments relate specifically to the proposal to reimburse Medicare providers for Advance Care Planning counseling sessions. See id.at 39882-83. Background [We have] no objection to encouraging patients to consider treatment decisions that may have to be made in the future, in light of their personal values and medical condition, in case they become unable to communicate their wishes. On the contrary, [there is] a long and rich tradition on the parameters for such decision making, providing concepts and distinctions that have long played an important role in secular medical ethics as well. We hold that each human life, at every stage and in every condition, has innate dignity, and that acts or omissions directly intended to take an innocent life are never justified. We also recognize that the moral obligation to preserve one’s life has limits, particularly when the means offered for supporting life may be useless or impose burdens that are disproportionate to their benefits.1. Accordingly, … and other organizations have actively participated in the nationwide debate on end-of-life decision making and on the pros and cons of various “advance directives.” Many state … conferences have even provided their own advance directives that conform...

Worse Than Fiction: Euthanasia on the Rise (2015)

[Comment: The idea of using assisted suicide/euthanasia victims for organ harvesting is not a new one. It was brought up in 1998 by Jack Kevorkian when he offered the kidneys of one of his assisted suicide victims to organ transplantation organizations. Note this quote: “In an interview with the Tribune before the most recent controversy, Kevorkian promoted the transplant idea and his “obitorium” proposal for a national chain of hospital-type settings where consenting assisted suicides and prisoners awaiting execution would agree to medical tests and removal of organs while alive and under anesthesia.”  (Source: “Kevorkian Controversy Sheds Light On A Problem-Removal Of Suicide’s Kidneys Shows National Need For Organ Donors” by Ellen Warren. Chicago Tribune. June 10, 1998, Online at http://articles.chicagotribune.com/1998-06-10/news/9806100226_1_organ-donors-transplant-experts-organ-procurement ) Despite this and the fact that many of his victims were found to have no terminal illness , Kevorkian became a “hero” to many, culminating in an award-winning 2010 movie starring Al Pacino called “You Don’t Know Jack” and people opposing assisted suicide/euthanasia ultimately called extremists. Unfortunately, when feelings and bias rather than facts or principles are allowed to drive ethics, the unthinkable soon becomes inevitable. N. Valko RN] If you believe in the sacredness of human life from conception to natural death, it’s time to watch and pray for those at the end of life, not just the beginning. In his novel, Never Let Me Go, Kazuo Ishiguro tells the story of three young people—Kathy, Ruth, and Tommy—who are repeatedly told, with their classmates at boarding school, that they’re special. But it’s not until they leave school that they learn why: They are clones whose sole...

Oregon’s End of Life Orders Document: POLST (2006)

POLST is being proposed in a number of states across the US. In North Carolina, the form has undergone pilot tests, and the North Carolina Medical Society is considering its adoption. The purpose of this letter is to: Review the history of POLST on a national level Update you on the status of North Carolina’s version of POLST   POLST: the ultimate pink slip POLST is an end-of-life orders document. It is a form — along with a coaching process — to convert advance directives into physician’s orders as a patient’s condition changes. POLST was devised in Oregon in the 1990s under grants from the Greenwall Foundation and Cummings Foundation,[1] frequent sponsors of right-to-die organizations. The POLST Task Force emphasizes that the POLST form is not an advance directive, which means that in Oregon — and many other states — it is not bound by state advance directive statutes which often require the patient’s signature.[2] Assisted-suicide proponent Ann Jackson testified before a Senate subcommittee this past May on the success of the Oregon Death with Dignity Act. In the course of her testimony, she said that one of Oregon’s successes was POLST. According to Jackson, “respect for end-of-life wishes is virtually 100% when POLST…is in place.”[3] No wonder there is 100% compliance with POLST. POLST forms are typically written as the patient’s condition changes; frequently they are written when the patient and/or his agent are under duress. So, for example, as a patient is going into a crisis, an EMT or nurse or respiratory therapist might counsel the patient — or surrogate — on next steps with regard to...

Terminal Withdrawal of Life-Sustaining Supplemental Oxygen (2006)

First 150 words of the full text: An influential report released in 1983 defined life-sustaining therapies as “all health care interventions that have the effect of increasing the life span of the patient.”1 This definition is highly inclusive: aspirin for stable coronary artery disease, intravenous antibiotics for osteomyelitis, and mechanical ventilation for respiratory failure all qualify. However, when considering withholding or withdrawing life-sustaining interventions, clinicians commonly refer to a more discrete group of therapies intended to forestall impending death by augmenting or replacing a vital bodily function. A hallmark of life-sustaining therapies, therefore, is that withholding or withdrawing them leads to physiologic decompensation foreseeably to cardiac arrest. Supplemental oxygen has not commonly been considered a life-sustaining therapy. Yet it clearly serves this purpose for spontaneously breathing patients in whom pulmonary gas exchange is so impaired that the needs of vital organs cannot be met with ambient air… [JAMA. 2006;296:1397-1400. Terminal Withdrawal of Life-Sustaining Supplemental Oxygen, Scott D. Halpern, MD, PhD, MBioethics; John Hansen-Flaschen, MD; Vol. 296 No. 11, 20Sept06, http://jama.ama-assn.org/cgi/content/extract/296/11/1397?etoc; N Valko RN] [Comment: Although I can’t get the entire article here, it’s truly outrageous to consider withdrawing such a simple comfort treatment ALREADY in use when, apparently, the only possible reason is to hasten death. Unfortunately, I’ve seen this done with the so-called “terminal weans” involving people who don’t die fast enough after being removed from ventilators and I’ve seen people gasping for air even though apparently unconscious. I protested vigorously when this first happened and fortunately, this stopped in my hospital-for the time being....

Stop Harvesting Organs after ‘Cardiac Death,’ Say MDs (2010)

A group of doctors have called on the medical community to cease harvesting organs from patients whose hearts have stopped pulsating, saying that doctors are misleading families to believe that the patient has died when in fact their loved one is still alive. The story was featured in 2010 on the cover of Canada’s National Post. “A longstanding tenet of ethical organ donation [is] that the nonliving donor must be irreversibly dead at the time of donation,” explain the eight paediatric intensive care specialists, writing in Pediatric Critical Care Medicine. The doctors say that the public’s “underlying assumption” when they agree to donate organs is that “they are giving permission to have their organs removed after they are dead.” But the authors observe that “death” has been redefined in the last few decades to meet the demand for more organs. They say organs were originally taken from “cadaveric donors who died in the conventional way, irreversibly losing all electrical and mechanical activity from the heart (circulation) and all brain function, despite medical efforts to save them.” But “this method of organ procurement created a problem for organ transplantation.” “If the patient died in the conventional way then, at the time of irreversibility, so did most organs.” The notion of “brain death” was created in 1981 in order to harvest more organs, they say. Then in 1991 the Pittsburgh Protocol was developed to allow doctors to harvest the organs of adults after a person’s heart has stopped for a certain period. The Protocol involves removing the person from life support for 30 to 60 minutes. If the patient’s heart continues...

Study Shows Patients in Vegetative States Can Learn, Predicting Recovery (2009)

Brain-damaged patients who appear to have lost signs of conscious awareness might still be able to create new memories — showing signs of new neural networks and potential for partial recovery, a new study shows. In patients who have survived severe brain damage, judging the level of actual awareness has proved a difficult process. And the prognosis can sometimes mean the difference between life and death. According to a Scientific American report, new research suggests that some vegetative patients are capable of simple learning — a sign of consciousness in many who had failed other traditional cognitive tests. The findings are presented in a paper today in Nature Neuroscience. Mariano Sigman, senior study author and director of the Integrative Neuroscience Laboratory at the University of Buenos Aires, said researchers wanted to “have an objective way of knowing whether the other person has consciousness or not.” The neuroimaging work had surprised doctors by showing that some vegetative patients, when asked to imagine performing physical tasks such as playing tennis, still had activity in premotor areas. In other patients, verbal cues sparked language sectors. Recent research has revealed that about 40 percent of vegetative state diagnoses is incorrect — which could have an impact on cases such as the painful starvation and dehydration death of Terri Schiavo. [26Sept09, Washington, DC, www.LifeNews.com,...

British Doctors Practicing “Slow” Euthanasia through Deep Sedation (2009)

Second Story: Sedation with Dehydration used as “Slow Euthanasia” UK Survey Reveals “Slow euthanasia by deep sedation” is a current reality in the British health care system, and not just a journalistic myth, a survey of UK doctors has revealed. The study found that continuous deep sedation (CDS) was more frequently requested by patients or relatives seeking a “hastened death” and was associated “with a greater incidence of other end-of-life decisions containing some intent to end life by the doctor”. Under existing medical care protocols in the UK, patients who are designated as dying, can have food and hydration withdrawn until they die of dehydration, even when continued hydration can still be of medical benefit. “Doctors supporting legalization of euthanasia or physician-assisted suicide, or who were nonreligious, were more likely to report using CDS,” the researchers found. Published in the Journal of Pain and Symptom Management, the survey also said that 18.7 per cent of the 2,923 doctors polled used CDS to keep patients unconscious for long periods to control pain, most often for those who were dying of cancer. Ethicists say that this use of CDS is legitimate if it is not in conjunction with premature withdrawal of hydration. The study also noted that “specialists in care of the elderly were least likely to report the use of CDS”. Critics of the Liverpool Care Pathway (LCP), a widely used protocol for treating the terminally ill, have said that it is a “pathway to death” that presumes the intention to end the life of the patient. In September, after the publication of a letter by physicians warning that the...

19-Year-Old Recovers as Doctors Start to Harvest Her Organs (2012)

The world of organ donation in Denmark was in turmoil. A documentary was aired which showed family members reacting in anguish to the news that their 19-year-old daughter was brain dead after a car accident, agreeing to donate her organs and allowing doctors to turn off her respirator. About 1.7 million viewers tuned in to the heart-rending drama. But Carina Melchior did not die after her respirator was removed. She is now undergoing rehabilitation and may make a full recovery. About 500 people immediately removed their names from Denmark’s organ donor register. http://www.lifenews.com/2012/11/20/19-year-old-recovers-as-doctors-start-to-harvest-her-organs/ [Comment: Another article on the subject said that after the documentary was shown, 500 people tore up their organ donor cards. N. Valko RN http://www.medicaldaily.com/articles/12771/20121018/danish-teen-wakes-dead-doctors-prepare-harvest.htm...

Ethical Questions Abound as Organ ‘Donation’ Becomes More Aggressive

Organ Donation Doctors Push Exploiting Poor College Students by Paying for Kidney Donations The drive to turn living human bodies of the poor and destitute into natural resources for the well off continues. http://www.lifenews.com/2013/11/01/doctors-push-exploiting-poor-college-students-by-paying-for-kidney-donations/   Safer Cars Means Fewer Brain Deaths Means Fewer Organ Donors Means Organ Harvesting I blame my pal Ralph Nader and the law of unintended consequences: Improved safety–such as seat belt and helmet laws–resulted in far fewer catastrophic brain injuries....

Belgium Pioneers Organ Donation from Euthanized Patients (2012)

The practice of transplanting organs from patients who die after voluntary euthanasia is becoming more common in Belgium. A leading specialist, Dirk Van Raemdonck, told a conference in Brussels recently that there had already been nine cases. A year ago, a team at a hospital in Leuven announced that it had successfully transplanted lungs from four euthanized patients between 2007 and 2009. Over the next three years there appear to have been another five. According to the website De Redactie, run by the Flemish public broadcasting company VRT, Belgium is the world leader in organ removal after euthanasia. This has been done only once elsewhere in the world, in neighboring Holland, Dr Van Raemdonck told De Redactie. Only a small proportion of euthanized patients are able to donate organs, since most of them are terminally ill with cancer. About 1,100 Belgians were euthanased in 2011. Most of the patient donors have muscular or neurological disorders. [Michael Cook | Oct 05, 2012,...

The Erosion of Ethics in Organ Transplantation (2012)

Comment: The basic principles are sound for anyone. N. Valko RN 2nd Comment, 2nd Nurse: Unless the donor is alive and can live with one organ (kidney for instance), and the transplant will not kill the donor, it is morally and ethically in question. Back in my 20s we had a trauma one day. Beautiful, beautiful little 4 yr old girl, with white blonde curls. Her head hit the dashboard, parents didn’t have her strapped in (that was back when dashboards were still metal). The doctors rushed to declare her brain dead, in fact – within 2 days of the accident. This was puzzling because although comatose, supposedly her brain MRIs weren’t that bad. Well, the ravenous doctors talked those grieving parents into organ retreival. They took that childs life and gave away all those organs. The surgical team was greatly disturbed by the procedure (you have to understand, they have anesthesia monitoring until they take the heart and kidneys, then they unplug and walk off, treating the body like a piece of dead trash). A couple days later I asked a neurosurgeon if a child with a subarachnoid hemorrhage would be a candidate for retreival. He said ‘oh no, aubarachnoids can appear horrid at first but really those patients do fine. Completely salvageable with no permanent brain impairment. Ya just gotta get the blood to clear out then they’re fine.’ I have NEVER looked at organ harvesting as ‘noble’ again. J.B. RN *** Caleb Beaver died at age 16 on Christmas Day in 2011 due to a previously undiagnosed congenital malformation of his blood vessels. His devastated parents...

Danish Teen Wakes From the “Dead” Just as Doctors Prepare to Harvest Her Organs (2012)

A teenage girl who had been stuck in a coma after a catastrophic car crash miraculously woke up just as doctors were about to declare her brain dead and harvest her organs. A teenage girl who had been stuck in a coma after a catastrophic car crash miraculously woke up just as doctors were about to declare her brain dead and harvest her organs. Doctors had assessed Carina Melchior’s chances of recovery as being very low and asked her family whether they would consider organ donation. Her parents agreed and the 19-year-old was taken off of her respirator. However, after a few days when doctors were preparing her for organ donation, to the astonishment of the staff at the Aarhus University Hospital, in Denmark, Carina suddenly opened her eyes and started moving her legs. The teenager is now recovering at a rehabilitation center and is now able to walk, talk and even ride her horse Mathilde. However, her family is now suing the hospital for damages, claiming that doctors took her life support too soon because they were desperate to harvest her body parts. “Those bandits in white coats gave up too quickly because they wanted an organ donor,” Carina’s father Kim told the Danish newspaper Ekstra Bladet. The family’s lawyer Nils Fjeldberg said that Carina keeps asking if her doctors were trying to kill her. “Of course this is a great trauma, both for her and her parents who were convinced that there was nothing else that could be done and agreed to donate her organs,” he told the newspaper. Carina, now 20, had crashed her car in...

A Very Real Story of “Direct Euthanasia” (2012)

This story is not unique. It is happening thousands of times a year. Please be aware of what is happening in some U.S. hospitals, nursing homes and Hospice. “I believe my mother was killed while in hospice care this August. Mother had congestive heart failure, kidney issues and some Dementia. I had moved mother to a new facility which meant she had to have a change in hospice nurses. Up to the point of her move, her nurse and another staff nurse told me explicitly that my mother definitely did not need any Morphine, at least not at this point. “A couple hours later Mom was at the new facility, eating lunch in the dining room. An hour after the meal was done; I meet with Mom, the new nurse and a social worker in the Activity room. Mother was answering questions, smiling and eating an ice cream soda. Mom told us that she had no pain, yet the nurse told me she wanted to give her a little bit of morphine just for “comfort.” This nurse ordered and scheduled, to begin that day, 5 mg. morphine, Xanax and Haldol gel (atavan, benadryl, haldol), to be administered through the day, not as needed but “scheduled”. “In the evening, in addition to these drugs, mother would get Seroquel, another anti-psychotic sedative and Restoral, a benzodiazepam for sleeping. I was completely duped. I was going on what the other nurse, just hours before had said. She was adamant that my mother was not at the point of needing any morphine. Mother was on Tylenol for pain until this new nurse and...

As More Hospices Enroll Patients Who Are Not Dying, Questions About Lethal Doses Arise (2014)

The Hospice Industry is Booming, But Concerns Are Rising About Treatments for Patients Who Are Not Near Death. This story is part of an ongoing WashPost series on the hospice industry in America. Read part 1, part 2, and part 3. Clinard “Bud” Coffey, 77, a retired corrections officer, did the crossword in The Charlotte Observer after breakfast every morning, pursued his hobby of drawing cartoons, talked seven or eight times a day to his son Jeff and, just two weeks before his death, told a pal that he still felt “like a teenager.” He did, however, have some chronic back pain, and in late March he was enrolled in hospice care “essentially for pain management,” his doctor said. Over a two week period, he received rising doses of morphine and other powerful drugs, grew sleepy and disoriented, and stopped breathing, dying peacefully at home, according to his family and medical records they provided. His death certificate, which was signed by the hospice doctor, listed the cause as “renal cell carcinoma” or kidney cancer. But that doctor had never examined Coffey, his family said, and medical records from just a few weeks earlier do not mention it. “My dad wasn’t dying of cancer,” said his son, Jeff Coffey. “Once he was on hospice, their answer for everything was more drugs. Everything we know about his death is consistent with an overdose.” An attorney for the hospice company, Curo Health, said it could not comment on the case without authorization from Coffey’s family. When Jeff Coffey authorized the company to comment, however, the attorney said that the company would not...

Use and Abuse of POLST Forms Expands (2015) / When “Doctor’s Orders” Mean Death (2014)

Use and Abuse of POLST Forms Expands “Physician’s Order for Life-Sustaining Treatment” (POLST) forms were designed as a tool for end-of-life planning. More simple in concept than an advance health care directive, durable power of attorney for health care, or living will, the POLST is an order signed by a doctor that goes into immediate effect. Printed on brightly-colored card stock, the POLST is posted prominently in a person’s home and/or in their medical record, as appropriate. If emergency medical personnel are called to a person’s home, they can see at a glance if there is a POLST form and quickly determine whether the person has a do-not-resuscitate order in effect. As originally conceived, the POLST was to be offered by a doctor to a patient who was seriously, chronically ill, and whose condition was deteriorating to the point where the doctor would not be surprised if he died within a year. Under those circumstances, and particularly where the person was not living in a health care setting, the POLST served to ensure a patient’s end-of-life wishes were respected in the case of an emergency where their advance directive was not readily available. Both studies and ample anecdotal evidence have shown that frequently in nursing home and other institutional settings, POLSTs are being not suggested but required upon admission, and not just of the seriously ill but of everyone. Not uncommonly, the POLST form is presented to a family member for his or her approval, even when the patient still has legal capacity to make decisions. In the case of a conflict between instructions in advance care planning documents...

A Look at Living Wills (2012)

[Comment: The basic problem is this quote: “The hardest choices center on when quality of life will be so diminished that death is preferable.” The real issue is about causing or hastening death, not whether predicted quality of life is “good enough” to continue basic medical care or treatment. It’s this attitude that so many doctors and nurses as well as the public have adopted that is so dangerous, especially to people with existing disabilities.There is already talk in ethics circles about having a “no feeding tubes” default policy with the so-called “vegetative state” rather than have the family decide. Not surprising since polls show a vast majority of people say they would not want feeding tubes if they were in a “vegetative” state. Attitudes and biases can have lethal consequences in ethics. Also, it’s a shame that futility policies weren’t even mentioned. People are not as in control of their death as articles like this would lead them to believe. I’ve seen many families where doctors and ethics committees tried to intimidate them into refusing or withdrawing treatment. Ironically, most of the families who decided to continue treatment saw their loved ones improve or even recover-like the writer of this article. I have also seen that that even when a loved one didn’t survive, families usually said they gained comfort from knowing that that doctors and nurses tried hard to give their loved ones at least a chance. N. Valko RN] A New Look at Living Wills These critical documents about your preferences for end-of-life care don’t always work as planned. More flexibility might be the answer. My...

Donor: Before or After Death?

Excerpt from “Death and the Organ Donor” [Comment: Truog, et al. have been advocating organ harvesting before death for many years. Non-heartbeating organ donation (now called DCD here) has been going on since the early 1990s and I’ve been writing about this unethical practice since the late 1990s (see excerpt from my 2009 article “Death and the Organ Donor” below) but the whole issue has received little media attention. Now it seems that the “bioexperts” are finally ready to go public. As usual, this controversial issue is portrayed as “just” taking the kidneys with the excuse that this is harmless to the person. Really?? But look at the comments! Almost all the current ones are against this. Even without knowing all the facts about DCD, it seems most people have basic common sense. N. Valko RN] Excerpt from “Death and the Organ Donor”, online at http://www.wf-f.org/09-01-Valko.html : “The Council’s (the President’s Council on Bioethics) white paper admitted that the legal definition of irreversible cessation of heartbeat and breathing used to justify DCD/NHBD has problems. Most people would consider “irreversible” in this context to mean that the heart has lost the ability to beat. But in DCD/NHBD, “irreversible” instead means that there is a deliberate decision not to try to restart the heart when it stops and that enough time has elapsed to ensure that the heart will not resume beating on its own. However the Council had to admit the dearth of scientific evidence supporting this determination. In some cases involving babies, for instance, the heart is harvested and actually restarted in another baby. “The Council also admitted that...

Dutch Doctors Use “Deep Sedation” to Hide Assisted Suicides

Dutch Doctors Use “Deep Sedation” to Hide Assisted Suicides The Lancet has just published an article purporting to show that euthanasia rates have not increased in the Netherlands since legalization in 2002. This news will probably be seized upon by enthusiasts for decriminalisation in the UK and elsewhere but the figures are not at all what they seem at first sight and the press release sent out by the journal is selective and misleading in its reporting of the facts. If you read the press release sent by the Lancet (reproduced by Medical Xpress) it all seems cut and dried. There were about 4,050 cases of euthanasia or assisted suicide in 2010 (2.8% of all deaths) and this was only slightly up from the 2001 figure of 3,800 (2.6%). But if you read the abstract along with the full article and accompanying comment you get a very different picture altogether. Most news outlets will do neither but will simply propagate the press release which is why it is important to look at the original sources. Thus far, the Daily Telegraph is the only national newspaper to cover the story. The key fact which should alert people to something odd going on is the reference to ‘continuous deep sedation’ in the Netherlands which appears in the article’s abstract but tellingly (and perhaps even disingenuously) not in the Lancet press release. The abstract states, ‘Continuous deep sedation until death occurred more frequently in 2010 (12.3% [11.6—13.1; 789 of 6861]) than in 2005 (8.2% [7.8—8.6; 521 of 9965]).’ But what was the rate of ‘continuous deep sedation until death’ in 2001 and...