Responses – Declarations / DPA / Advance Directives / Talking Points

Belgian Doctors Call for End to Euthanasia for Mental Suffering

[Comment: Once again, evil cannot limit itself. N. Valko RN, 10 Dec 2015] Dr Marc Van Hoey with Simona de Moor shortly before she was euthanised. (SBS Dateline) Comment: On December 8, a group of psychiatrists, psychologists, philosophers and others published a letter in De Morgen, a Flemish newspaper, asking the government to remove the option for euthanasia on the basis of psychological suffering alone. Here is an English translation from the blog of Trudo Lemmens, Professor and Scholl Chair in Health Law and Policy at the University of Toronto Faculty of Law. * * * * * For the first time since the adoption of the law in 2002, a decision to allow euthanasia –the De Moor/Van Hoey case – has been challenged by the euthanasia evaluation committee and forwarded to the public prosecutor. The Australian broadcaster SBS made a documentary about this case and about the conversations between the patient and doctor. Another poignant video report was recently made public by The Economist, involving a 24-year-old young woman from Bruges, who ultimately declined the execution of her euthanasia request, which had been granted, and which was based on psychological distress. (24 and Ready to Die). In our open letter in the Artsenkrant (September 2015) we have already drawn attention to the legal uncertainty for the doctor in cases of euthanasia based on purely psychological suffering. In this opinion piece we draw attention to its particularly problematic character, in particular the impossibility of objectifying the hopelessness of psychological suffering. One would expect that the untreatable nature of this condition is supported by, for example, indications of an organic...

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...

Not Dead Yet Disability Activists: Talking Points to Oppose Assisted Suicide As A Deadly Form of Discrimination

[Comment: NDY has done great work in the Brittany Maynard case. I read NDY’s blog, and NDY’s activism is amazing and far surpasses anyone else’s. Please read these excellent NDY talking points below to get a picture of the great work done by Diane Coleman and Stephen Drake and the others in NDY. www.notdeadyet.org N. Valko RN] ——————————————————————————– Lessons From Disability History Prior to the formation of Not Dead Yet, disability activists opposed a number of so-called “right to die” court cases involving ventilator users who sought freedom from nursing homes, essentially arguing “give me liberty or give me death.” Society’s response, denying them freedom but granting them death, was a wake up call to the disability rights movement. (Herr, S.S., Bostrom, B.A, & Barton, R.S. (1992). No place to go: Refusal of life-sustaining treatment by competent persons with physical disabilities. Issues in Law & Medicine, 8 (1), 3-36.) ——————————————————————————– Suicide v. Assisted Suicide It should be noted that suicide, as a solitary act, is not illegal in any state. Disability concerns are focused on the systemic implications of adding assisted suicide to the list of “medical treatment options” available to seriously ill and disabled people. ——————————————————————————– What’s Disability Got To Do With It? The disability experience is that people who are labeled “terminal,” predicted to die within six months, are – or will become – disabled. It is well documented that the six month prediction called for in the Oregon and Washington laws is unreliable. The Oregon Reports demonstrate that some people who received prescriptions were not terminal (i.e. lived longer than six months). ——————————————————————————– Broad Agenda, Incremental...

Group Offers Power of Attorney Forms (2005)

Quad City Right To Life has developed a durable power of attorney for health care to protect a patient’s right to receive medical care, nutrition and hydration. QCRTL director Bowman said the form is being offered in the wake of the Terri Schiavo case. “One week ago, Terri Schiavo lost her life. Her death was not about end-of-life care, it was about putting an end to a life.” The group’s form will specify that a patient must receive medical care and that nutrition/ hydration cannot be withheld “unless death is inevitable & imminent”. “Unfortunately, all living wills and most widely-available durable powers of attorney, the two kinds of advance directives, are slanted towards death, directing that food and water be removed from a patient simply because he or she has suffered brain damage and is not likely to recover,” Bowman said. Quad City Right To Life, 1530 State St., Suite 4, in Bettendorf; (563) 324-0035. The Int’l Anti-Euthanasia Task Force also has Durable Power of Attorney for Health Care forms – http://www.internationaltaskforce.org/ 740-282-3810. The International Anti-Euthanasia Task Force is now termed Patients Rights Council. [Janeé Jackson, BETTENDORF [email protected]; N Valko RN,...

Policy Statement on Euthanasia (2001)

WHEREAS the National Association of Pro-life Nurses acknowledges the value of all human life from conception to natural death regardless of the circumstances or physical capabilities of that life, AND WHEREAS we reject the prevailing notion that some lives are less worthy to be lived than others, AND WHEREAS we, as nurses in the practice of our profession, are called on to deal with human beings at all stages of development whose quality of life is considered by some to be compromised, WE THEREFORE DECLARE that the practice of euthanasia is objectionable by our members and the following guidelines for the respectful treatment of all individuals is to be promoted: 1. The act of mercy-killing by which doctors or others knowingly kill individuals by a lethal dose of a drug or by other means is never justified. It is not permissible to cause or assist in one’s own death or the death of another through suicide, mercy-killing or assisted suicide. 2. Supportive nursing care must be provided to all individuals. 3. Nutrition and hydration are basic human needs and provision for those needs sometimes requires medical expertise and technology. Nutrition and hydration should not be withheld or withdrawn unless and individual is in the final stage of a terminal condition, the individual’s death is imminent, and doing so would not cause the individual’s death. 4. A competent, non-suicidal individual has the right to refuse medical treatment, but not nutrition and hydration. Medical personnel and institutions have the right to withdraw from the care of any such individuals for reasons of conscience. 5. Medical treatment should not be withheld or...

Sites Encourage Doctors, Caregivers to Pledge NO to Assisted Suicide

With more states legalizing assisted suicide, euthanasia opponents have put together a web site to urge doctors, medical caregivers and citizens to say ‘no’ to assisted suicide. The site comes after doctors and medical centers have said they won’t urge patients to kill themselves. The Take the Pledge web site urges the three different categories of people to sign an online pledge affirming they will help patients, not urge their death. “I will treat the sick according to my best ability and judgment, always striving to do no harm. Whenever I care for a terminally-ill patient, I will provide optimal comfort care until natural death,” the pledge for doctors says. Wesley J. Smith, a noted author and attorney, has endorsed the new web site and urges people to take the pledge to affirm pro-life principles over assisted suicide. “Just because assisted suicide is legal in Oregon and Washington-State, that does make it right. The time has come for a very public and vibrant declaration of non cooperation with the culture of death,” he says. Take The Pledge – http://www.pccef.org/ttp/index.htm Our Pledge to Our Patients – http://www.pccef.org/whoweare/ourpledge.htm Declaration of Hope Canada, opposing euthanasia and assisted suicide – http://declarationofhope.ca/ [http://www.lifenews.com/bio2632.html; Olympia, WA www.LifeNews.com]   “Take the Pledge” Campaign Calls for Loyalty to Patient Health rather than Assisted Suicide Anti-euthanasia groups in Canada and Oregon are calling physicians, caregivers, and concerned citizens across the world to “Take the Pledge” to pursue genuine care for even the most dependent patients, and never to consent to assisted suicide. Take-the-pledge.com, created by The Physicians for Compassionate Care in Oregon and the Euthanasia Prevention Coalition, provides links...

Living Wills: Have They Failed? (2010)

[Comment: Yes, they [Living Wills] have [failed], and most of them are downright dangerous. However, note the example of short-term ventilator assistance for pneumonia. This is probably new information for most people. This is why I tell my patients who are wondering about “living wills” about a protective durable power of attorney and that they might consider not signing off on any specific treatments or care. Much of what people know about such things as feeding tubes and ventilators is not accurate and it’s virtually impossible to predict a future situation. Would you sign an operation permit before you have any problems? Wouldn’t you would want to know all relevant information beforehand in order to make a good decision? Then why sign an advance directive to refuse all sorts of basically undefined treatments or care that might save or improve your life, especially when you are still healthy? N. Valko RN] The great health reform debate over alleged death panels has fizzled. Lawmakers guaranteed that by stripping provisions supporting end-of-life planning from legislation enacted last month. What remains is the status quo. It’s left to individuals to decide if they want to think about their medical destiny at life’s end, talk to their families and make their wishes known — as it has always been. Some doctors initiate these discussions before people are at death’s door, but most don’t. Despite intensive educational efforts, only 30 percent of adults have prepared an advance directive: a living will or a durable power of health care attorney appointing a surrogate decision-maker. To many experts, this indicates that current approaches to advance care...

On Being a ‘Burden’ to One’s Family, Especially One’s Spouse and Children

Guest commentary by William E. May, Ph.D. Frequently, elderly people like me (I will soon be 82 years old), some suffering from an assortment of health problems, are heard to say that they don’t want to be a burden on their families, especially their spouses and children. And there is surely some truth in this. But rightly understood—and I hope to make it so here—I want to be a burden to my loved ones. Gilbert Meilaender’s thoughtful reflections and their relevance to care of dying
 I began thinking seriously about this a short time ago when I received a copy of the 20th anniversary issue of the journal First Things (March 2010), in which selections from its first 20 years were reprinted. Among these was Gilbert Meilaender’s brief piece in the October 1991 issue called “I Want to Burden My Loved Ones.” In his thoughtful and thought-provoking article, Meilaender points out that in this life we do not come together as autonomous individuals freely contracting with each other. Rather we find ourselves living with other persons, beginning with our families, and are asked to share the burdens of life while caring for each other. He emphasizes that “morality consists in large part in learning to deal with the unexpected and unplanned interruptions in our life.” In short, we can ask ourselves, “How do I bear the contradictions of each day?” –traffic jams when we are in a hurry to get to work; slipping on the ice and breaking some bones; losing our job because of downsizing. Do we accept these or rebel against them and against God, who loves...

National Health Care Decisions Day (NHDD) in April

April 16 was National Health Care Decisions Day (NHDD), a day to “inspire, educate & empower the public and providers about the importance of advance care planning”. Many organizations and individuals are participating in this to raise awareness of how vital it is to make your wishes known regarding medical treatment, and to designate an agent to make decisions for you in the event you become unable to participate in your own medical treatment decisions. The Patients Rights Council (PRC) strongly encourages everyone to make sure they have executed one of our Protective Medical Decisions Documents (PMDD)s. Protect yourself, and make sure your loved ones are protected as well!...

The Living Will – Expansion or Erosion of Patients' Rights?

BACKGROUND  Not long ago, the concept of legalized assisted suicide, or lethal overdoses or injections for sick or handicapped people would have been considered outrageous and obscene, reminiscent of the ugly time earlier in this century in which medicine ran amok and society pledged “never again.”  Court-approved starvation of persons who are severely brain-damaged would have been utterly unthinkable.  Any suggestion that we balance the budget at the expense of hurrying death for vulnerable people would have sparked outrage from all but the most heartless fiscal conservative or elitist bigot. Yet today, each of these concepts has gained some social acceptability – and in many circles, respectability.  To a great extent, the question is no longer whether euthanasia ought to be permitted, but under what “very limited,” “carefully controlled” circumstances it should be permitted. * Since the 1980’s, dozens of courts have authorized withholding life-sustaining food and fluids from severely handicapped persons who were not dying.  Each of these cases has further eroded protections for the rights and lives of medically vulnerable people. * In 1990, the United States Supreme Court ruled on its first euthanasia case, that of Nancy Cruzan, a Missouri woman who was severely brain injured but was not dying.  Ms. Cruzan depended upon others for help with basic care and feeding (she had a feeding tube), but did not require any “heroic” life-sustaining measures.  According to court records, Ms. Cruzan could see, hear, and respond to ordinary pain (such as menstrual cramps).  She smiled at amusing stories and wept when her visitors left.        Before her feeding tube was put into place, she was...

‘Always to Care, Never to Kill’ (1991)

We are grateful that the citizens of Washington state have turned back a measure that would have extended the permission to kill, but we know that this is not the end of the matter. The American people must now prepare themselves to meet similar proposals for legally sanctioned euthanasia. Toward that end we offer this explanation of why euthanasia is contrary to our faith as Jews and Christians, is based upon a grave moral error, does violence to our political tradition, and undermines the integrity of the medical profession.      In relating to the sick, the suffering, the incompetent, the disabled and the dying, we must relearn the wisdom that teaches us always to care, never to kill. Although it may sometimes appear to be an act of compassion, killing is never caring. Current proposals would legalize euthanasia only for the terminally ill. But the logic of the argument – and its practical consequences – will inevitably push us further. The well-organized campaign for legalized euthanasia cruelly exploits the fear of suffering and the frustration felt when we cannot restore to health those whom we love. Such fear and frustration is genuine and deeply felt, especially with respect to the aging. But to deal with suffering by eliminating those who suffer is an evasion of moral duty and a great wrong. Deeply embedded in our moral and medical traditions is the distinction between allowing to die, on the one hand, and killing, on the other. That distinction is now under attack and must be defended with all the force available to us. Medical treatments can be refused or withheld...

End Of Life Resources

Advance Directives are an important protection… End of life decisions can cause great anguish in families. In the current health care climate, it is important to be informed concerning all your options. No one is required by law to have an advance directive; do not let anyone pressure you into signing any type of advance directive. The following are offered as sources of information concerning advance directives:    Euthanasia, Assisted Suicide & Health Care Decisions: Protecting Yourself & Your Family by Rita L. Marker http://www.internationaltaskforce.org/rpt2006_TOC.htm International Task Force Update http://www.internationaltaskforce.org/iua40.htm To obtain the Protective Medical Decisions Document (the ITF's durable power of attorney for health care), call 740-282-3810 or 800-958-5678, 8:30am – 4:30pm (eastern time). American Life League The Loving Will — Ethical Alternative to the "Living Will" http://www.all.org/article.php?id=10171&search=loving%20will National Right to Life The Will to Live http://www.nrlc.org/euthanasia/willtolive/index.html     Lives considered by some to be "imperfect" and "burdensome" may not be here on earth for themselves, as much as they are here for us, the care-givers. As care-givers, we may actually be the ones who benefit from these lives, as we learn to care for others, and to put their welfare before our own. If people contemplate and really see the Sanctity of Life, their "quality of life" arguments fall away and they will understand that we are here to Care for each other, not to kill each other. Caring, and not convenience, is the sign of a civilized and just society… Preserving the original prolife hospice mission… Ron Panzer, Hospice Patients Alliance http://www.hospicepatients.org *************************************************** Here is a wonderful example of growing as human beings, of sacrificing for...

"Loving Will" and PMDD Offer Options / Nutrition & Hydration Help (updated Nov 12)

“LOVING WILL” OFFERS ETHICAL MEDICAL OPTIONS With growing concerns about advance directives such as “living wills”, “do not resuscitate” (DNR) orders, and other critical issues related to health care, a Loving Will package is available which “enables you to tell your loved ones and health care professionals – in writing – that you desire all appropriate actions necessary to preserve your life if you are hospitalized and unable to speak for yourself. Call 1.866.LET.LIVE for this package [no charge, but a $9.95 shipping/handling fee for each will]. A similar packet is available from the International Task Force on Euthanasia & Assisted Suicide, the Protective Medical Decisions Document (PMDD) is the International Task Force's Durable Power of Attorney for Health Care in which the signer names an agent to make health care decisions in the event that the signer is unable to do so. The document expressly defines and prohibits euthanasia. Each PMDD set includes questions and answers, a checklist, 3 PMDD documents and one Protective Identification Card. It is available in Multi-State version and state-specific versions. [$8.00 for postage and handling] [740.282.3810; www.internationaltaskforce.org]. LIVING WILLS The concept of the “living will” was originally invented in 1967 by two groups, the Euthanasia Society of America and the Euthanasia Education Council.  The “living will” opened the new strategy of an incremental approach… Along with the “living will”, these groups also made strategic name changes: The Euthanasia Society of America changed into the Society for the Right to Die and the Euthanasia Educational Council became Concern for Dying. In the 1990’s, the groups formally merged and are now known simply as Choice...

The Limited Wisdom of Advance Directives (PCB, 9/05)

Comment: Not surprisingly, the media has studiously ignored this report. This chapter is quite long; this is an excerpt. To read the entire chapter or report, please go to the URL. [N Valko R.N.] URL–   http://www.bioethics.gov/reports/taking_care/chapter2.html The President’s Council on BioethicsWashington, D.C.    September 2005 The Limited Wisdom of Advance DirectivesChapter 2 As the American population ages, the dilemmas and obligations of making caregiving decisions for incapacitated patients—including decisions about when to initiate, forgo, or cease potentially life-sustaining treatments—will only become more widespread and more acute. As we described in the previous chapter, more people will experience longer periods of dependence, including years of mental incapacitation. Deciding the best course of medical care during this extended period of debility will typically fall to surrogates—including family members and friends, health care professionals and social workers, and sometimes state guardians called upon to speak for those without proxies or courts called upon to adjudicate cases in which surrogates disagree. If we fail to think ahead about what we want done and what we owe to those who can no longer speak for themselves, we are more likely to make the necessary decisions in a state of excessive confusion and crisis. But if we plan ahead thoughtlessly or unwisely, we may in fact hamper efforts, when the time arrives, to provide the kind of care that we will then need and deserve. In the United States, our effort to think ahead about caregiving for incapacitated persons has taken shape mainly around the legal instrument of advance directives—both “instruction directives” that aim to dictate how one should be cared for and “proxy directives” that appoint...

Model Resolution to Protect Patients

WHEREAS: The Arizona Medical Association is opposed to euthanasia, including “physician-assisted suicide”; and WHEREAS: The diagnosis of Persistent Vegetative State cannot be made with certainty,” being mistaken in up to 43% of cases, especially when functional neuroimaging has not been performed; and WHEREAS: Patients in a “minimally conscious state” or with a “locked-in syndrome” may be aware of their surroundings yet unable to communicate this awareness; and   WHEREAS: Patients with severe brain injury, who may be diagnosed as being in a Persistent Vegetative State, are often not terminally ill; and WHEREAS: Severely disabled patients may nonetheless desire to live, regardless of what their expressed premorbid wishes may have been; and WHEREAS: Death from thirst or starvation can be extremely painful; and WHEREAS: Disabled persons look upon their feeding tubes as “assistive devices” that permit them to be nourished without tremendous burdens on caregivers and without the distress of choking spells; and WHEREAS: Withholding fluids and food from a person who is not terminally ill (i.e. almost certain to die in less than a week) is a method of deliberately causing death that would not otherwise occur, and WHEREAS: it is unlawful to execute a person who is not mentally competent, even if guilty of committing a crime at a time when he was mentally competent; and WHEREAS: even mentally disabled patients are persons who are entitled to protection against deliberate infliction of pain or death, BE IT THEREFORE RESOLVED THAT: The Arizona Medical Association oppose as unethical the withdrawal of fluids and nutrition from a patient who is not terminally ill, unless the patient is mentally competent, capable...

PFL Statement on Euthanasia: Do No Harm

According to top bioethicists, medicine should always be at the service of life – Do No Harm. Even when medical treatment cannot eliminate a serious disease, the goal then is to alleviate suffering. Every possible act and caring attention should be brought into play to lessen the suffering in the last part of a person’s earthly existence, and to encourage an end of life as peaceful as possible. In order to help the patient in every situation, everyone involved in end of life decisions must be aware of the innate dignity of every human being, even during terminal illness.  Every patient is entitled to basic health care, no matter what the “quality of life” has become. Basic health care includes nutrition, hydration, cleanliness, warmth, etc.  To withhold such care would violate the inherent dignity of the human person. Moreover, it would introduce into society a discriminatory and eugenic principle. Food and fluids are a natural and ordinary means of preserving life, even when administered artificially, and are morally required even for patients in a persistent vegetative state (PVS), so long as the food and fluids provide nourishment and alleviate suffering. Feeding, even when through technology, is not a medical procedure intended to cure a disease, but a pro-medical form of basic human care. While patients who need pain killers should be able to receive the relief the medications can bring, the dosage should be proportionate to the intensity of their pain and its treatment.    The refusal of aggressive treatment is neither a rejection of the patient nor of his or her life. The decision to begin or to continue a...

Protecting Your Health Care Decisions

In order to protect yourself and those you love in the case of a life-threatening situation, it is imperative to have clear protocol for decision-making. The following is excerpted from the article “The MOST Important Life & Health Insurance: Protect Your Health Care Decisions”, by Rita Marker, J.D., Euthanasia: Imposed Death by Human Life Alliance, 2004; 6510484-1040; www.humanlife.org. “In a durable power of attorney for health care, you designate a trusted family member or friend to make health care decisions for you if you are unable — either temporarily or permanently… “Most people think such a document is only for those who are very sick or very old…It’s absolutely essential for anyone who is 18 years old or older. “To be certain that a person you trust will be making decisions for you if you can’t do so yourself, you must have a durable power of attorney for health care that specifically names that person. “As with any legal document, the wording of the durable power of attorney for health care is critically important. And it must comply with the laws in your state. “That’s why the International Task Force (ITF) formulated the Protective Medical Decisions Document (PMDD). The PMDD is a durable power of attorney for health care that has been drafted to protect you. “It gives the person you name to make your halth care decisions the authority to act on your behalf. That person is generally referred to as your ‘agent’. “The PMDD limits your agent’s authority in one specific way. It clearly states that your agent does not have the authority to approve the direct and...

Declaration on Life and Death

[This is a SAMPLE Text] DECLARATION ON LIFE AND DEATH This Declaration on Life and Death, made while I am of sound mind, is provided as a means of indicating my desires and directions regarding treatment of care for me in the event I become irreversibly and terminally ill. I therefore admonish and direct my family, physicians, lawyer, pastor, and friends that, because of my belief in the dignity of the human person and my eternal destiny in God, if I become irreversibly, incurably, and terminally ill, I be fully informed of the facts so that I can prepare myself spiritually to die. I have the right to make my own decisions concerning treatment that might inordinately prolong the dying process beyond the limits dictated by reason and good judgment. If I should have an incurable injury, disease or illness, certified to be a terminal condition by two physicians who have examined me, one of whom shall be my attending physician, and the physicians have determined that my death will occur whether or not the life-sustaining procedures are utilized and where the application of life-sustaining procedures would serve only to artificially prolong the dying process; and if I am unable to make my own decisions and have no reasonable expectation of recovery, then I request and direct that no ethically extraordinary means be used to prolong my life, but that my pain be alleviated. (The term "ethically extraordinary means" signifies treatment that does not offer a reasonable hope of benefit to me, and that cannot be accomplished without excessive expense, pain, or other grave burden.) Nothing should be done...