UK Physicians Move From Neutral to Rejecting Assisted Suicide

CA Senate Committee Rejects Measure to Legalize Assisted Suicide

Oregon's End Of Life Orders Document - POLST - On the National Level

Execution Suffering

UK DOCTORS MOVE FROM NEUTRAL TO REJECTING ASSISTED SUICIDE. In a vote this week, the British Medical Association (BMA) took a clear stand against physician assisted suicide. 65% of the 500 doctors at the BMA's meeting in Belfast voted against the proposal to accept assisted suicide. This represents a significant development from previous trends.

In a narrow vote last year the BMA refused to take a position against assisted suicide, though individuals and pro-life organizations have said the practice is going on quietly and the courts have ruled that disabled patients do not have the right not to be dehydrated to death.  In July 2005 the BMA was discussing whether to support then-pending legislation in the House of Lords that would legalize assisted suicide. Members voted narrowly not to oppose the legislation. Lord Joffe, the author of the bill, praised the BMA’s decision to stay out of the way of the movement that pro-life advocates say leads inevitably to active euthanasia. He said, “The BMA’s decision to adopt a neutral stance is an important move because the Government is really thinking carefully about the issue.”

The bill was blocked in May, but Lord Joffe and its supporters have vowed to reintroduce it until it is passed into law. A poll of UK doctors showed that 70 per cent were opposed to assisted suicide. Dr Andrew Davies, from Cardiff, told the BBC that terminally ill patients in his care had “a lot on their minds,” but for many their main concern was the effect their illness was having on their families. “My worry is that a right to die will become a duty to die, a duty to unburden their families.” [Hilary White, London, 29June06 LifeSiteNews.com]

CALIFORNIA SENATE COMMITTEE REJECTS MEASURE TO LEGALIZE ASSISTED SUICIDE. It would have made CA the second, following Oregon, to legalize assisted suicide. The Senate Judiciary Committee voted 28June against the measure, meaning the legislation is dead for the rest of the legislative session. Democratic Sens. Martha Escutia of Whittier and Sheila Kuehl of Santa Monica voted for the bill but it died on a 2-2 vote.

The measure would have allowed doctors to prescribe lethal barbiturates for patients who are declared terminally ill and have less than six months to live. Patients would have had to undergo psychological examinations and waited 2 weeks after the request to take the drugs.

Dunn said he opposed the bill because he worried lawmakers would come back in future legislative sessions and expand assisted suicide by allowing patients who are not terminally ill to kill themselves as well.

A coalition of groups including doctors organizations, disability activists, Hispanic organizations and pro-life groups banded together to oppose the measure. Assemblyman Lloyd Levine, one of the lead sponsors of AB 651, said "We'll keep fighting." Even if the state legislature signs off on the assisted suicide bill, Gov. Arnold Schwarzenegger said in January he would veto it. [29June06, CA LifeNews.com]

OREGON'S END-OF-LIFE ORDERS DOCUMENT — "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 accepting a feeding tube or respirator. POLST instantly converts these "wishes" into physician's orders. Naturally, the orders are usually followed. However, one wonders whether the same "wishes" would have been expressed by a more informed patient, counseled in less stressful circumstances.

According to the POLST website (www.polst.org), some form of POLST has been endorsed by the following states or regions: Oregon, Washington state, West Virginia, sections of NY, Wisconsin, and Pennsylvania. The following states are developing programs: NH, MI, HI, NV, UT, NE, MO, TN, NC, GA, and FL. The forms may be implemented voluntarily through medical boards, and/or via direct legislation.

North Carolina's End-of-Life Orders document "MOST"
When we last wrote to you, the North Carolina end-of-life document was named POST (Physician's Orders for Scope of Treatment). The document has been reviewed, amended, and approved by the North Carolina Medical Society's Ethical and Judicial Affairs Committee. The document is scheduled to be returned to the Task Force, and there may be other reviews and changes in its future before implementation.

Newest version of the North Carolina document (MOSTjun2006.pdf). The document's name, which was POST in March, has changed to "MOST" (Medical Orders for Scope of Treatment).  There are also a few other changes in addition to the name change. Next week we will post a full discussion of MOST on our website (www.lifetree.com). In the meantime, here are changes we've noted:

The name has changed from POST to MOST (change from "Physician's orders" to "Medical Orders")
Signature was "optional;" signature is now "preferred."  However, the form is "still effective without signature," and at that, the signature can be that of a "Person, Parent of Minor, Guardian, Health Care Agent, Spouse, or Other Personal Representative."

Informed consent:  Statement to be signed by patient/proxy now begins "I agree that adequate information has been provided..." and ends with "This document . . . indicates informed consent."  (Q: Is the patient really as well informed as the boilerplate statement indicates?) 
Where the POST form referred to "physician", the MOST form expands to "physician (MD/DO), physician assistant, or nurse practitioner." 

Bottom line, these forms are being tested across North Carolina.   LifeTree does not endorse the POLST program at all, and does not recommend the adoption of the MOST form. If it is really true that too many patients are being forced into life-saving technologies at the end of life, this form does not solve the problem. The form will often be completed under duress, without full information, and further corrodes communication between the primary physician and his or her patient.

Pro-life physicians should be made aware of what the NC Medical Society is trying to move into the system.
 
Elizabeth D. Wickham and Ione Whitlock
Executive Director and Chief Research Associate
LifeTree, Inc
www.lifetree.org

PO Box 17301
Raleigh, NC, 27619

Endnotes:
[1]  "History of POLST Paradigm Project" at POLST Paradigm website, maintained by the Center for Ethics in Health Care at the Oregon Health & Science University; also Recent Developments in Physician-Assisted Suicide, June, 1998, "Medical Developments," #10 at Willamette University's web site. 
[2] See "Information for Health Care Professionals" at the POLST Paradigm website; also,  S. Tolle, S. Hickman, J. Newman, The National POLST Paradigm Initiatve, page 4.  For a history of POLST in Oregon, and what to look for in other states, see  State Initiatives in End-of-Life Care, Issue 3, April 1999, "Implementing End-of-Life Treatment Preferences Across Clinical Settings."
[3] Testimony of Ann Jackson, MBA, Executive Director, Oregon Hospice Association, before the Senate Committee on Judiciary Subcommittee on the Constitution, Civil Rights, and Property Rights, “The Consequences of Legalized Assisted Suicide and Euthanasia”, Thursday, May 25, 2006.

DOCTORS SEE WAY TO CUT SUFFERING IN EXECUTIONS. A flood of lawsuits challenging lethal injection as cruel and unusual has stalled executions in some states and may prompt others to abandon them. And a Supreme Court ruling last week made it easier for death-row prisoners to file such suits. At the core of the issue is a debate about which matters more, the comfort of prisoners or that of the people who watch them die. A major obstacle to change is that alternative methods of lethal injection, though they might be easier on inmates, would almost certainly be harder on witnesses and executioners. With a different approach, death would take longer and might involve jerking movements that the prisoner would not feel but that would be unpleasant for others to watch. "Policy makers have historically considered the needs of witnesses in devising protocols" for execution, said Dr. Mark Dershwitz, a professor of anesthesiology at the University of Massachusetts who has testified about the drugs used in lethal injection.
"There's an innumerably long list of medications that can be given to cause someone to die," Dr. Dershwitz said. But, he added, the emphasis on ensuring a speedy death may have prevented states from considering all the options.
Deborah W. Denno, a Fordham University law professor who is an expert on execution methods, said speculation about whether any states would change their procedures was "the question of the moment." Professor Denno said some states might tinker with their procedures just enough to avoid court cases.
And Dr. Jay Chapman, a forensic pathologist who created the nation's first lethal injection protocol, in Oklahoma in 1977, said that were he to do it once more, he would not recommend the three-drug concoction now in widespread use.
Instead, Dr. Chapman said, an overdose of one drug, a barbiturate — the method veterinarians use to end the lives of sick animals — would painlessly cause prisoners to lose consciousness, stop breathing and die. "Hindsight is always 20/20," he said.
Even some opponents of the death penalty favor such a change in lethal injection technique, reasoning that if execution cannot be banned, it should at least be made more humane.
Dr. Chapman's original approach, still the policy in the federal prison system and in most of the 37 death-penalty states that use lethal injection, calls for an overdose of a barbiturate, sodium thiopental, which causes unconsciousness and in sufficient doses can also halt breathing. The sodium thiopental is followed by two other drugs: pancuronium bromide, or Pavulon, which causes paralysis and halts breathing as well, and potassium chloride, which stops the heart within seconds.
But opponents of lethal injection say that in some cases, the second and third drugs may cause severe suffering. They argue that the drugs may be mishandled because most doctors and nurses refuse to participate in executions, leaving the responsibility to people with less training.
If the sodium thiopental did not work because the dose was too low, for example, or if the drugs were given in the wrong order, an inmate could still be conscious when the paralyzing drug and the potassium were injected. In that case, the paralyzing agent would cause a feeling of suffocation. And the potassium chloride would cause a burning sensation, muscle cramping and chest pain like that of a heart attack.
The pain from the potassium would not last long: once the drug stopped the heart, the person would lose consciousness in 10 to 15 seconds, Dr. Dershwitz said. But while the pain lasted, the inmate would be paralyzed and unable to complain, and would appear serene to witnesses.
Pavulon "gives a false sense of peacefulness," said Dr. David A. Lubarsky, chairman of anesthesiology at the University of Miami.
Indeed, because drugs like Pavulon can mask suffering, many states outlaw them for animal euthanasia.
Execution by barbiturate alone would take longer than the current method, Dr. Dershwitz said. Although prisoners would quickly lose consciousness and stop breathing, they could not be pronounced dead until electrical activity in the heart had stopped. That could take as long as 45 minutes.
In addition, Dr. Dershwitz said, barbiturates could cause "significant involuntary jerking" that would be disturbing to witnesses even though an unconscious prisoner would not feel it.
Intravenous barbiturates are not the only option, Dr. Dershwitz said. Drugs could also be injected into a muscle instead of a vein, to avoid another source of lawsuits: pain among inmates whose veins are hard to find. But injection into a muscle would take much longer to work than the intravenous method.
Another possibility might be an oral dose of barbiturates, like those doctors in Oregon can prescribe to assist suicide of some terminally patients. But prisoners would have to swallow the pills, and Professor Denno said there had never been a procedure in which prisoners had been required to participate in their own executions, essentially agreeing to commit suicide.
Dr. Chapman said that when he first proposed the three-drug technique, he imagined that it would be carried out by people with enough medical training to start intravenous lines, mix and measure the drugs, and give them in the right order.
He was then Oklahoma's chief medical examiner, and came up with the formula at the request of a legislator who was looking for a humane alternative to the electric chair. His idea became law in Oklahoma and was also adopted by 36 other states.
Once the lethal injection laws were passed, professional groups like the American Medical Association, state medical societies and associations for anesthesiologists and nurses quickly distanced themselves, saying it would be unethical for members to participate. That creates a Catch-22 in which the medical establishment refuses to perform lethal injections and yet says no one else is qualified to do so.
Although some doctors and nurses do help in executions, lethal injection in many states is carried out by paramedics, technicians or other prison employees who do not have special training in anesthesia.
Dr. Chapman said that his original protocol had called for enough barbiturate to cause death by itself and that he had added the Pavulon just as a backup, and the potassium chloride to speed the process by stopping the heart quickly. "I think the whole concept of execution is that it's carried out rapidly," he said.
Whether inmates have actually felt pain or suffocation from lethal injection is not known with certainty.
[DENISE GRADY 23June06, http://www.nytimes.com/2006/06/23/us/23inject.html?ei=5065&en=daf2ded5144d01be&ex=1151726400&partner=MYWAY&pagewanted=all]

2004 "GREATEST CANADIAN” AND FATHER OF MEDICARE WAS “MERCILESS” EUGENICIST
Recently, Canadians voted in a nationwide contest for who they thought was the “Greatest Canadian” of all time. They chose socialist icon, Tommy Douglas, the “father of medicare,” and founder of the extreme left party, the New Democrats.

The 2004 “Greatest Canadian”, however, held views on the poor and disabled that his zealous fans on the left would like to keep quiet. In the July 3 edition of the Western Standard, John Robson quotes Douglas’ 1933 master’s thesis, where he argued that “The subnormal family presents the most appalling of all family problems.”

“Because this class tend[s] to intermarry…the second and third generations are nearly always worse than the first. The result is an ever increasing number of morons and imbeciles who continue to be a charge upon society.”
In his thesis, titled The Problems of the Subnormal Family, Douglas went on, “This does not include the generally low tone of morality among these people, which cannot be shown by statistics, but which is very low.”
Robson says that Douglas, as a man of the rapidly advancing left in the early 20th century, joined his like-minded peers in the US and Europe early on, before his political career, in adhering to the eugenics philosophy. And, as Robson says, he was a proponent “in the most merciless terms.”
Douglas advocated sterilization for the morally, physically and mentally “unfit,” using terms such as “defective” and “moron,” to describe those who, he said, should not be allowed into the mainstream of Canadian society. 
The “subnormal,” he said, should merely be educated in effective methods of contraception once a predetermined family size had been reached.
His thesis recommended compulsory certificates of “mental and physical fitness” saying, “Society does not hesitate to segregate criminals, lepers or any others that threaten the well-being of society.” It recommended that the state should operate “farms” or “a colony where decisions could be made for them by a competent supervisor.”
Although Robson goes on to say that Douglas appears to have later abandoned his early devotion to the eugenics philosophy, he points out, “One cannot simply dismiss these views as youthful folly; when he wrote it, he was nearly 30 years old.” Robson suggests that a visit in 1938 to Hitler’s Germany, where eugenics was being violently implemented on real people, was the “eye-opening” that ended his “flirtation” with the philosophy.
In its declaration of Douglas as the “Greatest Canadian of all time,” the CBC said, “From his first foray into public office politics in 1934 to his post-retirement years in the 1970s, Canada's 'father of Medicare' stayed true to his socialist beliefs -- often at the cost of his own political fortune -- and earned himself the respect of millions of Canadians in the process.”
Historically, eugenics has been a popular and integral element of leftist ideology that holds the good of the state above that of individuals. Prominent statists in the United States in the early 20th century advocated Margaret Sanger’s birth control program as a means of ridding society of mentally or morally undesirable people, poor immigrants, and for controlling the black population. Sanger’s theories were taken up by many who remain influential in international politics and who promote the organization Planned Parenthood, which she founded.
The Western Standard, in a sidebar article, points out some others among liberal icons of Canadian mythology who were also supporters of racial eugenics. Emily Murphy, the subject of a loving government-funded TV spot as the hero of the early Canadian women’s movement, wrote, “It sometimes seems as if the white race lacks both the physical and moral stamina to protect itself, and that maybe the black and yellow races may yet obtain the ascendancy.”
Mrs. Murphy was included in the recently minted Canadian fifty-dollar bill along with the other members of the so-called “famous five” – women widely credited with beginning the movement for ‘women’s rights’ in Canada and to whom a statue is erected on Parliament Hill. The famous five were all signatories of the infamous Albertan Sterilization Act, which victimized nearly 3000 “mental defectives” between 1928 and 1972.
 Read Douglas’ master’s thesis:
http://www.westernstandard.ca/douglas
Read related LifeSiteNews.com coverage:
Famous Five Statue Honours Racism and Eugenics Advocates
http://www.lifesite.net/ldn/2000/oct/001018a.html
McGill Speaker Condemns New 'Eugenics'
http://www.lifesite.net/ldn/2002/oct/02101003.html
[CALGARY, June 23, 2006 LifeSiteNews.com, Hilary White]