The intentional killing of human beings is NOT health care.
July - April 2009: End of Life, Euthanasia, Assisted Suicide
Doctors Missing Consciousness in Vegetative Patients
Switzerland Attempting to Curb "Suicide Tourism" with Stricter Regulations
British Medical Association Reaffirms Opposition to Assisted Suicide at Conference
Washington State Olympic Medical Center Changes Position on Assisted Suicide
Doctors Face Orders to 'Kill on Demand': New Assisted Suicide Law Requires Physicians to Act
The Slippery Slope Gets Oiled: Suicide on Demand for the Healthy: 'It's a Marvelous Possibility for All' says Dignitas Boss
Death Watch: Final Exit's Clandestine Ways Have Put the Assisted-Suicide Network on Life Support
Nurse Charged With Injecting 10 Patients With Bleach, Killing 5
Montana Doctors Refuse To Participate In Assisted Suicide...
Doctors Missing Consciousness in Vegetative Patients
If there's one thing worse than being in a coma, it's people thinking you are in one when you aren't. Yet a new comparison of methods for detecting consciousness suggests that around 40 per cent of people diagnosed as being in a vegetative state are in fact "minimally conscious".
In the worst case scenario, such misdiagnoses could influence the decision to allow a patient to die, even though they have some vestiges of consciousness. But crucially it may deprive patients of treatments to make them more comfortable, more likely to recover, or to allow them to communicate with family, say researchers.
In a vegetative state (VS), reflexes are intact and the patient can breathe unaided, but there is no awareness. A minimally conscious state (MCS) is a sort of twilight zone, only recently recognised, in which people may feel some physical pain, experience some emotion, and communicate to some extent. However, because consciousness is intermittent and incomplete in MCS, it can be sometimes very difficult to tell the difference between the two.
In 2002 Joseph Giacino at the JFK Rehabilitation Institute in New Jersey and colleagues released the first diagnostic criteria for MCS. Then in 2004, Giacino released a revised coma recovery scale (CRS-R) – a series of behavioural tests based on criteria that can be used to
distinguish between the two states.
Alarm 'appropriate'
To see if the revised scale improves diagnoses, Giacino and Caroline Schnakers of the Coma Science Group at the University of Liege in Belgium, with colleagues, spent two years using CRS-R to re-diagnose patients admitted to a network of Belgian intensive care units and neurology clinics with head injuries that resulted in some kind of disturbance to consciousness.
The clinics and units all used a "clinical consensus" agreed by a range of specialists to diagnose patients. Some of the specialists relied on qualitative, "bedside" observations to diagnose patients, others used older diagnostic tools, but none used the CRS-R – the only one designed specifically to distinguish between MCS and VS.
Of the 44 patients diagnosed as being in a vegetative state by the clinicians, the researchers diagnosed 18, or 41 per cent, as being in a MCS according to the CRS-R.
"We may have become much too comfortable about our ability to detect consciousness," concludes Giacino. "I think it's appropriate for there to be some level of alarm about this."
Giacino concedes that, because there is no objective way to measure consciousness, he cannot exclude the possibility that the reason for the discrepancy is that the CRS-R is over-diagnosing MCS.
Examiner bias
However, Schnakers argues that CRS-R should be more accurate because it specifies how many times each test must be repeated – and how many responses are needed to give an indication of
consciousness.
This, she says, guards against missing awareness in someone who pops in and out of consciousness, or mistaking a reflexive response for a response based on consciousness. It should also control for "examiner bias", where someone subjectively decides whether the patient is conscious or not, adds Giacino.
What's more, the revised scale also makes use of some new insights. One sign of consciousness is whether someone follows the path of a moving object, known as "visual pursuit". Many clinicians simply look at whether someone follows a moving pen or person, says Schnakers.
The CRS-R specifies the use of a mirror, which she argues may prompt a reaction in someone who is conscious, but who does not respond to a moving pen. "When you move an object, it is less powerful," she says.
'Death or survival'
So why do clinicians still use the qualitative assessment? "Their focus is more typically on death or survival" and on biological factors that need treatment, such as how long a patient needs to be in an intensive
care unit, says John Whyte of the Moss Rehabilitation Research Institute in Philadelphia, Pennsylvania, who was not involved in the study. "For their purposes, the distinction [between MCS and VS]
doesn't matter much."
For the patient and the family, the difference between MCS and VS can make a huge difference, though. Drug treatments, painkillers, physical therapies designed to stimulate the brain, as well as techniques for encouraging communication, are more likely to be given to someone in a MCS.
In some jurisdictions, whether food can be withdrawn may depend on whether or not they are in a VS, says Whyte. "It's very important to be sure of the diagnosis," says Schnakers.
Switzerland Attempting to Curb "Suicide Tourism" with Stricter Regulations
Swiss prosecutors in the region of Zurich have instituted stricter regulations that are intended to curb the growing problem of "suicide tourism," reports The Telegraph.
Numerous high-profile cases over the last several years of foreigners traveling to Switzerland to commit suicide - including the recent case of a renowned U.K. conductor and his wife - have brought the country's macabre suicide trade into the limelight, and appear to have triggered
concerns by Swiss officials that their country is becoming famous largely for being the premiere spot in the world to kill oneself. As of late last year approximately 100 U.K. residents had committed suicide
with the help of the Swiss group Dignitas, although individuals from numerous other countries have also used Dignitas' "services."
Prosecutors in Zurich have now announced arrangements with the country's second largest assisted suicide group, EXIT, that will see significant restrictions placed upon the process of obtaining the group's help in committing suicide, reports the Telegraph.
The new regulations come three years after federal Swiss politicians declined to institute any new legislation to address the growing problem. Swiss Justice Minister Christoph Blocher said in June 2006 that "the cabinet had come to the conclusion that [new legislation] was not necessary."
Cabinet spokesman, Christoph Blocher, also said there were also no plans to examine or monitor Dignitas or other euthanasia groups, that to do so would create too much "bureaucracy" and lend such groups legitimacy.
While the federal government has demurred from addressing the situation however, it appears that the local government in whose district hundreds of people have killed themselves for a fee, are less willing to let the suicide trade continue totally unmolested.
The new regulations will require that prospective suicide customers go through an extended counseling period, over a period of several months, to ensure that they truly wish to die. In addition, the doctors who prescribe the fatal drugs must meet the person at least twice. The regulations also place a cap on what people can be charged for suicide.
Zurich Justice Minister Markus Notter said, in announcing the new regulations: "Suicide trips to Switzerland are not going to be banned but there are going to be stricter controls; so called 'quick suicides' for foreign patients are set to be outlawed.
"It is essential that people decide by their own free will. They also need to be informed about alternatives such as palliative care."
While EXIT president Hans Wehrli publicly welcomed the new regulations (which are set to go into effect in the fall), Dignitas president Ludwig Manelli lambasted them, characterizing them as being directly targed at Dignitas and consistent with a "police state." Once the regulations go into effect, Dignitas will either have to abide by them or move their operations out of Zurich, according to the Telegraph.
That EXIT would be more open to the regulations is unsurprising, however, since the group already has a policy of refusing suicide requests from foreigners. Dignitas, on the other hand, has developed a reputation for its openness to and outright encouragement of suicide tourism, as well as its extreme position on who should or should not be permitted to legally commit suicide.
Dignitas has also been heavily criticized for its large fees and has been accused of being in the business simply to make a profit.
Bioethicist Wesley Smith responded to the news about the new regulations by pointing out that Dignitas and Exit are doing little to
boost Switzerland's profile on the world stage. "Switzerland is Jack Kevorkian as a country, a fact that for some, is becoming an embarrassment," he observed. "To try and put a modicum of control on the situation ... the Zurich prosecutor has decided to impose a few limits."
Smith said, however, that the new rules are bound to do little to curb what has become a significant problem. "This only applies in the Zurich area, and besides, is so much hoop jumping," he said. "The only way to
stop suicide tourism is to make assisted suicide illegal.
"Until people 'get' that one can't be for and against suicide at the same time, these restrictions are mere leaky plugs in the dikes that, if they ever apply nationwide, will probably be violated in a very public way.
Then watch as law enforcement backs down."
Related:
Wealthy UK Couple Die at Swiss Dignitas Suicide Facility http://www.lifesitenews.com/ldn/2009/mar/09030904.html
Swiss Lure Suicide Victims: Euthanasia Administered Within 24 Hours http://www.lifesitenews.com/ldn/2004/may/04052509.html
Neighbors Complain Swiss Euthanasia 'Clinic' Parade of Dead Bodies Disturbing http://www.lifesitenews.com/ldn/2006/jun/06060807.html
Mentally Ill have a Right to Assisted Suicide ~ Swiss High Court http://www.lifesitenews.com/ldn/2007/feb/07020206.html [20 July 09, John Jalsevac, Zurich, Switzerland, www.LifeSiteNews.com]
British Medical Association Reaffirms Opposition to Assisted Suicide at Conference
The British Medical Association reaffirmed its opposition to assisted suicide at its annual conference yesterday.
Despite an attempt by MPs to legalize the practice or allow so-called suicide tourism, doctors rejected a call from BMA member Kailash Chand to change its long-held views. Chand hoped to get the BMA to support a position allowing assisted suicide in cases where a patient is terminally ill and has the mental capacity to consent to killing himself.
Doctors also rejected calls to support a position against prosecuting physicians who break the law by participating in an assisted suicide. The motion, which encompassed both issues, was voted down 53-45 percent. [2July09, London, England, www.LifeNews.com]
Washington State Olympic Medical Center Changes Position on Assisted Suicide
Olympic Medical Center in Washington state has changed its position on whether staff and patients will be allowed to pursue an assisted suicide. The decision is a modification of its original one to opt out of participating in the law that made Washington the second state to legalize assisted suicide.
Olympic Medical Center originally said its physicians would not be ones who would assist elderly and terminally ill patients in killing themselves.
However, according to a Peninsula Daily News report, its board of directors held a debate at their May 20 meeting and voted Wednesday night 5-1 to pass the resolution changing its position.
Commissioners Jim Cammack, Arlene Engel, Jim Leskinovitch, John Beitzel and John Nutter approved the pro-assisted suicide measure while Jean Hordyk opposed it, the newspaper indicated.
The OMC board "has received further input from the medical staff and the public in consideration of end of life issues," according to the language of the resolution, since its March 4 vote.
Dan Kennedy, the head of Human Life, the statewide pro-life group, told LifeNews.com he is disappointed with the decision and blamed euthanasia proponents for lobbying the medical center to change its decision.
"It's very revealing, that during the campaign for Initiative 1000, the proponents insisted that no one would have to participate," he said. "After passage, Compassion & Choices has begun a campaign to intimidate hospitals into acquiescence, including a letter-writing campaign to local newspapers."
"If patients must use Olympic Medical Center, they better make certain what their doctor's position is, and be wary of staff," Kennedy added.
ACTION: Contact Olympic Medical Center with your comments against its decision at: Olympic Medical Center, 939 Caroline Street, Port Angeles, WA 98362, (360) 417-7000, email
Related web sites:
Human Life of Washington - http://www.humanlife.net
Olympic Medical Center - http://www.olympicmedical.org
Printed from: http://www.lifenews.com/bio2867.html
[Ertelt, June 5, 2009, Port Angeles, WA (LifeNews.com]
Doctors face orders to 'kill on demand': New Assisted Suicide Law Requires Physicians to Act
Physicians in Montana could be facing "kill-on-demand" orders from patients who want to commit suicide if a district court judge's opinion
pending before the state Supreme Court is affirmed.
The case has attracted nominal attention nationwide, but lawyers with
the Christian Legal Service have filed a friend-of-the-court brief in
the pending case because of what it would mean to doctors within the
state, as well as the precedent it would set.
The concern is over the attack on doctors' ethics and religious beliefs
– as well as the Hippocratic oath – that may be violated by a demand
that they prescribe deadly chemicals or in some other way assist in a
person's death.
M. Casey Mattox, a lawyer with the CLS, told WND that states allowing a
"right to die" across the country – Oregon and Washington – include an
opt-out provision for physicians with ethical or religious opposition to
participating in killing a patient.
Montana's situation, created late last year in a decision from First
District Court Judge Dorothy McCarter in the Baxter et al. v. Montana
case, is different. There is no provision for a doctor to refuse such
"treatment" for a patient.
Just how did America arrive at a court case ordering doctors to help a
suicide? Read it in "The Marketing of Evil: How Radicals, Elitists, and
Pseudo-Experts Sell Us Corruption Disguised as Freedom"
In that case, Robert Baxter, 75, a retired truck driver from Billings
who suffers from lymphocytic leukemia, filed the lawsuit along with four
physicians in the state's district court system. They were aided in the
case by the assisted suicide advocacy group Compassion & Choices,
formerly known as the Hemlock Society.
Baxter told the organization's magazine that society already provides
death when animals are suffering.
"I just feel if we can do it for animals," Baxter said, "we can do it
for human beings."
The CLS, joined by the Christian Medical Association, yesterday filed
briefs asking the state Supreme Court to protect the conscience rights
of healthcare professionals.
The groups, representing more than 18,000 Christian medical and legal
professions, are urging the court to reverse the district court's
decision and recognize a right not to participate in assisted suicide.
"The trial court's decision to create a constitutional right to 'obtain
assistance from a medical care provider in the form of obtaining a
prescription for lethal drugs' threatens the rights of healthcare
professionals and institutions that hold sincere ethical, moral, and
religious objections to participating in the intentional killing of
their patients," Mattox said.
"Medical professionals should not be coerced to violate the Hippocratic
Oath in order to practice in Montana," he said.
If a "right to die" is to be recognized, it should be developed from the
people through the legislative process, not imposed by a single judge,
the brief also argues.
The district decision, the groups also point out, would seriously
undermine the relationship between doctors and patients. Patients could
be uncomfortable knowing their doctor had provided a lethal dose to
another patient, and doctors would have concerns about such demands from
patients.
"At a time when states are experiencing a healthcare shortage, making
Montana the only state in the union to coerce professionals to assist in
suicides could jeopardize the state's healthcare system," Mattox said.
He told WND that the effort clearly is part of a nationwide agenda to
impose and mandate ethical standards on Americans. Similar are the Obama
administration's suggestions that that pharmacists may not have the
right to refuse to dispense abortion-inducing medications, and doctors
may not have a conscience right to refuse to do abortions, he said.
"I don't know where it's coming from, but there is certainly a push from
government to tell people to set aside religious or ethical qualms and
to abide by whatever the government tells you is appropriate," he said.
Mattox said the state still has several weeks to file its briefs in the
Montana case, and then there will be further arguments on behalf of
requiring doctors to provide terminal treatment.
"A mentally competent, terminally ill Montanan should have the right to
choose a peaceful death, when confronted by death," Kathryn Tucker,
Compassion & Choices director of legal affairs, told KTVQ-TV, Billings.
But Montana Assistant Attorney General Anthony Johnston disagrees.
Johnston told the television station, "The laws governing the medical
profession say the medical profession is to heal, not to kill."
[May 02, 2009, Bob Unruh, WorldNetDaily
http://wnd.com/index.php?fa=PAGE.view&pageId=96777]
A Chilling Message -- Suicide on Demand for the Healthy: 'It's a Marvellous Possibility' for All' says Dignitas Boss Dignitas founder Ludwig Minelli said he plans to test the legality of helping a healthy person end their life alongside their terminally-ill partner.The head of the Dignitas euthanasia clinic in Switzerland declared that he believed assisted suicide should be available 'on demand'.
Minelli, whose organisation has supervised the deaths of 100 Britons, said suicide was not just for those already dying but 'a marvellous possibility given to a human being'.
The human rights lawyer said there were no limits on who might be assisted to die, as long as they had the mental capacity to make the choice [ed. then what about coma or 'PVS' patients? If they cannot make the "choice", why are some promoting their killing? This is not logical or consistent.]
'It is without conditions,' he said. 'A human right is without any conditions except capacity.'
[ed.Just because we can, doesn't mean we should...Every freedom has a responsibility.]
Minelli dismissed concerns that assisted suicide should be reserved for the terminally ill as 'a British obsession' and called on Britain to legalise suicide. He told BBC Radio 4 that the UK could even save money by allowing suicide.
[ed. human life is less valuable than money, apparently]
'For every 50 suicide attempts we have one suicide and the others are failing, with huge costs for the National Health Service,' he said.
'In many many cases they are terribly hurt afterwards, sometimes you have to put them in institutions for 50 years, very costly.' [ed. that's why health care should be improved at the front end, to help them deal with their problems before they become despondent.]
But, despite his claim that mental capacity was a key factor in allowing death at Dignitas, Minelli said the organisation had assisted the death of those with mental health problems.
The admission that Dignitas is willing to kill those who are not already dying was immediately condemned by groups that have in the past supported it.
The Dignitas suicide clinic in Zurich, Switzerland
Dignity in Dying, which has campaigned for the right of British families to take terminally ill relatives to the clinic in Zurich, said: 'We need to prevent the needless prosecution of friends or relatives who accompany a loved one to Dignitas.
'But at the same time we need to send out a clear signal that assisting non-terminally ill adults to die is wrong.'
Anti-euthanasia campaigners said Minelli's willingness to kill anyone who requested it bore out fears that legalising assisted suicide for the dying rapidly leads to euthanasia for anyone.
Phyllis Bowman of Right to Life said: 'This is exactly what we have been predicting all along. Before long you will be able to get rid of anyone who is a nuisance.'
There was also criticism of the BBC for allowing Minelli airtime on the Today Programme without any balancing material from critics of assisted suicide.
The flagship news show heard from the journalist who interviewed Minelli for Radio 4's The Report. Simon Cox suggested that doubts over the Swiss clinic were an argument for liberalising the law on assisted suicide in Britain.
Paralysed rugby player Daniel James, 23, committed suicide at the Dignitas clinic in September last year
Simon Calvert of the Christian Institute said: 'The BBC is under an obligation to balance its coverage, and it is breathtaking that on this issue of life and death importance it has not bothered to find anyone to put the case against killing.'
Swiss police are investigating Dignitas over claims from a former assistant that Minelli had taken large donations beyond the standard £7,000 fee from those he helps to die, including one of £;120,000.
Soraya Wernli also alleges that Minelli collects the possessions of the dead, including jewelery and money, and sells them.
In Switzerland, those who assist a suicide need only a psychiatrist's report that says that the subject has the mental capacity to decide whether he or she wishes to die.
There are no further legal sanctions and Swiss law remains vague, drawing no clear distinction between suicides of the terminally ill and others.
Minelli told the BBC that his organisation now hoped to get a court ruling to definitively state if it legally assist the suicide of a healthy woman whose partner is terminally ill.
He added: 'I have a totally different attitude to suicide. Suicide is a very good possibility to escape a situation which you can't alter.
'It is not a condition to have a terminal illness. Terminal illness is a British obsession. 'As a human rights lawyer I am opposed to the idea of paternalism. We do not make decisions for other people.'
Dignitas is thought to have assisted the deaths of around 1,000 people, usually with lethal cocktails of drugs.
Robert and Jennifer Stokes from Leighton Buzzard were in their 50s when they went to Dignitas to die in 2003. The couple had a history of mental illness and failed suicide attempts and both suffered from chronic illnesses.
The Stokes case is among those complained of by former Dignitas nurse Wernli, who said Minelli dismissed concerns over their deaths by saying that depression was an 'irreversible illness'.
Assisting a suicide can bring a penalty of 14 years in jail in Britain, but no one has yet been prosecuted for helping a family member die at Dignitas.
In January Director of Public Prosecutions Keir Starmer QC effectively gave the go ahead for people to take relatives to die in Zurich, saying the tolerance extended to Daniel James's parents was a sign of how British authorities would act in future.
[http://www.dailymail.co.uk/news/article-1166620/Suicide-demand-healthy-Its-marvellous-possibility-says-Dignitas-boss.html, Steve Doughty
3April2009]
Death Watch: Final Exit's Clandestine Ways Have Put the Assisted-Suicide Network on Life Support
From the 2002 edition of Final Exit: How to kill yourself with helium.Jennifer Silverberg
Dalton Baker, a senior exit guide and Final Exit's treasurer, says GBI agents and St. Louis police raided his home and took his files and computer.Subject(s):Final Exit Network, assisted suicide, helium, exit guide, exit hood, Dr. Jerry Dincin, John Celmer, Dr. Lawrence Egbert, Hemlock Society, Derek Humphry, Death With Dignity Act, Compassion & Choices
James Hoggard has helped four people kill themselves. Or, as he and fellow members of the Final Exit Network prefer to say, he has hastened their exits.
The first time took place in a small northern Iowa town three years ago, just after Hoggard joined Final Exit and became what the network calls an exit guide.
The old man was terminally ill. Hoggard can no longer remember his age or diagnosis, though he does recall that, except for one hand, the man's limbs were completely paralyzed. The man and his wife learned of Final Exit on the Internet and called the group's 800 number. Then they explained their case to a volunteer, also known as a first responder.
As network protocol dictates, the responder asked the man a series of questions, 25 in all. Where did he live? Did he have caregivers? Why did he want to end his life? Did his family know of his plans? Did they approve? Was he suffering from depression? Could he please send a list of his medications and a letter from his doctor confirming his diagnosis to the network's medical adviser?
A few weeks later, Hoggard and another exit guide made the journey to Iowa.
Hoggard is 74 years old. He grew up on a farm in Arkansas. For years he was a Baptist minister, until he realized his liberal inclinations were at odds, as he puts it, with a congregation accustomed to fire and brimstone. So he quit, moved to St. Louis and became an auto mechanic.
"I don't want life prolonged unnecessarily," says Hoggard. "I've always felt that people should be able to end their lives on their terms. I can't find anything in the Bible that condemns suicide."
The two guides arrived at the old man's house before dark. They left their car in the garage. "We don't like anybody to see a strange car parked outside," explains Hoggard, who won't identify the town. Again, following network procedure, they looked around for nosy neighbors or security devices that might alert police. Then they went inside.
"We had a long conversation. We talked about careers and neighbors. It was a normal conversation until we got to the purpose of our being there. He knew he didn't have much time left. We talked it over. He signed a paper indicating his intention to do this."
Then the guides left, promising to return a week later. They wanted to give their client time to pause, reflect and be certain of his decision. They also knew he had to buy the needed death supplies: two tanks of helium and an "exit hood," a clear plastic bag with a Velcro band that fastens around the neck, available for purchase over the Internet. Altogether, the helium and the hood would cost him less than $100.
When the guides came back, they brought a spare hood and extra helium, just in case the old man's equipment malfunctioned. They also came with a prepared statement — that he alone made the decision to end his life — for him to sign. Again, they sat in the living room with the man and his wife, chatting idly about neighbors and the weather.
"It was a normal conversation," recounts Hoggard. "I was surprised. Finally, he said, 'I'm ready now.' We went into the other room to give him and his wife a private moment. She did not want to be there when it happened."
Hoggard's bright blue eyes fill with tears. He pauses for a moment to collect himself.
"We went back in. He was lying on a bed. He was wearing the same kind of clothing you might wear at night. He was lying in the same position, like he was going to sleep. He pulled the hood down tightly over his face. He was able to use his hand, and he opened the two valves on the helium tanks.
"It seems to me there's some discomfort for the first minute or so," Hoggard continues. "He raised his head, like he was trying to get oxygen. But there was no more conscious behavior on his part. They're no longer conscious after 30 seconds. The doctors tell us this. After five minutes there was no more bodily action. He was still, but he kept his eyes open. He was the only one I've seen who kept his eyes open.
"We let the helium run out. [The other guide] was able to get the eyes closed. We told his wife he was dead. She sat there with him for a while. Then she told us she was ready for us to leave. We gathered up everything, the empty containers of helium, the hood."
Then they threw everything away, making sure to scatter the equipment in different Dumpsters around town. They instructed the man's wife to delete the e-mail and phone messages that would link his death to the Final Exit Network.
The next morning, after the body had grown cold, she would call the doctor and the undertaker. Helium leaves no traces. By all appearances, the old man had died in his sleep.
"We don't want the medical examiner coming in," explains Dr. Jerry Dincin, a clinical psychologist near Chicago and Final Exit's president. "Otherwise they can't get their insurance money."
The two guides took with them the old man's signed statement.
It was the only evidence that they were ever there at all.
In its literature, the Final Exit Network boasts that it's "the only organization in the United States willing to help individuals who are not 'terminally ill' — six months or less to live — hasten their deaths. No other organization in the U.S. has the courage to make this commitment."
"'Hasten your death' is a key term," explains Dalton Baker, a 71-year-old exit guide who lives in St. Louis and serves as the network's treasurer. "'Killing yourself' trivializes what we're doing."
"One thing everyone says — assumes — is that we do euthanasia," adds Ann Mandelstamm, 69, leader of the St. Louis chapter that formed two months ago. "We don't ever do that. No guide ever administers euthanasia. That term gets our hackles up."
Founded in 2004 as an offshoot of the Hemlock Society, which fell apart the year before, Final Exit has 3,000 members across the country, including 58 exit guides. Annual dues are $50. The network claims it has helped accelerate the deaths of between 130 and 200 terminally ill patients, most of them in New York, Florida and California.
"We're not Jack Kevorkian," says Jerry Metz, a Final Exit board member and retired physician, via telephone from his home in Addison, Maine. "We don't hook people up to a machine and say good-bye. We need to stay within the legal guidelines. There's no law that says you can't be in the same room when someone dies."
"We're operating within the law," insists the 78-year-old Dincin. "But at the margin. No one has decided the limits of assisted suicide in court."
"Some states have criminal laws against assisted suicide, others don't," observes Rebecca Dresser, a professor of law and bioethics at Washington University. (The practice is illegal in Missouri.) "The nature of common law is on a case-by-case basis. These cases are very rarely prosecuted.
"Whenever you help others commit suicide, you're vulnerable to prosecution," Dresser continues. "The requirements for material assistance are what people argue about. You could materially assist by providing knowledge, or by knowing what the person is going to do.
"But it's hard to argue that being there is 'assisting.' There's no legal requirement to be a Good Samaritan and rescue someone unless you have a special relationship, like a health-care provider or parent."
Critics say Final Exit members, especially exit guides, have a skewed moral code. "They color things for their own self-interest," says Stephen Drake, a spokesman for Not Dead Yet, a disability-rights group that vigorously opposes assisted suicide. "They confuse the public about what they're actually doing.
"If you look at the statistics for [assisted suicide], intolerable pain is not the reason most of those people want to commit suicide. They have a fear of being a burden, of future pain, of being alone. Pain is far down on the list. They have a fear of losing autonomy. So Final Exit gets to pat themselves on the back for saying they honor autonomy."
Dr. Timothy Quill, a professor of palliative care, or pain relief, at the University of Rochester School of Medicine, says it is critical that a doctor be part of any assisted suicide. "Very sick people need very sophisticated medical evaluation. It's not for volunteers and activists."
Physician-assisted suicide is legal in Oregon and, as of March 5, in Washington state as well. The requirements of the Death with Dignity Act are stringent: Patients must be within six months of death and certified as terminal by two doctors. They must also file three separate documented requests and wait fifteen days before receiving their lethal prescription. Since it went into effect in 1997, 401 Oregonians have taken advantage of the law.
"Washington and Oregon have good laws," Dincin told the St. Louis chapter at its first meeting in February. "But they don't deal with diseases like ALS [Lou Gehrig's disease] or Alzheimer's or Parkinson's when the time of death is uncertain."
"It can take five years to die from ALS," notes Baker, who is also a hospice volunteer at Barnes-Jewish Hospital. "You become incapacitated. You lose muscle control, and then you eventually choke to death. It's a terrible way to die." (Baker keeps his Final Exit and hospice work separate: "I don't want people accusing me of harvesting patients.")
"I hear doctors say all pain can be managed," Baker continues. "But some pain cannot be controlled, and the only perfect answer is terminal sedation. The doctors give the patient morphine and drive him into a coma. This is an accepted medical practice. But some people don't want to go out that way. They'd rather go out with a good mind and on their own accord."
Final Exit's members refer to the period between the diagnosis of a degenerative illness and the point when a patient is physically incapable of turning the valve on a helium tank as the "window of opportunity."
Dr. Lawrence Egbert, 81, an anesthesiologist affiliated with Johns Hopkins University School of Medicine in Baltimore, is the network's medical advisor. It's his job to sign off on every case. He never actually meets the patients, but he relies on letters from their doctors and records of their initial phone conversations with first responders.
"We get occasional people who want to commit suicide and try to fake us out," says Egbert. "I read very carefully what the doctors and first responders say, and then I make the decision. If I'm uncomfortable, I call someone for a psychological point of view."
But Egbert rarely rejects a patient. Most applicants have given much thought to their decision to end their lives well before calling the network. Sometimes, though, it is difficult to distinguish between a patient who is clinically depressed and one who is depressed because of illness.
"Everybody with cancer gets depressed," Egbert says. "The question is: Is the depression dominant or is the cancer dominant? Sometimes patients just aren't getting enough care."
Says Dincin: "There are plenty of people who don't want to die. Look at Stephen Hawking. He's still living his life. It's not a life I would want to live, but he wants to do what he's doing. Do I have to live that way? The answer to that is no. My life is my life."
On the afternoon of February 25, in Dawson County, Georgia, some 50 miles northwest of Atlanta, Final Exit's clandestine ways finally caught up with the group.
That day, an exit guide named Thomas "Ted" Goodwin, the network's founder and former president, visited a client named Richard Sartain. In the past four years, Goodwin had assisted in 35 deaths, most of them in the southeast.
This was to be Sartain's "death event." He'd bought the exit hood and helium tanks, and Goodwin began to walk him through the exit procedure. He showed Sartain how to put the hood over his head and how to attach a hose to the helium tanks and run it up into the hood.
Then, according to court records, Goodwin climbed on top of him to demonstrate how he would hold Sartain's hands down to keep him from removing the hood. Goodwin later maintained that he only held Sartain's hand to comfort him and let him know he wouldn't die alone.
Sartain did not, as he claimed, have pancreatic cancer. In fact, he was in perfect health. "Richard Sartain" was the alias of an undercover agent for the Georgia Bureau of Investigation (GBI). For the past eight months, the agency had been looking into the June 2008 death of a man named John Celmer.
Celmer was 58 years old and living in Cumming, Georgia. He'd lost part of his face to jaw cancer. His doctors claim he was cancer-free at the time of his death. Still, by some accounts, he was depressed by his appearance and could no longer swallow. His estranged wife found Final Exit pamphlets among his things and called the police.
Goodwin's death rehearsal, says the GBI, is what it will need to prove in court that exit guides helped facilitate Celmer's death.
As soon as Goodwin finished showing the undercover investigator how he would die, agents burst into the house and arrested him. Goodwin was charged with assisting Celmer's suicide, racketeering and tampering with evidence.
The GBI also arrested Claire Blehr, the other exit guide in the Celmer case. In Baltimore, meanwhile, police apprehended Egbert and Nicholas Sheridan, Final Exit's southeast regional coordinator. All four were released on bail, but under the condition that they have no contact with any network member.
After the Georgia sting, search warrants were issued at fourteen locations in nine states, including Missouri, Florida, Arizona and Colorado. GBI agents and local police seized computers and cell phones belonging to members of Final Exit's executive board. They wanted evidence that Final Exit had assisted in other deaths.
Baker says the GBI and St. Louis police broke into his south St. Louis home while he was out and took his computer and files. "I just missed them by ten minutes," he recalls. "I was mad as hell. I refused to talk to them about the network. They called and asked me for my computer passwords. I thought it was kind of strange, because they wanted me to help make their work easier."
Kathleen O. O'Sullivan, a St. Louis Metropolitan Police Department spokeswoman, confirmed that the incident occurred.
On March 2, one week after the Georgia arrests, National City Bank in St. Louis — where Baker kept all the organization's funds — froze Final Exit's checking account when a Georgia judge issued a warrant to classify the network as a "criminal conspiracy" under the Racketeer Influenced and Corrupt Organizations Act (RICO).
"The RICO law is supposed to counter drug trafficking," Baker says. "This is an inappropriate application of that law."
Without money, Final Exit's operations ground to a halt.
"It's unfortunate," says Dincin, who suspects the network will never see its money again. "The GBI is using some tactics that would be better applied to the Hell's Angels and the Mafia and Colombian drug lords. They froze our assets without appearing before a judge. We had $550,000 in the bank. Now we have no money for legal defense. They declared us guilty before the trial even started."
This was not the first time Final Exit's tactics had gotten the group in trouble with the law.
At the time of the Georgia arrests, two exit guides were under investigation in Arizona for their roles in the 2006 suicide of a 58-year-old Phoenix woman named Jana Van Voorhis. (See "Death Wish," Phoenix New Times, August 23, 2007.) Van Voorhis did not inform her family of her plans. After her death her sister and brother-in-law claimed Van Voorhis did not have cancer, as she told Final Exit, but was, in fact, mentally ill.
Dincin concedes he's unfamiliar with the specifics of the Van Voorhis case but maintains that Final Exit did nothing wrong.
"Just because someone has a history [of mental illness] doesn't mean it's available all the time," he says. "There were a host of other difficulties. There were complaints by this woman's sister that she had been disinherited by $700,000. The sister was mad. We don't do anything to anybody they don't want done to them."
After the Van Voorhis affair, though, Final Exit began scrutinizing its clients much more carefully.
The Maricopa County attorney has yet to decide whether to press manslaughter charges against the two exit guides. The case of the so-called "Georgia Four" is also in legal limbo. No trial date has been set.
"We'll see what happens," says Mandelstamm. "This could shut us down. Or, if it comes out in the legitimate press, it could get people talking. When I was young, no one ever mentioned cancer out loud. It was, 'She has'" — Mandelstamm's voice drops to a whisper — "'cancer.' There's a secret phase and a scary phase, and then it's out in the open."
James Hoggard has noticed that sometimes his clients' bodies will jerk and appear to gasp for breath as they die. But he doesn't believe they feel any pain once they pass out.
"We used to kill chickens on the farm by wringing their heads off," he says. "We'd pick the chicken up and swing it around till the body fell off. The body tries to get up and run. Sometimes it takes two or three steps, but it's not controlled by the brain. It's the body reacting."
Since its inception, Final Exit has preferred helium as its killing agent. Says Dincin: "It's quick, painless, certain, comfortable and humane."
In the 1992 edition of his best-selling Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, Derek Humphry recommended prescription drugs — specifically barbiturates, preferably Nembutal — ground up in Jell-O or swallowed with a stiff drink. He also suggested that patients tie plastic bags over their heads, just in case the pills didn't do the trick.
Deadly cocktails of this sort, though, often made patients dependent on their doctors and pharmacists. Humphry decided to bypass the medical profession altogether and, in the 2002 edition of Final Exit, unveiled a new method of painless suicide: inert gases, especially helium, which is easy to obtain.
"You can buy it at Toys 'R' Us!" Dincin proclaimed, to surprised laughter from the St. Louis group back in February.
Normally, you breathe in oxygen and exhale carbon dioxide. Most methods of asphyxiation prevent you from exhaling, so the carbon dioxide accumulates in the body and makes you gasp for air. Helium, however, flushes all the oxygen from the blood, and organs start to die off, one by one, starting with the brain.
Hoggard's companion, Julia Peggs, 64, attempted suicide eight months ago. Final Exit, she says, would not have approved her case. She'd recently had her colon removed and was in despair over the demise of an abusive relationship and unresolved grief over the suicide of her twin sister 30 years earlier.
After the colectomy, Peggs tried to slice herself open. "I was hoping to die in the ambulance because there had been a lot of blood. I felt myself going up and away. It felt wonderful. All the troubles of the world fell away. I thought I would see my sister. I was disappointed when the EMT started slapping my face around and giving me oxygen."
Scientists say that when the body senses impending death, it produces large quantities of soothing hormones, endorphins, to make final moments more pleasant.
Exit guides have also observed this sort of tranquility. Jerry Metz recalls one case where the client's wife sat at his feet with her eyes closed as he pulled the hood down over his head.
"She wanted to be with him, but not," Metz recalls. "She didn't see the 'V for Victory' sign he flashed with a big grin."
Lawrence Egbert joined the Hemlock Society fifteen years ago, after his minister asked him to help a fellow parishioner end his life. In the end, though, the patient didn't go through with it.
"His daughter didn't want it," Egbert remembers. "She thought it was bad, wrong. So he had two more months of Hell on this earth. He was doing what his daughter wanted. Was that better? I don't know. It's hard to argue."
Baker and Mandelstamm joined after witnessing the prolonged, painful deaths of close relatives.
They, like many of Final Exit's eventual members, wanted to be part of what Dincin calls a "direct service organization," more concerned with relieving suffering than trying to change the assisted-suicide laws. Unlike Dr. Kevorkian, who actually pushed the button to deliver fatal drug doses to his patients, the Hemlock Society's volunteers, called Caring Friends, did not play an active role.
When the Hemlock Society finally unraveled in 2003, its more radical members formed the Final Exit Network.
"A group of us got together in Chicago," Egbert remembers. "We said, 'What about the people right now who are suffering horribly?'"
The remaining members of the Hemlock Society evolved into Compassion & Choices, which has some 15,000 members and focuses on hospice care and legalizing physician-assisted suicide. Two days after the Georgia arrests, it released a statement disavowing any connection to Final Exit.
"There is a distinction between aid in dying and assisted suicide," says Compassion & Choices' president Barbara Coombs Lee in a phone conversation from her home in Portland, Oregon. "Assisted suicide is irrational, the result of mental illness. Aid in dying is not mental illness. It's a courageous and prayerful inner dialogue on the meaning of life."
Persis Oberreither, a member of Compassion & Choices in Florissant, says she would never use the helium method. "Visually, it conjures up an image to me of an executioner's hood with gas pumped in. There has got to be a better way. That method is so undignified, it defeats the purpose."
Kurt Perry was scheduled to die on February 26 at his home outside Chicago. The Georgia arrests disrupted his plans. He'd been talking with Dincin and Rosalie Guttman, his exit guides, for three years. "They listen to me and give me advice about how to go through my life," he told the Chicago Tribune, "until my decision is made and I've suffered enough."
Perry, who is 26, has Charcot-Marie-Tooth, a neurological disease that weakens the nerves that control muscles in the hands and feet. It is not considered fatal. Perry can still speak and walk with a cane, and experts say his condition probably won't get any worse.
How can Final Exit justify helping a young man with a non-fatal disease end his life?
"The right to die is a civil right," argues Dincin. "It's not a right of religion to determine, it's not a right of the government, it's not the right of your family and friends. Whose life is it, anyhow?"
"We get a very small number of nut cases who are attracted to our organization," admits network board member Jerry Metz. "Some are lonely, some want the attention and the drama. Some make us jump through hoops until we find out we've been had. Those are darned rare, fortunately.
"We're not interested in talking people into ending their lives," Metz continues. "We try to talk them out of it. Some members get tired and protest that this is what they really want to do."
If clients waver in their decision to die, the exit guides are instructed to walk away.
"There was one woman near New Orleans," Hoggard recalls. "She had told the first responder she was off-and-on about wanting to do this. Her condition had periodic pain, and when the pain was present, she wanted to exit. When it wasn't present, she'd call us and say she wasn't ready."
Hoggard and his partner made three separate trips to see the woman, at Final Exit's expense. Each time, she changed her mind. Finally, says Hoggard, "We told her, 'It's your decision, but we don't think headquarters would want us to come back.' She called us at 4 a.m. and asked us to come back. We went back, and she went through with it.
"I felt OK about it," he continues. "She had gone back and forth the whole time. She knew she could change her mind, but she was in so much misery. She knew what she was doing."
This is one of the contingencies covered at exit-guide training, which takes place three weekends a year, usually at a hotel in a conveniently located city. At training new guides study the group's history and exit procedures, listen to stories from experienced guides, practice handling the hood and helium tanks, and learn how to deal with police. ("We tell them to refuse to say anything until they have a lawyer," Metz says.)
Exit guides say they have few regrets about their work. When describing cases, they speak calmly and matter-of-factly, though some are reluctant to give out specific details.
"It's nicer to die at home with your family if it is your wish and their wish," says Baker. "It can be a very tender experience. One time, there were teenagers involved. We all sat around and held hands. The man's wife said a prayer as he was dying. It was very touching and satisfying."
Says Ann Mandelstamm: "It's not like we do this every week. The cases are spaced apart. The exit-guide part is the most sensational, but really we want to help people with getting older and avoid being caught without advance directives."
Mandelstamm notes that last year in Oregon, 89 people got prescriptions of lethal drugs under the Death with Dignity Act. But only 60 of them decided to use them.
"Most people want to know they have a way out if things get horrible," she says. "They just don't want to do it that week. It makes sense. They're entitled to a way out if they want it."
Hoggard's most recent case was a man in his early 90s who lived near Little Rock. "I don't remember his exact diagnosis. He was becoming less and less mobile, and he knew before too long he wouldn't be able to get out of bed. He talked to his son and daughter-in-law about taking things into his own hands. They went on the Internet and found Final Exit.
"His whole demeanor changed once he realized he could do his exit in a safe way," Hoggard goes on. "He was much less depressed. When he pulled the hood down over his face to breathe the helium, he was so happy to be doing that. I was able to help this man do what he wanted to do and, in my opinion, needed to do." [8Apr09, Aimee Levitt, http://www.riverfronttimes.com/content/printVersion/707741, Jennifer Silverberg]
Nurse Charged With Injecting 10 Patients With Bleach, Killing 5. A former nurse has been charged with injecting 10 patients with bleach — killing five of them — at a dialysis center in Lufkin.
Kimberly Saenz has been indicted by an Angelina County grand jury on one count of capital murder and five counts of aggravated assault. She's charged with injecting bleach into the blood stream of her dialysis patients over a span of four weeks last April.
Family members of several DaVita patients who died at the clinic last April have long speculated about the nurse, and were not surprised by the indictments. The Lufkin Daily News first reported the indictments. [1April 2009 http://www.foxnews.com/story/0,2933,512117,00.html, Lufkin, TX]
Montana Doctors Refuse To Participate In Assisted Suicide
After Montana joined Washington and Oregon in legalizing physician-assisted suicide late last year, Montanans trying to kill themselves are having trouble finding a doctor to fill their "exit prescriptions."
The Denver-based assisted suicide advocacy group Compassion & Choices (formerly the Hemlock Society) is seeking to attract doctors willing to help patients exercise their "constitutional right to physician-assisted suicide" in Montana by releasing a statement from a 67-year-old woman who was not able to find a doctor willing to prescribe lethal drugs.
"It's really sad," said Kathryn Tucker, a lawyer for Compassion & Choices, in an Associated Press report. "Here we are after the ruling and Janet Murdock can't exercise that right."
The Montana Medical Association, which represents physicians in Montana, issued a policy statement following the December 2008 ruling by First Judicial District Court Judge Dorothy McCarter which allowed doctors to help people kill themselves without facing penalties under the state's homicide laws.
"The Montana Medical Association does not condone the deliberate act of precipitating the death of a patient," the policy states, "and does not accept the proposition that death with dignity may be achieved only through physician-assisted suicide."
Dr. Kirk Stoner, president of the Montana Medical Association, said assisted suicide goes against the group's code of ethics.
"Our reason for being is to care for our patients," he said in the AP report.
Conservative bioethicist Wesley J. Smith praised the Montana Medical Association for "refusing to cooperate with the suicide agenda" and pointed out that assisted suicide proponents have twisted the meaning of the Hippocratic Oath to defend their position.
The Compassion & Choices (Hemlock Society) blog states that, "The Hippocratic Oath demands this foremost from physicians: Do No Harm. Prolonging the suffering of a dying person is doing harm. Offering a choice to end the suffering, if that is what the person desires, is the way to do no harm."
Smith notes that the Oath actually states: "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. But I will preserve the purity of my life and my arts."
Montana District Court Legalizes Assisted Suicide
http://www.lifesitenews.com/ldn/2008/dec/08120808.html
[7Apr09, T. M. Baklinski, Helena, MT, www.LifeSiteNews.com]
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