Euthanasia meeting cancelled in Qld

Voluntary euthanasia advocate Philip Nitschke says a public meeting he was due to host in Queensland has been cancelled because the subject is seen as too controversial.

Exit International director Dr Nitschke said the meeting, scheduled for Tuesday afternoon at the Grand Central Shopping Centre in Toowoomba, 127km west of Brisbane, was going to discuss the history of the voluntary euthanasia movement in Australia.

The shopping centre cancelled the event the same day it was advertised in the local press, he said.

Dr Nitschke said bookings had been taken from more than 40 people, with some travelling from as far as Magnetic Island, in far north Queensland.

He said he feared the community forum was cancelled because he was a "controversial figure" and would not be appropriate to host the meeting.

"It is a coincidence indeed that the venue should pull out on the very same day we ran an advertisement in the Toowoomba Chronicle advertising the public meeting," Dr Nitschke said.

"This type of censorship of what can and can't be discussed in a public forum shames Australia," he said.

"If some people are upset with the subject material they should come along to the meeting and air their views.

"It is not good enough to stifle discussion even taking place."

Exit International is considering holding the meeting in a car park or public park near the shopping centre.

A spokeswoman at the shopping centre said no one was available to talk to the media on Saturday.

Where there's a will, there's a relatively messy squabble

Australian gets jail time for euthanasia

13Nov08

By KRISTEN GELINEAU 

SYDNEY, Australia (AP) — Alzheimer's battered Graeme Wylie so much that he could no longer recall his own birthday or remember that he had children. But, his partner said, Wylie did know this: Life was no longer worth living.

So, Shirley Justins obliged her sweetheart of 20 years, handing him a lethal dose of drugs. What she called an act of love, an Australian judge labeled manslaughter and sentenced the 60-year-old Justins to spend several days a week in jail for nearly two years.

Supreme Court of New South Wales Justice Roderick Howie insisted the case was not about euthanasia's morality. Instead, he wrote in his decision Wednesday, it centered on whether the 71-year-old Wylie had the mental capacity to decide that he wanted to die.

Assisted suicide is illegal in Australia, as it is in most of the world. Some places, like Oregon and Washington in the United States, allow physician-assisted suicide. The Netherlands decriminalized doctor-assisted suicide in 1993.

Wylie's case, however, prompted debate about a delicate dilemma in an already morally complicated question: At what point does a person advancing through Alzheimer's — a degenerative, terminal disease that is the most common cause of dementia — lose their ability to decide to die?

"They wouldn't be able to make it for themselves; somebody would make it for them," said Dr. Rosanna Capolingua, president of the doctors' professional group the Australian Medical Association. "And would we be able to do that?"

Capolingua said a person suffering advanced Alzheimer's could not be trusted to make the choice attributed to Wylie, raising the question of influence by outsiders.

In Wylie's case, his daughter said, she was kept out of the critical decision.

"She did deceive our family, she did deceive Dad," Wylie's daughter, Tania Shakespeare, said after the sentencing. "I'm heartbroken that I wasn't able to say goodbye to my father."

Alzheimer's patients are particularly vulnerable as their cognition level can vary daily, said Roy Jones, director of the Research Institute for the Care of Older People, a nonprofit group in the United Kingdom.

"I think the problem is that as the course of Alzheimer's progresses, the person's ability to make decisions for themselves becomes more and more difficult and ultimately impossible," Jones said. "I don't think there's an easy answer."

Wylie, a former commercial airline pilot and the father of two daughters, was diagnosed with Alzheimer's in March 2003. Over the next two years, according to the judge's sentencing report, his mental faculties declined; he stopped reading newspapers and had difficulty making conversation.

By 2005, tests showed he had "severe cognitive impairment." That September, he tried to cut his wrists, but survived.

That month, he told Justins he wanted to enlist the help of Dignitas, a Swiss organization that helps incurably ill people end their lives. It is legal in Switzerland for foreigners to travel to the country to commit assisted suicide, and dozens do so each year.

Dr. Philip Nitschke, a pro-euthanasia campaigner nicknamed "Dr. Death" by the Australian media, assessed Wylie and found that although he couldn't remember his date of birth, or whether he had children, he still had the presence of mind to decide his own fate.

But Dignitas rejected Wylie's application, saying it was unclear whether he had the cognitive ability to decide to die.

Wylie later tried to poison himself on lawnmower fumes, but again, survived. In March 2006, Justins handed him a lethal dose of a barbiturate and watched him drink it. She said he died within seconds.

"I believe that generally the offender was caring and supportive of the deceased and compliant to his wishes," Justice Howie wrote. "There is little doubt that he was genuine in seeking death through the Dignitas application."

Nevertheless, the judge found, shortly after the Dignitas application was rejected, Wylie's mental state had deteriorated to the point where he could no longer make a decision about ending his life. Justins, he argued, should have realized the situation had changed.

Nitschke, who followed the case closely and met Wylie several times, said there was no doubt about Wylie's wishes.

"He got what he wanted — a peaceful death," Nitschke told The Associated Press. "You can have significant dementia, but still know in an overwhelming way that your one desire is (for) a peaceful death."

Right-to-die law being debated

THE Greens have introduced legislation to the South Australian Parliament to allow voluntary euthanasia.

Greens Upper House MP Mark Parnell said his Bill would stretch existing laws on medical treatment rather than create new, stand-alone, regulations.

"I have watched closely previous debates in South Australia and interstate and have attempted to allay the concerns of opponents,'' Mr Parnell said.

"I am introducing a fresh approach to balance the need for protection for the vulnerable with the right to die with dignity.''

The Greens Bill adds voluntary euthanasia provisions to the existing Consent to Medical Treatment and Palliative Care Act.

It will also provide safeguards, including the introduction of a five-person board, involving medical and palliative care experts, which would need to give final approval before a physician could act.

The board would have the power to investigate, seek further psychiatric or other medical testing and hear from concerned family members.

"It's well and truly time for a fresh debate in SA,'' Mr Parnell said.

"Worldwide, there is increasing support for similar laws.''

Mr Parnell said South Australia was once a trailblazer on social reform and it now had a great chance to again take a lead.

"Overwhelmingly the SA community wants the law to change,'' he said.

"It's time for the SA Parliament to once again have this debate.''

Previous attempts to introduce voluntary euthanasia laws in SA by the Australian Democrats and by independent MP Bob Such faltered, despite the issue being subject to a conscience vote.

'Bloody mess' ends in detention

Main: Guilty of manslaughter and sentenced to nearly two years of weekend detention, Shirley Justins, who helped her partner Graeme Wylie (inset) die, leaves the Supreme Court yesterday.

Geesche Jacobsen
November 13, 2008

THERE is probably one thing the euthanasia campaigner Philip Nitschke and the family of Alzheimer's sufferer Graeme Wylie would agree on: the man's death in March 2006 from the drug Nembutal resulted in a "bloody mess".

Yesterday, as Mr Wylie's long-term partner Shirley Justins was sentenced to nearly two years of weekend detention, Dr Nitschke and her other supporters remained unrepentant.

But Mr Wylie's daughters remained equally strong in their castigation of the two women who were convicted over their father's killing.

Justins was sentenced for his manslaughter, and Mr Wylie's friend Caren Jenning took her life after being found guilty of being an accessory before the fact of manslaughter.

Justice Roderick Howie yesterday painted Jenning as the dominant of the two women, describing her as "manipulative and dishonest" and more criminally liable.

He expressed the need to denounce the killing which, as the "calculated and unlawful taking of human life, is an affront to … civilised society".

The Supreme Court jury found Mr Wylie lacked the capacity at the time of his death to decide he wanted to die.

If Justins had not received any prison sentence, many in society would have seen her mere conviction "as a badge of honour", Justice Howie said. "In this case there appears to be an attitude which found its expression in some of the media coverage … that somehow the conduct of the [women] was justified or at least of a different moral order than other criminal conduct that results in the loss of life."

Justins still believed she had carried out her partner's wishes, Justice Howie said.

Jenning's daughter Kate Jennings rejected Justice Howie's description of her mother as a criminal. "To be portrayed as a criminal and mastermind is abominable." Her mother had spent her life helping other people including Mr Wylie, Ms Jennings said, but she would have accepted the greater blame to obtain a lighter sentence for Justins.

Dr Nitschke, founder of the euthanasia group Exit International, said outside court he believed the women had done the right thing, but should have done it in a way that did not get them into so much trouble.

He praised the "lenient sentence" but maintained Mr Wylie knew he wanted to die.

Mr Wylie had been selfish by failing to obtain the drug Nembutal for himself earlier - Jenning was also convicted of illegally importing it from Mexico. If he had planned ahead he would not have exposed two women who loved him to the ordeal of prosecution, Dr Nitschke said.

"It was an act of some selfishness on the part of Graeme Wylie that he got the peaceful death that he wanted and left behind this bloody mess."

Mr Wylie's daughter, Tania Shakespeare, said the "morals and ethics" of the two women had been "out of line". Justins had deceived Mr Wylie and his family, and Jenning had lied and fabricated evidence, she said. Her father was not happy to have Alzheimer's but did not want to die. "He needed better treatment and care."

Exit International was a "cult", she said, which people followed and they became "mesmerised by Dr Nitschke". She and her sister were deprived of a chance to say goodbye to their father.

Periodic detention for 'cruel' euthanasia killer

12Nov08

'Cruel and selfish': Shirley Justins (AAP: Sergio Dionisio)

A judge has sentenced a "selfish and cruel" 60-year-old woman to at least 22 months of periodic detention for killing her partner with a euthanasia drug.

In June, Shirley Justins was found guilty of the manslaughter of Alzheimer's sufferer Graeme Wiley, who died from an overdose of Nembutal in his Sydney home in 2006.

The court heard Justins took the 71-year-old former Qantas pilot to change his will a week before he died, leaving her most of his $2.4 million estate.

It was told she was influenced by family friend Caren Jenning, who was convicted of being an accessory after travelling to Mexico to get the drug.

Ms Jenning committed suicide in September. The 75-year-old cancer sufferer said she did not want to die in jail.

In sentencing Justins today, Justice Howie said while she believed she was doing what her partner of 18 years wanted, she knew he lacked the capacity to decide whether to take his own life.

The judge said Justins was "selfish and cruel" for denying her partner's daughters the chance to say goodbye.

He sentenced her to 30 months of periodic detention, with a non-parole period of 22 months.

Justice Howie said the case was unusual and Justins has no prior convictions.

She had pleaded guilty to the lesser charge of aiding and abetting suicide.

Justins had argued that although her partner had Alzheimer's, he knew he wanted to die and had twice tried to kill himself.

She was found guilty of manslaughter after a five-week trial.

Urgent call for `let me die' option

Kim Thomas Health Reporter - The Press |

Saturday, 08 November 2008

A nationwide system of let-me-die orders for those who do not want to be revived after a collapse is urgently needed, says Canterbury's outgoing health chief.

Canterbury District Health Board chief executive Gordon Davies, who retires next week, told the board he supported the development of a nationwide advance-directives scheme.

Advance directives are instructions written by the healthy on how they want to be treated when they are deteriorating, including whether they want to be resuscitated. They are also known as living wills.

Davies' proposal was attacked by Age Concern Canterbury chief executive Andrew Dickerson, who said it could lead to elderly people who saw themselves as a burden not getting necessary care.

Davies said he had indicated to the Ministry of Health he was happy to work on a project to investigate the use of advance directives.

End-of-life care needed to be publicly debated, he said.

He used the example of a man whose mother had drawn up an advance directive saying she did not want to be resuscitated, but when she collapsed on the street, this instruction, asserted by her son, was ignored by ambulance staff.

She was resuscitated on the street in an "undignified" situation that was against her wishes and upsetting for her family, Davies said.

Dickerson, a health board member, said he would oppose Davies in any public discussion on advance directives. "Clinicians have to make instant decisions. No advance directive should get in the way of this."

Dickerson said frail and vulnerable elderly people could be pressured by some family members to refuse medical treatment.

Dr David Galler, principal medical adviser to Health Minister David Cunliffe, said end-of-life treatment was a sensitive area, but one that needed to be debated.

Advance directives gave people the chance to express what they wanted.

It was not euthanasia, he said.

Advance directives were most useful for extremely old people or those with chronic diseases who would not have a good quality of life or would be unlikely to recover from a serious turn or decline in condition, he said. Many hospital patients received "aggressive" and "disrespectful" investigations and treatment that were unlikely to prolong their life by much.

If they had the chance to choose, after informed discussion, many of these people might prefer to die at home with less aggressive palliative care, Galler said. A Melbourne hospital was trialling the use of advance directives that had been successful in allowing patients to end their lives receiving the kind of treatment they desired.

Advance directives were also being trialled in cancer set-tings and would become more common in future, Galler said.

Guilty plea on suicide pact

By Milanda Rout

8th November, 2008

THEY were found in each other's arms, a married couple of 55 years nestled beneath blankets and a doona in the bedroom of their Victorian home. Bernard Rolfe hugged his wife, Janetta, who lay facing him.
It could have been a picture of any elderly couple resting at home except for two tragic things.

A gas bottle was next to the bed and a short rubber hose connected to its valve had been run over Mr Rolfe's hip and under his arm. And a suicide note was found in the pair's dining room, where they would have shared countless breakfasts, lunches and dinners together.

``I am sick of the meals on wheels, and other food cooked, they are tasteless and Janetta cannot eat them,'' the note read. ``We don't want to be parted or put in a home. Janetta told me tonight there is only one way out. We have had a long happy life together and need peace -- Bernard.''

The Rolfes were discovered early on November 17 last year when a community care worker smelled gas after going to visit them at their Inverloch home on Victoria's southeast coast.
After repeatedly knocking, the carer called the authorities. Firefighters and ambulance officers arrived and found the couple in their bedroom.

Mrs Rolfe, 84, was dead and Mr Rolfe, 80, was unconscious. Paramedics administered oxygen to Mr Rolfe, who regained consciousness and was rushed to hospital. In the ambulance, he told paramedics: ``Leave me alone. Let me go.''

Yesterday, almost a year after they were found, Mr Rolfe pleaded guilty in the Victorian Supreme Court to the manslaughter of his wife of 55 years. His defence lawyer, Mark Rochford, said the now 81-year-old was suffering from depression and helplessness at the time of the suicide pact.

He said Mrs Rolfe had significant health issues -- including Alzheimer's disease and heart problems -- and Mr Rolfe was struggling to cope but did not want his wife to go into respite care.

Mr Rochford said prosecutors accepted it was a genuine suicide pact entered into by both Mr and Mrs Rolfe.
``This is a tragic case, your honour, in all the circumstances. It's a matter that was driven out of depression and desire not to be separated from his wife of a significant period of time,'' he told the plea hearing. ``He accepts now that he should not have committed the offence ... he didn't want his wife to suffer and that was his motivation at the time.''
Mr Rochford urged judge Philip Cummins to sentence his client to a wholly suspended sentence.

But Justice Cummins said he had to be careful about the messages he sent to the community about ``voluntary death''. ``Are there not always issues, even in a clear case like this, of margins being moved? Shouldn't the court be conscious of the dangers of marginalisation?'' he said. ``(There are) a whole lot of moral arguments about the dangers of euthanasia ... to people who perhaps aren't as moral as the accused.

``What happens to a very elderly person who says I am just a burden ... I have got no future. What does the law do about them? ... No matter how sad and tragic the case ... the law and the court should not go down the path of voluntary death.'' He bailed Mr Rolfe to reappear on November 28 to be sentenced.
Section:  LOCAL

Ban threats boost suicide book sales

Euthanasia campaigner Philip Nitschke said sales of the online version of The Peaceful Pill have ''risen steeply'' after Communication Minister Stephen Conroy threatened to censor it.

He said the plan was ``insulting to all Australians'' because it was a ``Chinese-style regime of internet censorship''.
Nitschke's book contains information on Mexican Nembutal and prescription drugs for people who want to end to their own suffering.

Undercover Reporters: Drug Used in Worldwide Euthanasia Faces Crackdown

by Steven Ertelt
LifeNews.com Editor
November 14, 2008

Tijuana, Mexico (LifeNews.com) -- An undercover news team from a television station in San Diego has found that officials in Mexico are cracking down on a drug promoted for suicides. Euthanasia advocates worldwide have been promoting Mexico as a destination to obtain drugs that elderly people or terminally ill patients can use to kill themselves.

As LifeNews.com has reported, at least 200 people from English-speaking countries have traveled to since 2001 to end their lives by obtaining a drug normally used to euthanize animals -- Nembutal.

Exit International, a pro-euthanasia group from Australia, is one of the groups promoting the purchase of the drug because it was easy to obtain for a small amount of money.

But undercover reporters from News 10 in San Diego find that's not the case anymore.

The drug, a strong barbiturate, was formerly used as a sleeping pill and it has been blamed for the deaths of luminaries such as Marilyn Monroe, Judy Garland and Jimi Hendrix.

To see if the drug is still as readily available, undercover reporters from News 10 went to Tijuana and followed the instructions found in a book Australian euthanasia advocate Philip Nitschke has written with specific instructions on obtaining Nembutal.

They found that one pharmacy would sell the drug under the name pento barbital without a prescription and for the cost of $40. However, when a hidden camera malfunctioned and alterted the owner, he said the drug was no longer available.

The News 10 reporters then went further south to Rosarito to a veterinarian's office and showed him pictures of the drug they wanted to purchase. But the veterinarian told the reporters that Mexican officials are cracking down on the drug and are now requiring a doctor's note to purchase it.

Other pharmacies in the two towns where the reporters inquired about the drug found it unavailable and they indicated the only way to purchase it now may be to resort to the black market.

No infant euthanasia reported in Netherlands

15 November 2008

AMSTERDAM, Netherlands (AP) — No cases of infant euthanasia were reported in the Netherlands in the first year after laws on mercy killings were expanded to cover newborns, Dutch officials said Friday.

The Netherlands legalized euthanasia for adults in 2001 in cases where the patients are suffering unbearable pain due to illness with no hope of recovery, and ask to die. Several doctors must agree before a lethal cocktail of sedatives and painkillers is administered.

In 2006, that policy was expanded to include newborns with extreme birth defects, who can be killed at the request of their parents.

The commission set up to vet whether guidelines are followed in such cases said doctors did not report any incidences in 2007, the commission's first year of operation.

Studies in the 1990s found that 15-20 such babies were probably euthanized illegally each year in the Netherlands, a country of 16 million people. Doctors were hardly ever prosecuted because authorities were reluctant to press charges in a country where euthanasia has been widely accepted as ethical.

The panel of medical and ethical experts wrote in a report sent to Parliament that one explanation for the absence of reported infant euthanasia cases may be that fetuses with dire defects are being detected via ultrasound examinations and aborted before the 24th week of pregnancy.

The commission said members plan to visit all neonatal intensive care units in the country this year to encourage more reporting of euthanasia.

Dad gets nod to end coma daughter's life

Italy's highest court has ruled in favour of a man's request to disconnect his daughter's feeding tube and allow her to die after 16 years in a vegetative state.

Courts, politicians and the Vatican have weighed in on the fate of Eluana Englaro, who fell into a vegetative state following a car accident in 1992, when she was 20.

The Court of Cassation said it had rejected an appeal by prosecutors against a lower court ruling in July in favour of Beppino Englaro. The father had said his daughter visited a friend in a coma shortly before her accident and expressed the will to refuse treatment in the same situation.

Italy does not allow euthanasia using methods such as fatal doses of drugs. Patients have a right to refuse treatment, but no law allows them to have a living will in case they become unconscious.

Beppino Englaro had fought a decade-long court battle to disconnect his daughter's feeding tube.

The decision "confirms that we live under the rule of law," he was quoted as saying by the ANSA news agency.

Catholic and anti-euthanasia groups had protested the ruling by the lower court in Milan in front of the city's Duomo.

Conservative politicians reacted angrily to the ruling, saying that the courts had overstepped their bounds. Enrico La Loggia, a legislator in Premier Silvio Berlusconi's party, likened the decision to a "death sentence."

The Vatican's top health official, Cardinal Javier Lozano Barragan, was quoted by the Apcom agency as saying that disconnecting a feeding tube amounts to "killing a person."

Eluana Englaro has been kept in a hospital and fed artificially in the northern city of Lecco. Doctors have called her condition irreversible.

Her case has evoked comparisons to that of Terry Schiavo, the American woman at the centre of a right-to-die debate until her death in 2005. Schiavo was diagnosed as being in a persistent vegetative state after her heart stopped in 1990.

Schiavo's husband, who wanted her feeding tube removed against her parents' wishes, prevailed in a polarising battle in the United States that reached Congress, President Bush and the Supreme Court.

Government will be forced to change law on assisted suicides

Nov 13 2008

Birmingham Post

MP backs call for reforms to the law to permit assisted suicides

Britain will eventually be forced to change the law to allow assisted suicides, a Black Country MP has predicted.

David Winnick (Lab Walsall North) backed calls for reforms allowing people to seek help in ending their own lives.

His comments followed the high-profile case of Worcestershire man Daniel James, aged 23, who travelled to a Swiss clinic to end his life.

Mr James, from Sinton Green, near Worcester, was paralysed when a rugby scrum collapsed on him during a training session at Nuneaton Rugby Club in March last year.

His parents, Mark and Julie James, face a police investigation after they took him at his request to the Dignitas euthanasia clinic in Switzerland, which helped him to commit suicide.

Mr Winnick said he believed it should not be necessary to go abroad.

Speaking in the House of Commons, he said: “We are faced with a small number of people - it will always be a small number - who take the position, as their health worsens, that they simply want to end their lives.”

There was no law against attempting suicide, but it was a crime to help another person to do so, he said.

“Of course, if they were in a position to commit suicide, that would be quite legal; if they attempted suicide and did not succeed, they would not be prosecuted. Those people are either unable to commit suicide, because of their medical condition, or simply do not wish to do so.

“If I were terminally ill and I decided that I wanted my life to come to an end, I would not wish to commit suicide, perhaps for lack of courage.

“The question arises,: should the law permit those who are in such a condition that they want to end their lives to do so in this country, without travelling abroad?

“That is the nub of the issue.”

Keeping a Promise When a Life Is Near Its End

“If something should happen to me, and I couldn’t help myself, would you be willing to help me?”

Vivienne Flesher

It is the question so many of us dread hearing. My mother asked it of me around her 75th birthday. Of course I didn’t need to ask what she meant by “something” or “help.” She was a card-carrying member of the Hemlock Society. On her bookshelves were titles like “Final Exit” and “The Peaceful Pill Handbook.”

“Can I think about that?” I said, hoping she might forget to follow up. It was a ridiculous hope: she took as gospel my every medical comment, and she never forgot a single one.

My mother had been ready to die for years. Not that she was suicidal, but she had always been one of those people who found the cloud in every silver lining. For my mother, life’s positives outweighed its negatives, but just barely.

When she lost all but her peripheral vision to macular degeneration and could no longer read, drive or teach, the scales tipped in the opposite direction. Whenever an acquaintance died or received a diagnosis of something swift and painless, her reaction (often to the dismay of those around her) was “Oh, that lucky fellow.”

Her greatest fear was of a stroke or some other catastrophe that would force her to live on for unwanted years, unable to care for herself. Her own mother, after a stroke, had spent the end of her life in a nursing-home wheelchair.

In a phone call two weeks to the day after her initial question, my mother did follow up: “Did you get a chance to think about what I asked?” Of course I had. I had spent large chunks of time obsessing about it. So I gave the only answer I could stand to give, the only kind answer I could think of.

“Yes,” I said. “If you ever need my help, of course I will help you.”

Then I changed the subject, but not before hearing the immense relief and gratitude in her voice. Even though I was quite sure my definition of “help” did not match hers, to answer otherwise would have been cruel. What did it matter, I thought; she couldn’t possibly hold me to it, and with a little luck it will never come up. And in fact, the subject did not come up again for more than a decade.

A couple of months short of her 87th birthday, my mother began to complain repeatedly of being unable to work the remote for her large-screen television. Each time she said this, someone would painstakingly walk her through the steps. But a few days later something would go wrong and she would need help again. A few weeks later, when her shower faucet went on the blink, it finally dawned on me that the fault might lie not in the remote or the faucet but in their user. I persuaded her to see her internist, and I called to let him know my concerns.

The internist called me right after her appointment to tell me she was being admitted to the hospital. She was wheezing, and a chest X-ray showed pneumonia. In addition, the brain M.R.I. showed several lesions — strongly suggestive of a tumor.

Multiple scans and doses of antibiotics later, the pneumonia was reclassified as a lung tumor and the brain lesions as metastases. My mother was put on steroids, and after considering and rejecting brain irradiation, she left her home near Boston and moved into a hospice five minutes from my house in Philadelphia.

She lived three more weeks — three weeks during which the only help she ever asked of me was to bring her chocolate milkshakes (which I did, often several times a day).

The night she died, I sat with her. She was unconscious by then, seemingly comfortable but breathing more and more rapidly, her skin growing more and more mottled. As I held her hand and mopped the bubbles from the corners of her mouth, I remembered a conversation we had had in the hospital in Boston right after her doctor had given me the results of her chest scan. I had told him that I would give the news to my mother.

My mother knew there were “masses” in her brain (she herself was calling them tumors), so I expected the news not to be a great surprise and, more than likely, welcome.

When I finished speaking, she looked concerned and frightened, making me wonder whether all her talk of wishing to die had been just that — talk.

“What if I don’t go quickly?” she asked. “What if this takes forever?”

“It won’t, Ma,” I answered, relieved at such an easy question. “Everything’s going to be O.K.”

“Are you sure?”

“Yes,” I replied, with the certainty I knew she craved and trusted. “All the tests confirm that it won’t be long now.”

Tears filled her eyes. “Do you remember, years ago, you promised you would help me if I ever needed it?”

I nodded.

“Well,” she said, “you just did.”

Ellen D. Feld, M.D., is an internist who teaches at Drexel University in Philadelphia.

'Senator Death' sparks euthanasia debate

Published: 11 Nov 08

A German politician dubbed "Senator Death" has been providing paid assistance to old ladies who want to die, sparking a debate whether he’s a money-hungry granny-killer or a euthanasia rights champion. Exberliner Magazine’s Jacinta Nandi reports.

"Senator Death's been at it again!" roared the yellow press last October, after 84-year-old Inge Iassov was found dead on September 30 in her Würzburg flat in Bavaria. If Hamburg's former justice senator (minister), Dr. Roger Kusch, were a more sensitive type, reading the German tabloids could deal him quite an ego-blow. But the pro-euthanasia activist says the lurid headlines don't bother him at all: "The situation for dying patients in Germany is really bad. Doctors aren't allowed to help them commit suicide," explains the Herr Doktor, who is a lawyer, and not a medical doctor.

Far to the contrary: the scandal brought his new business to the spotlight - an assisted suicide service which for just €8,000 helps willing volunteers to, well, top themselves. Inge Iassov was not his first customer. In July, Kusch provided similar assistance to 79-year-old Bettina Schardt.

Kusch is certainly a controversial figure. A doctor of law, the man was Hamburg's CDU justice minister from 2001 to 2006. Forced to come out of the closet in 2003 because he was accused of having an affair with mayor Ole von Beust, his boss, Kusch was heavily criticised by his party for his pro-euthanasia position, until finally being sacked for refusing to co-operate with a parliamentary inquiry.

Early this year, Kusch started his own party, Heimat Hamburg, which was meant to offer citizens a more conservative alternative to the CDU. Along with racist promises, law and order clichés and anti-Islamic propaganda, the liberalizing of existing euthanasia laws figured highly in his programme.

Heimat Hamburg did so badly in the 2008 local elections that they disbanded in April. Never short of initiatives, Roger Kusch then proceeded to set up his foundation, Dr. Roger Kusch Sterbehilfe e.V., which, as well as campaigning for the rights of those who wish to end their own lives, offers a special suicide machine - an intravenous device - which he plans to offer for sale. But his most popular idea so far has been his assisted suicide service. Bettina Schardt was Kusch's first client.

After his first success, Kusch decided to take things even further. Advertising the assisted suicide service on his website, Kusch even named the price - for €8,000 one can be helped to a humane death.

The moral debate surrounding euthanasia and assisted suicide is complex. Even finding an adequate definition for euthanasia is tricky. Things get even trickier in translation because 'euthanasia' is usually translated into German as

, or "death help,“ because

is associated with Nazi eugenics.

But what is

? There is passive, active and indirect

. Passive is when doctors and family members agree to discontinue use of, for example, dialysis machines or artificial feeding methods, and thus shorten the dying process.

Active

is when a doctor administers a dying patient with an extra dose of painkiller, usually morphine, which they know will kill. This is illegal in Germany. Then there's indirect

, which is when the doctor gives the dying patient some kind of painkiller, primarily to ease pain, but which 'could' shorten the patient's life.

Physician assisted suicide (PAS) is a bit different from

. Here the patient expresses their wish to die and is physically capable of administering the medication on their own. Although this is not legally considered

, when we discuss euthanasia, we often mean PAS. PAS is allowed in very few places in the world, including Switzerland and Oregon, USA.

In the Netherlands assisted suicide and other forms of euthanasia are still technically illegal, but doctors will not be prosecuted.

Interestingly, assisted suicide in itself is not illegal in Germany. "No, you couldn't be prosecuted for helping someone to commit suicide," Edgar Dahl, Bio-Ethics professor at the University of Giessen, explains. "Suicide is not a crime, so helping someone to commit suicide isn't a crime either."

The only trouble is that, once the patient actually starts dying, the doctors should do everything they can to bring them back to life, or they could get prosecuted for

, i.e. the failure to assist a person in danger. Dahl chuckles. "I mean, it's a grey area. But the trouble isn't the law. The law was changed in 2006 so that if it's a case of PAS, rather than normal suicide, a doctor will be given the benefit of the doubt. If I came in and found my partner had attempted suicide, and didn't phone the ambulance, that is

. But that's not the case for doctors helping a terminally- ill patient. Lawyers decided that in such cases the doctor would not get in trouble."

But if it's not illegal, what's the problem? "The trouble is the German Medical Council. They say that assisted suicide is against medical ethics." Doctors who assist with suicides are scared of losing the right to practice.

The Medical Council's harsh stance allows Roger Kusch to take advantage of the situation. Becuase he's not a medical doctor, he doesn't have a license to lose. As a trained lawyer, Kusch takes all legal precautions: like with the case of Bettina Schardt. This elderly but healthy woman contacted Dr. Kusch via his pro-euthanasia foundation with the concrete wish to commit suicide. Kusch then counseled her through the necessary medication to take, but, importantly, Kusch did not provide or administer the drugs himself. Instead, he entered the woman's home, and videotaped not only her suicide request but also the actual moment when she swallowed the deadly tablets. He left the room before she fell into a coma, and re-entered the room three hours later, to find her dead. He then publicized her death widely – and his own participation in the process. Dahl comments, "I think Kusch knows that it isn't ideal. It's an emergency solution until the Medical Council sees reason."

But Kusch is not the only option. Many Germans seeking PAS are turning to Switzerland, where, although the legal situation is more or less the same as here, doctors have a little more leeway. "The Swiss Medical Council added one line to their charter that gives doctors the freedom of discretion: the doctor's decision must be respected in individual cases." This loophole allows Dignitas, a Swiss foundation which campaigns for the right to die, to offer an assisted suicide service to both Swiss and foreign citizens. Dignitas charges its patients €4,000 for preparation and suicide assistance. Despite being a non-profit organization, Dignitas has repeatedly refused to open its finances to the public. Around 80 Germans go to Switzerland to use Dignitas' services each year. This practice is referred to in the German media as

- death tourism.

Kusch's methods raised many outraged voices, notably among the German clergy. If the Archbishop of Berlin, Cardinal Sterzinsky, had his way, assisted suicide would be a crime and suicide organizations would be forbidden from advertising their services in Germany. "Suicide can't be made into a criminal offence," explains Cardinal Sterzinsky. "But 'helping' someone to commit suicide, that should be made illegal."

The Church's stance is irremediably opposed to euthanasia. "We have to be careful here. Helping someone while they die is one thing. But helping someone to die is not allowed. We cannot choose to end life!"

Eugen Brysch, the CEO of the German Hospice Foundation, was also shocked by Kusch's shameless business approach: "Making money through assisted suicide - that should be a criminal offence. I think Roger Kusch is showing his true face here - rather than really being there for the dying people, he just wants to make money. In fact he is exploiting the biggest fear of elderly people - the fear of becoming a burden." Many politicians agree.

In July this year a group of German politicians, including Baden-Württemberg's justice minister Prof. Dr. Ulrich Goll (FDP), tabled a motion demanding that assisted suicide be made illegal. But the motion failed. "It's this political inaction which enables an inhumane egocentric like Kusch to abuse people's natural fears," laments Brysch.

Many doctors are scared that tightening the rules will lead to more doctors being discredited, prosecuted, or even imprisoned: increasing numbers of medical practitioners are asking for the rules to be made more flexible. "What we need in Germany is a situation like in Oregon, in the US." Edgar Dahl says. "There, the Death with Dignity Act, which is about 10 years old, gives terminally-ill patients the freedom to apply for the right to die. They have to apply for it twice, and they have to think about it for two weeks. Two independent doctors have to sign the application, and then the patient can receive the necessary medication to die."

Sara, an American-German PR consultant based in Berlin, knows all about the difficulties of growing old in today's medically advanced society. Her sickly German grandmother has been in and out of old people's homes for the past 20 years. "It's awful to see her like this. But I think we should worry that a more liberal approach towards euthanasia could lead to state-sanctioned murder. Old people are getting older and poorer all the time - they've got no pensions, of course they're going to be depressed! And we might just end up ... getting rid of them."

But Edgar Dahl says she shouldn't really worry about that. "The figures from Oregon show that it is not the more vulnerable members of society who are taking advantage of the system. It is the more privileged - people with private health insurance." Kusch also rejects the idea of a slippery slope to state-condoned murder. "This danger simply doesn't exist. Even in the future people won't have to justify their will to live! Wanting to live will always be the norm in our society, and the desire to commit suicide an exception!"

Whichever side of the euthanasia debate you're on, one thing is deadly clear. The current situation in Germany is good for no-one, except Kusch, who is making €8,000 per dead granny. And what exactly does that money get you? It seems like a steep price for a few drugs. Dahl says he was surprised to learn that Kusch was charging a fee. "I don't really know what Dr. Kusch is charging €8,000 for. I do find it a bit hard to understand. The whole reason we want to allow assisted suicides here is to spare people the cost and trouble of going to Switzerland. At the moment the trip to Switzerland costs around €6,000. That's why we want the doctors to change their rules - so that poorer people can have some autonomy at the end of their lives."

Roger Kusch is certainly a dodgy figure. It's not even certain that the pensioners he's been helping to die would have been allowed to kill themselves legally in Oregon or Switzerland. Although Kusch says that he was absolutely convinced of Bettina Schardt's determination to die, the truth is she was not terminally ill and did not suffer from constant pain.

Instead, she lived under a terrible fear - of a retirement home, which in Germany has a truly horrible reputation: "I will never enter a

," announced Bettina S. resolutely in her video-recorded suicide statement.

According to the Federal Statistics Office 9,402 people in Germany committed suicide last year. Of these, 3,993 were over 60 years old. Suicide numbers in Germany are going down - but amongst older people they are rising. "The situation for old people in Germany is not good enough," says one caregiver, who wished to remain anonymous. "Old people can't grow old with any dignity in homes like ours - instead they are left alone all day, to lie in their own excrement, open wounds, hungry, thirsty - no wonder most people say they would rather die than end up in a home."

In the meantime, until the rules in Germany are finally tightened up - or loosened - how many more grannies will be ending their days at the hands of Roger Kusch? Meanwhile, the Hamburg police say they are investigating the case of Inge Iassov's death - but not, at this point, as murder

Italy court to rule in landmark right-to-die case

ROME (Reuters) - Italy's top court could have the final word on whether a man can remove the feeding tube which has kept his comatose daughter alive for 16 years, in a landmark right-to-die case that has split the country.

Eluana Englaro, 37, has been in a vegetative state and receiving food and water artificially at a hospital in the northern Italian town of Lecco since a 1992 car crash.

Her father, Beppino Englaro, has battled through Italy's courts to seek an end to the life support for nearly 10 years.

The country's top court, the Corte di Cassazione, began debating Tuesday whether an appeal against a July ruling by a lower tribunal -- which, for the first time in Italy, authorized the removal of the feeding tube -- was legitimate.

The court has one month to decide, although a verdict is expected later Tuesday because of the case's sensitivity.

If, as requested Tuesday by its general prosecutor, the court rejects the appeal, that would clear the last legal hurdle for Englaro's father to have his daughter taken off life support.

"We are satisfied with the general prosecutor's argument that the appeal is unacceptable, we are hopeful for the final verdict," lawyer Franca Alessio, a court-appointed guardian for Eluana, told Reuters.

The Vatican and Catholic politicians, mainly on the center right, have said authorizing the removal of the feeding tube amounts to justifying euthanasia, which is illegal in mainly Catholic Italy.

The Milan court which delivered the July ruling said it had been proven that Englaro's coma was irreversible and that before the accident she had stated her preference to die rather than being kept alive artificially.

Pro-euthanasia activists hailed that ruling as historic, but Italian political leaders were split over the case.

The Englaro case has been compared to that of American Terri Schiavo, who spent 15 years in a persistent vegetative state and was allowed to die after a long court battle.

(Reporting by Silvia Aloisi; editing by Elizabeth Piper)

Teenage girl wins right to die

Experts call for clearer difference between euthanasia and AMD

Channel NewsAsia - Tuesday, November 11

SINGAPORE : Doctors, caregivers and religious groups in Singapore have said there is a distinct difference between euthanasia and the Advanced Medical Directive (AMD) which the Health Ministry wants to simplify

Experts call for clearer difference between euthanasia and AMD

While the AMD extends a person’s autonomy on how he would like to die, euthanasia is seen as an act of killing.

As Singapore’s population ages, the country is in the midst of a debate on how one can die with dignity. At the centre of it is the Advanced Medical Directive.

The Health Ministry is studying how to make it easier for people to sign up for the AMD — a document, where you can explicitly state how you want your final days to be, if you are terminally ill.

The issue now is a confusion between what is AMD and what is euthanasia.

Singapore’s Health Ministry has stressed there has been no proposal to legalise euthanasia.

Experts said it is all in the definition. They said signing the AMD to say you would rather have the plug pulled — than be kept alive by machines if you are terminally ill — is not euthanasia.

Dr Chin Jing Jih, Executive Director, Centre for Medical Ethics and Professionalism, Singapore Medical Association, explained: "A lot of times, people think that when doctors switch off these life support systems, it is as if it is that act of stopping that kills the patient.

"But in actual fact, it is not. It is the underlying disease that has killed the patient. We are merely removing an intervention that is no longer effective on the patient. Emotionally, it looks as if that act has ended the patient’s life but it is actually the underlying illness.

"We know that if we do not remove the life support, the patient will perish too in a matter of days. That is not euthanasia because if we remove these cumbersome machines and the patient is still alive, we accept that and we palliate the patient.

"But if it is euthanasia, I remove the machine and the patient is still alive, then I would say... what else do I have to do to make sure the patient dies. So the intent is very clear. When doctors remove these machines, death is foreseeable, but it is not intended, so we make that ethical decision and intent is central to euthanasia."

Experts believe the AMD is not a slippery slope towards euthanasia. Doctors said a key issue is in ensuring optimal palliative care to ease the pain of patients.

Dr Cynthia Goh, head, Palliative Medicine Department, National Cancer Centre Singapore, said: "Palliative care includes care that takes care of physical symptoms and physical pain, but we also do a lot of psycho—social support, which is to support the person emotionally and to sustain hope.

"Much of it is about treating that person as a person... showing that person that he is worth something, and he will also be worth something provided that he is alive.

"And showing respect and showing that we are there for them and we won’t abandon them — I think these are common things that people are afraid of, and they say, ’I would rather be dead before I am abandoned or before the pain becomes unbearable or before my suffering becomes unbearable’.

"But if we can encourage them and say we would do our best to ensure that it does not become unbearable and we will stand by you, very often people will feel encouraged and they generate a little hope for themselves to say that things can get a little bit better."

Another point medical professionals agree on is that if euthanasia is allowed, then doctors should not be the ones administering death because it affects the integrity of the profession. Instead, euthanasia should be done by trained personnel.

Major religious groups in Singapore are also strongly against euthanasia, saying it is tantamount to killing.

The National Council of Churches of Singapore has condemned the act as "diminishing the value of human life", while both the Singapore Buddhist Federation and the Islamic Religious Council of Singapore see euthanasia as tantamount to the act of killing.

However, it is a grey area for Hindus. Channel NewsAsia understands that the terminally ill can choose to fast till death or refuse medical treatment, but subject to certain conditions. These include getting the blessing of the family and so long as the dying process is unaided.

Meanwhile, all four religious groups support AMD. The Buddhist Federation said that in AMD, "the patient is dying in a natural way as no device is used just to prolong his/her life". — CNA/ms

German medic wants to help Midlanders die

Nov 8 2008

By Adam Aspinall

A CONTROVERSIAL German doctor who invented a suicide machine has revealed he has been contacted by desperate Midlanders - and is willing to help them die.

Dr Roger Kusch, nicknamed ‘Doctor Death’ in his homeland, is one of Europe’s leading supporters of assisted suicide and claims he has helped people to take their own lives.

The politician wants Germany to replace Switzerland as the destination of choice for suicidal people.

And he said he is inspired by the Swiss euthanasia clinic Dignitas, where Midland rugby player Dan James, who was paralysed while training, went to die in September, aged 23.

Speaking through an interpreter he said: “We have had quite a few inquiries from people in Britain.

“In fact people from Britain have made most of all the inquiries we received from foreign countries.

“And I will go on in assisting people to commit suicide and talk about it.”

The politician made headlines across the globe in April when he revealed his sick suicide machine to the world.

The device is a modified perfusor, a machine normally used to inject medicine over a long period of time.

Kusch has modified the item by installing a button that allows the patient to set it off. He said: “It is no problem to build the machine for someone with basic knowledge of physical science.

“The suicide machine was necessary to be invented to show how absurd the legal situation of people being willing to die in Germany is.

“Up to now it has not been used and it is not determined to be exported to any other country.

“We are fighting for the sovereign right of any person to die in dignity.”

But last night Dr Kusch’s boasts were condemned by leading assisted-suicide opponent Dr Peter Saunders, from the charity Care Not Killing.

Killing

He said: “This guy sounds like Dr Death.

“He should be caring for people, not killing them.

“In my experience a request for suicide is always a request for help.

“Doctors working in palliative care for their whole career will tell you that they come across thousands of patients who want to commit suicide.

“But once their basic needs are taken care of they could count the number of people who want to go through with it using the fingers on one hand.

“In my career as a surgeon I only had two requests and both patients changed their minds once we responded to their own particular needs.

“What people need to remember is that in the last five years just over 100 people have gone to Dignitas to die, but in that same time period over 3 million people have died of natural causes.

“So no matter what people like Dr Kusch argue, the demand is actually very small indeed.

“For example take the case of Dan James. There are over 20,000 tetraplegics in Britain but the vast majority want the help to live, not to die.

“I think he (Dr Kusch) is profoundly misguided and is only increasing the risk that vulnerable people will be abused and exploited.

“There is a reason assisted suicide is illegal in most of the world, and that is to protect people and increase public safety.

“We at Care Not Killing believe that the answer does not lie in suicide but in improving the care for people in the first place.”

The law on suicide in Britain remains vague, and while it is not illegal to commit suicide under the Suicide Act 1961, it is illegal “to aid, abet, counsel or procure a suicide or a suicide attempt”.

But since Dignitas opened 10 years ago, 101 British citizens have taken advantage of Swiss laws that allow them to die with help from doctors and nurses.

During this period not a single spouse, relative or friend has been convicted under the 1961 Suicide Act for helping them.

A handful who have admitted to travelling to Dignitas have been arrested, including the parents of Dan James, from Worcester.

This usually happens after the police receive a complaint.

Last night a spokesman for the Department of Health said: “Issues around assisted suicide and euthanasia have always been dealt with as a matter of conscience.

“There have been a number of Private Members Bills related to this issue in recent years (including the Assisted Dying for the Terminally Ill Bill) and the Government’s stance has been to remain neutral and to listen to the debate.”

* The Samaritans are available 24 hours a day for emotional support by calling 08457 90 90 90.

Assisted Suicide Crusader Jack Kevorkian Loses Bid to Become Congressman

by Steven Ertelt
LifeNews.com Editor
November 7, 2008

Muis says 'no' to euthanasia

Mercy—Killing Debate

7Nov08

SINGAPORE: It would be a mistake to see euthanasia, voluntary or otherwise, as an act that affects only the individual patient and their families, said the National Council of Churches of Singapore (NCCS).

Days after the Archbishop of Singapore condemned euthanasia in an open letter to Catholics and priests, the council, too, has joined in the growing public debate in the media, yesterday releasing a strong statement decrying the act of so—called mercy killing.

Legalising and accepting the act, the NCCS warned, would have serious consequences for society, creating a “euthanasia mentality”.

“Death becomes the solution to many social ills. Just as abortion is seen as the answer to 'problem or unwanted’ pregnancies, so euthanasia becomes the solution to pain and suffering,” said the association of Singapore churches and Christian organisations. This would “very subtly” impress upon the elderly and dying that “it is their 'duty to die’” and “diminish the value of human life itself”.

The issue of euthanasia was last month highlighted by Health Minister Khaw Boon Wan as an ethical “dilemma” Singaporeans had to confront as the population aged.

The proposed changes to encourage more Singaporeans to make an Advanced Medical Directive (AMD) have been seen, by some, as condoning euthanasia — even though the AMD Act clearly states it does not “condone, authorise or approve abetment of suicide, mercy killing or euthanasia”.

The NCCS said euthanasia, which it described as “societal killing”, would “open the door to serious abuses that would threaten the rights and dignity of persons and society”.

Like the Archbishop’s letter, its statement likened euthanasia to suicide, both — as acts of terminating human life — prohibited by their teachings that consider life sacred. “Human beings do not have the right to die,” the NCCS maintained.

Euthanasia also went against the Hippocratic oath taken by doctors. “The duty of the physician is not merely to 'minimise suffering’ but always to 'maximise care’.”

Similarly, society should “care for those who are suffering and those who are dying”, given that “there is strong evidence to suggest that patients whose symptom and pain control has been inadequate often request for euthanasia” — and that such requests usually cease after proper care is administered.

“More funds should therefore be directed at the establishment of hospices, the training of physicians and nurses, and research in palliative medicine and symptom relief techniques,” said the NCCS.

Mr Khaw has already called for more discussion on issues like AMD and palliative care to better care for the dying in Singapore.

Among other things, the ministry is supporting the expansion of hospice care in the community, and extending palliative care to address the needs of the dying person’s relatives.

A scheme to bring palliative care in nursing homes is also being piloted. — TODAY/sh

Husband Says Wife's Strangling Euthanasia

07 November 2008

A Stavropol resident has been arrested on murder charges after using a cell phone cord to strangle his wife who was dying of liver cancer, a senior investigator said Thursday.

The unidentified 32-year-old suspect said his 43-year-old wife had repeatedly begged him to help her die, and he strangled her at their dacha outside Stavropol, Vitaly Batishchev, head of the Stavropol branch of the Investigative Committee, said by telephone.

"He said he did this out of mercy to her," Batishchev said.

Russian law does not permit euthanasia. If convicted of murder, the suspect faces a sentence of six to 15 years in prison.

The woman was diagnosed with liver cancer several years ago, but treatment was unsuccessful, and her health deteriorated rapidly in the weeks before she died, Batishchev said.

Her relatives told investigators that she had no longer wanted to live and had spoken about committing suicide.

The suspect, however, gave investigators several explanations for her death before admitting that he had strangled her, Batishchev said.

The couple were married last year.

State second in nation to allow lethal prescriptions

End-of-life, care worker measures pass

By JOHN IWASAKI
P-I REPORTER

6Nov08

It is interesting to note how, in the throes of the Scottish Enlightenment, its most famous thinker, David Hume addressed and answered that question of perennial as well as topical importance and concern.

His posthumous essay On Suicide (1777) begins with the claim: "One considerable advantage that arises from Philosophy consists in the sovereign antidote which it affords to superstition and false religion". However, he does not say or imply that all religion is false or that all religion is superstition.

What is of particular interest in his arguments, and a cause of particular discomfort to some adherents of religion, is that his case for justifying suicide is based on taking religion seriously rather than denigrating it. Hume's arguments suggest that within the framework of theism, suicide can be justified.

According to Hume, if suicide is always wrong, it will always be a breach of a duty to God; to our fellow members of society; or, as he curiously puts it, to ourselves. In his view, suicide is not always the breach of such a duty and hence it is not always wrong.

If our life is merely a burden to us, we owe no duty to ourselves to continue to bear it. It can be both prudent and courageous to end it, so he thinks. Similarly, he thinks that we do not always have a duty to other people to refrain from killing ourselves.

He writes: "A man who retires from life does no harm to society: he only ceases to do good; which, if it is an injury, is of the lowest kind". Suicide can be excusable and even, in some circumstances, praise-worthy.

For instance, consider someone who can no longer do anything useful for society and who prevents other people from being more useful than they could otherwise be.

He thinks that, in such circumstances "resignation of life must not only be innocent but laudable".

What about religious objections? Is it not to thwart God's will to kill one's self? Does it not defy the laws of nature? Is it not an act of gross ingratitude? According to Hume, "It is a kind of blasphemy to imagine that any created being can disturb the order of the world, or invade the business of providence!"

All that occurs in the world occurs in accordance with the universal laws of nature. They are immutable and inviolable. Human beings and other animals might be said to act upon nature but, more accurately, they act within it and their actions are no more or less natural than anything else which exists or occurs.

As Hume says: "When I fall upon my sword, therefore, I receive my death equally from the hands of the deity as if it had proceeded from a lion, a precipice, or a fever."

Were it a breach of a duty to God to kill ourselves and thereby alter what would otherwise be the natural course of events, it would, similarly, be a breach of duty to alter the natural course of events by intervening to prolong our lives. As Hume says: "If I turn aside a stone which is falling upon my head, I disturb the course of nature; and I invade the peculiar province of the Almighty, by lengthening out my life beyond the period by which, by the general laws of matter and motion, he has assigned it."

The classification of some particular actions, events and occurrences as "unnatural" and thereby contrary to God's plan is irrational, according to Hume. His response to the claim that suicide is impious is: "… why not impious, say I, to build houses, cultivate the ground, or sail upon the ocean? In all these actions we employ the power of our mind and body to produce some innovation in the course of nature; and in none of them do we any more. They are all of them therefore equally innocent, or equally criminal."

Is it not an act of gross ingratitude to spurn the precious gift of life? Should it not be treasured whatever may befall us? No, says Hume. If life is a divine gift, so too is the means of ending it. Hume, I think, is right here.

After all, it would not be ungracious or in any other way inappropriate to say to a generous host something like: "Many thanks for your unexpected hospitality. I enjoyed the occasion very much but I have had enough and want to leave now".

Hume's rational, wise and humane discussion of suicide is a useful prelude to debates about the ethics and desirable legal status of euthanasia and assisted suicide. His arguments and conclusions will be acceptable to many atheists and theists alike.

• Hugh McLachlan is professor in the School of Law and Social Sciences at Glasgow Caledonian University.

Mon, Nov 03, 2008
The Straits Times

Dying without causing guilt

By Salma Khalik, Health Correspondent IN THE past 11 years, out of a population of over four million, only 10,000 people have signed Advance Medical Directives (AMD), a document that in essence indicates that you don't want doctors to prolong your life unnaturally should you be seriously ill. Why so few? It could be because Singaporeans do not agree with what the AMD represents. If that's the case, then the Government should respect their wishes. Health Minister Khaw Boon Wan, however, is confident that that is not the case. Based on feedback he has received, and from the personal experience of his wife, who agrees with the philosophy behind the AMD but hasn't yet signed one, he concluded that there are other factors holding people back. It could be sheer lethargy - people can't be bothered to go through the trouble of addressing an issue that is not pressing. It could be the hassle of getting a doctor who is willing to act as a witness. Surprisingly, quite a number of doctors have said they are not comfortable lending their signatures. A reader wrote to say she was turned down by a polyclinic doctor when she approached him to be a witness for her AMD. A chat with doctors revealed that some were not even sure what an AMD involves. Some who know do not want to spend the time explaining it to patients - a duty the doctor witness has to bear. Although doctors are entitled to charge a fee for this service, most feel awkward doing so. In their minds, they would have performed no 'real' medical service. Thus, the Health Minister has suggested amending the AMD so that a doctor witness is no longer needed. This makes sense. Explaining the ramifications of an AMD can be done by non-doctors. Even better, there could be more extensive mass education to explain what signing an AMD means. Such explanations are necessary, as most people aren't really sure what they are getting themselves into when they sign an AMD. Some equate it with euthanasia or medically-assisted death for the terminally ill. This, however, is way off the mark. An AMD is not about helping terminally ill patients die. That is against the law. The AMD states clearly that 'nothing in the Act shall authorise an act that causes or accelerates death as distinct from an act that permits the dying process to take its natural course'. There are also people who think signing an AMD means telling doctors not to work so hard to keep them alive should they be seriously ill. Some fear that doctors might be less willing to save an elderly, highly subsidised C class patient who has signed an AMD - when they would do so for an A class private patient. Again, totally off the mark. Doctors have no way of knowing who has signed such a directive. Only at the point when they have exhausted all hope of saving the patient, does the hospital check on what the patient wants done in such a situation. If the patient has signed an AMD, his wishes will be followed. If he hasn't, the doctors will need to ask his family what they want to do. Three doctors have to unanimously agree that nothing can save a patient, before the AMD kicks in. Even if you have signed an AMD and are dying, you will still be given medicine, especially if it is to ease pain, as this is part of 'normal' medical treatment accorded to all. What the AMD means is merely that doctors will not attempt 'extraordinary life-sustaining treatments', such as putting a patient with multiple organ failure on a respirator to help him breathe, a dialysis machine to clear toxins from his kidney, and repeatedly shocking a heart into beating every time it stops. But all this will be done - whether an AMD has been signed or not - if doctors feel that there is a chance that doing so could lead to recovery. These treatments will be stopped only if three doctors - and the AMD requires all three, two of whom must be specialists, to be unanimous in their opinion - are sure that such treatment would only prolong the process of dying. Given the stringent conditions before an AMD kicks in, you may well ask if such a document is even necessary. If doctors decide that nothing more can be done to save a patient, isn't that final? Associate Professor Chin Jing Jih, a senior consultant in geriatric medicine at Tan Tock Seng Hospital, says most families will go with the doctors' advice in such cases - whether a patient has an AMD or not. Dr Robert Lim, a cancer specialist at the National University Hospital, says there is usually time to discuss the issue with terminally-ill cancer patients and their families, and most will opt for not going to extremes when the end is near. But there are rare cases when the family will not accept that the patient is near death, and insist on doing everything possible, at all cost. In spite of going all out to save the person, the end is often as the panel of doctors predict. The result is that the patient suffers for a few more hours or days, and the hospital bill soars. If these people were the patient, chances are they will say: 'Let me go.' Not all, of course, as there will always be people who fear death too much to be willing to embrace it. Why is it so difficult to make the same decision for someone else, that we are willing to make for ourselves? Sometimes, it is fear of being accused of being ungrateful, of 'wanting' Mum or Dad to die. In moments of emotional stress - and few things are more stressful than the impending death of a loved one - accusations may be made which, no matter how unfair or untrue, can be extremely hurtful. It is times like this that an AMD from the patient could save a lot of uncertainty and ill will that could tear a family apart. Perhaps the AMD is more to assuage the guilt of the living than to accede to the wishes of the dying. If so, it does play a useful role. salma@sph.com.sg

Hard-headed researcher of 300 suicides maintains he's pro-life