Lies, Damned Lies and Statistics

A newspaper has the prerogative of promoting an unpopular social or political agenda.

It does not have the right to tell lies to support that cause.

The Sunday Times Ireland, published the editorial: “Assisted dying law in Ireland needs to be done right, but it must be done” on November 28, 2021 and the editors thinks it is “an appropriate time to debate the issue.” Perhaps they didn’t get the memo about the 1400+ submissions to the Justice Committee of the Oireachtas? (Overwhelmingly opposed to the Dying with Dignity Act / An Bille um Bás Dínitiúil, 2020.)

The editors contend:

“We now know the “slippery slope” argument has little credibility. That’s because in states and countries where assisted dying is allowed, there has been no evidence of abuse.” [my emphasis]

The Editorial team referenced Oregon as the paragon of safety in the provision of Assisted Suicide:

“In the American state of Oregon, for example, with a population of 4.2 million people and where the Death with Dignity Act was passed in 1997, there have been about 2,000 assisted deaths, and so far no wrongful ones have been reported or detected.” [my emphasis]

If these 3 key assertions are refuted, their thesis fails.

The Sunday Times may claim innocence because the Oregonian agency collecting data on Assisted Suicide — the Department of Human Services — does not document or investigate cases of alleged abuse. (“…has no authority to investigate individual Death with Dignity cases / The state law authorizing physician-assisted suicide neither requires nor authorizes investigations by DHS.”)

A quick Google search shows there are many cases of abuse even in Oregon but also Washington State, the Netherlands & Belgium. The best evidence of a precipitous “slippery slope” can be seen in Canada.

Their poor investigative skills aside, the editors miss the point: dead people don’t complain…

Oregon

In a letter to the editor of The Oregonian, Dr. Kenneth R. Stevens Jr. noted: “although the prescribing physician is to refer a patient for psychological evaluation if there may be depression or other conditions impairing patient judgment, only 4% of those dying from the drugs received such evaluation (only 0.5% in 2020). Recent changes in Oregon’s law have removed many safeguards from Oregon’s Death with Dignity law.”  In a group of people of whom 100% are trying to kill themselves, it beggars belief that only 4% merited a Psych Eval: Really?  

The seven quoted examples below are only a selection of those mentioned in an article by the Disability Rights Education & Defense Fund. The first two are also discussed in the BMJ’s Journal of Medical Ethics.  

• Doctor shopping: “Kate Cheney, 85, died by assisted suicide under Oregon’s law even though she had early dementia. Her physician had declined to provide the lethal prescription. Her managed care provider then found another physician to prescribe the lethal dose. The second physician ordered a psychiatric evaluation, which found that Cheney lacked “the very high level of capacity required to weigh options about assisted suicide.” Cheney’s request was denied, and her daughter “became angry.” Another evaluation took place, this time with a psychologist who insisted on meeting Cheney alone. Disturbingly, the psychologist deemed Cheney competent while still noting that her “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive.” Cheney soon took the drugs and died, but only after spending a week in a nursing home.”

• Lack of psychiatric consultation: “Michael Freeland, age 64, had a 43-year medical history of acute depression and suicide attempts. Yet when Freeland saw a doctor about arranging an assisted suicide, the physician said he didn’t think that a psychiatric consultation was “necessary.” …When Freeland chanced to find improved medical and suicide prevention services, he was able to reconcile with his estranged daughter and lived two years post-diagnosis.”   (Freeland did receive a prescription for the fatal medication.)

• Coercion by family or friends: “Thomas Middleton was diagnosed with Lou Gehrig’s disease, moved into the home of Tami Sawyer in July 2008, and died by assisted suicide later that very month. Middleton had named Sawyer his estate trustee and put his home in her trust. Two days after Thomas Middleton died, Sawyer listed the property for sale and deposited $90,000 into her own account. It took a federal investigation into real estate fraud to expose this abuse. Sawyer was indicted for first-degree criminal mistreatment and first-degree aggravated theft, partly over criminal mistreatment of Thomas Middleton.”

• Administration of the poison by others: “Patrick Matheny received his assisted suicide prescription by Federal Express. He couldn’t take the drugs by himself so his brother-in-law helped. Commenting on the Matheny case, Dr. Hedberg of Oregon Department of Human Services said that “we do not know exactly how he helped this person swallow, whether it was putting a feed tube down or whatever, but he was not prosecuted …”

• Duress from US health-care costs: “Barbara Wagner…a 64-year-old great-grandmother, had recurring lung cancer. Her physician prescribed Tarceva to extend her life. Studies show the drug provides a 30 percent increased survival rate for patients with advanced lung cancer, and patients’ one-year survival rate increased by more than 45 percent. But the Oregon Health Plan sent Wagner a letter saying the Plan would not cover the beneficial chemotherapy treatment “but … it would cover … [among other things,] physician-assisted suicide.”

• Duress from health-care workers: “Kathryn Judson wrote of bringing her seriously ill husband to the doctor in Oregon. “I collapsed in a half-exhausted heap in a chair once I got him into the doctor’s office, relieved that we were going to get badly needed help (or so I thought),” she wrote. “To my surprise and horror, during the exam I overheard the doctor giving my husband a sales pitch for assisted suicide. ‘Think of what it will spare your wife, we need to think of her’ he said, as a clincher.”

• Violation of procedure: “Wendy Melcher died in August 2005 after two Oregon nurses, Rebecca Cain and Diana Corson, gave her overdoses of morphine and phenobarbital. They claimed Melcher had requested an assisted suicide, but they administered the drugs without her doctor’s knowledge, in clear violation of Oregon’s law. No criminal charges have been filed against the two nurses.”

The Netherlands

In the Netherlands, euthanasia of children under 1 year of age is still technically illegal, but was “decriminalized” in 2005 for those doctors following The Groningen Protocol.

A tragic case of a Dutch nun was reported in the Psychiatric Times, 2004. She was dying painfully of cancer and her physician felt her religion prevented her from agreeing to euthanasia, so felt “justified and compassionate” in ending her life — without telling her he was doing so.

In 2019, Judge Mariette Renckens ruled that, "all requirements of the euthanasia legislation" had been met in 2016 when an anonymous female doctor decided that the prior directive of an 80-year-old woman should be enacted. First, she attempted to sedate the elderly woman by slipping medication into her coffee. The lady woke up and resisted the doctor’s attempts to kill her and said “NO” repeatedly. The doctor then asked the family to hold the elderly woman down while she administered the fatal medication.

Belgium

The Journal of the Canadian Medical Association reported that the physicians in one area of Belgium, admitted that over 30% of the Voluntary Euthanasia/Assisted-Suicides occurred WITHOUT explicit request…

Canada

Voluntary Euthanasia and Assisted Suicide [VE/AS] were legislated 2016 under the euphemistic term of Medical Assistance in Dying [MAiD]. Related legislation in 2021 immediately removed the requirement for natural death to be “reasonably foreseeable” and allows AS/VE for those suffering from mental illnesses alone by 2023.

In 2018, 42-year-old Roger Foley from Ontario wanted to live despite suffering from a progressive, neuro-degenerative disease. There were issues with home-care services and after being stuck in hospital, he recorded administrative staff offering him Euthanasia as an alternative to forced discharge or being billed $1,800 per day. 

Despite the Supreme Court of Canada specifying: “Nothing in this declaration would compel physicians to provide assistance in dying,” physicians in Ontario are mandated to provide an “effective referral” for MAiD/AS/VE by the provincial government, the medical College, the Divisional Court and the Court of Appeals.

(The courts admitted there was religious discrimination but over-ruled it saying, “The evidence in the record establishes a real risk of a deprivation of equitable access to health care, particularly on the part of the more vulnerable members of our society, in absence of the effective referral requirements of the policy.” Curiously, there is a perfectly effective self-referral system in Alberta which takes one phone call and it deprives nobody!)

Conclusion

Humanist, Dr. Donald Boudreau, McGill University noted: “My personal belief is that healing and euthanizing are simply not miscible.”

The Hippocratic Oath pre-dates Christianity, but again the Sunday Times verbalised their sad anti-religious sentiment while not providing any coherent rationale as to why a modern country like Ireland should introduce Euthanasia / Assisted Suicide. The emotive plea that “death should not be a trial or a trauma” and because ‘other countries are doing it,’ that basically Ireland ‘must do it too’ is a childish response. The platitude “This newspaper feels everyone should have the right to choose how they leave this world” is a trite response to a very difficult life-event — one which we will all face. 

Terms like ‘unbearable suffering’ are often used though physical pain (or even fear of pain) is an infrequent reason for people to request Assisted Suicide in Oregon. In the 2019 report, Oregon showed that the majority of requests arise from an existential crisis: “The most frequently reported end-of-life concerns loss of autonomy (87%), decreasing ability to participate in activities that made life enjoyable (90%), loss of dignity (72% ) and being a burden to family/caregivers 59%.”

The treatment of physical pain is one of the remarkable advances in modern Palliative Care — never mind the careful attention paid to resolving people’s existential issues. A truly caring society would call for the provision of universal access to Palliative Care, long before any call for Assisted Suicide/Voluntary Euthanasia.

Universal access to Palliative Care will help vastly more people than Assisted Suicide to achieve a truly dignified, peaceful death. 

Dr. Kevin Hay

* “LIES, DAMNED LIES AND STATISTICS” is probably from Leonard H. Courtney, (1832-1918), later Lord Courtney, New York in 1895.