Tag: suicide

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PAS in California: the first 6 months

In a 2016 data report, the California Department of Public Health says that in the first 6 months after California enacted the “End of Life Option Act,” 111 people committed suicide with the help of a doctor’s intentionally lethal prescription, as permitted under the terms of the law.  The time period reviewed was the last 6 months of 2016.

The people in question are understood to all have been terminally ill, as the law intends.  The majority of these 111 were white and college-educated.  The median age was 73.  They had a variety of diseases; a few more than half of the 111 had cancer. 

The report says 258 people asked their doctors about PAS.  Of these, 191 got prescriptions, and 111 took the drugs (orally) and died.  Another 21 did not take the drugs.  What happened to the remaining 59 of the 191 is not known.  The law calls for prescribing physicians to report outcomes after prescription, when known.

In the time period PAS accounted for 6 of every 10,000 deaths in California.  By comparison, the Associated Press reported that the figure for 2016 in Oregon was 37 of every 10,000.

84% had been enrolled in hospice or palliative care, suggesting to me the acceptance of PAS as a standard of care by specialists in palliative care.   Or perhaps the patients decided palliative care had failed them.  Details of the mindsets of the 111 are not part of the report.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Confronting Medicine in the Holocaust & Beyond

By Hedy S. Wald

Galilee, Israel, May 7-11, 2017. I was privileged to be at the Second International Scholars Workshop on “Medicine in the Holocaust and Beyond.” Why so meaningful?  Why so needed? 140 purposeful, passionate scholars from 17 countries delved into the past history of medicine at its worst in order to inform the future.  From 1933-1945, presumed healers within mainstream medicine (sworn to uphold the Hippocratic Oath) turned into killers (1).  Yes, medical ethics in Nazi-era medical school curricula existed, yet included “unequal worth of human beings, authoritative role of the physician, and priority of public health over individual-patient care”(2).  In Western Galilee College, (Akko), Bar-Ilan University Faculty of Health Sciences (Safed), and Galilee Medical Center and Ghetto Fighters’ Museum, (both in Nahariya), historians, physicians, nurses, medical and university educators, medical students, ethicists and more gathered to grapple with this history and consider how learning about medicine in the Holocaust can support healthy professional identity formation with a moral compass for navigating the future of medical practice with issues such as prejudice, assisted reproduction and suicide, resource allocation, obtaining valid informed consent, and challenges of genomics and technology expansion (3)…

The conference, in essence, served as a lens for the here and now, reinforcing my contention (and others’) that history of medicine in the Holocaust curricula including confronting the Nazi physicians’ and scientific establishment’s euthanasia of “lives unworthy of life,” forced sterilizations, horrific experimentation on their victims, and medicalized genocide (leading to the destruction of a third of the European Jewish population and many others) is a “moral imperative” in healthcare professions education (1,4).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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The most permissive assisted suicide country is Switzerland

Assisted suicide is legal in Switzerland, and moreover, is accessible without having to provide any reason. There are no rules that require the participation of a doctor, and most suicides are assisted by associations that support the right to a dignified death. Even though, in Europe, euthanasia and assisted suicide are permitted in Holland, Belgium and Luxemburg, and in some states in the United States, the situation of assisted suicide facilities in Switzerland is unique because of the facilities that exist specifically for it. A recent study recorded 611 cases in a centre in Zurich, which is where most assisted suicides occurred between 2008 and 2012 (see HERE).

Euthanasia and assisted suicide. Attitudes and practice in countries where they have been legalised

Photo ABC

La entrada The most permissive assisted suicide country is Switzerland aparece primero en Bioethics Observatory.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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National Right to Life Tackles End of Life Medicine

Several sessions at next week’s National Right to Life Conference address end-of-life medicine, including the general session: How to Prevent an Assisted Suicide Roe v. Wade.


Assisted Suicide Battles Rage in Nearly Every State: Is Your State Next?
Mary Hahn Beerworth, Scott Fischbach
The threat of doctor-prescribed suicide is advancing in the states. Moreover, the next Supreme Court nomination could lead to legalization of euthanasia nationwide. Assisting suicide is now legal in California, Oregon, Washington, Vermont, and, via the courts in Montana. With battles raging in states
across the country, the ongoing battle in Vermont will be discussed as will other battles nationwide. This workshop will give background and break open the myths surrounding doctor-prescribed suicide. The speakers will cover the current legal and legislative landscape, describe some different kinds of successful winning (and losing strategies), and talk about what you can do in your own state. In the wake of massive state legislative push and upcoming Supreme Court nominations, it is more important than ever that doctor-prescribed suicide be stopped in its tracks.


The Battle Against Simon’s Law: How Dirty Tricks Lost To Smart Negotiations
Kathy Ostrowski
When hospitals choose to fight against parental decision-making rights – the battle for life can take two paths, and only one leads to life. This workshop will provide a firsthand account of those who fought for Simon’s Law in Kansas. Simon’s Law is a very significant pro-life measure that combats selectively “rationed” care and medical discrimination against children with life-limiting diagnoses.  Kathy Ostrowski will share how the triumph of artful dialogue beat back bullying tactics and whisper campaigns.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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2nd International Conference on End-of-Life Law, Ethics, Policy, and Practice

Check out this remarkable collection of concurrent sessions coming up at the 2nd International Conference on End-of-Life Law, Ethics,
Policy, and Practice (ICEL) in Halifax.



The Ethics of POLST
Lloyd Steffen


The Perils of POLST
Jean Abbott


Advanced Directives and Advanced Care Planning
Peter Saul


“Rock, Paper, Scissors” – Ideologies of End of Life Care for Older People in Hospital
Laura Green


The Cultural Construction of End of Life Issues in Biomedicing: Anthropological Perspectives
Betty Wolder Levin


Caregiver Perspectives of Palliative and End of Life Care for Individuals at End-Stage Dementia in Newfoundland and Labrador: A Qualitative 
Phenomenological Perspective
Barbara Mason


End of Life Regulation and Recent Evolutions in France
Veronique Fournier


To Live and Let Die. Withholding and Withdrawing Life Sustaining Treatment in Argentina: From Therapeutic to Judicial Obstinacy
Maria Ciruzzi


When and How I Shan’t Live: Refusing Life-Prolonging Medical Treatment and Article 8 ECHR
Isra Black


Divorcing Mercy Killing from Euthanasia
Bryanna Moore


The Shift Away from Suicide Talk: Incorporating Voices of Experience
Phoebe Friesen


Elderly Who are Ready to Give Up on Life and the Right to Autonomy
Michelle Habets


Dutch GP’s Views on Good Dying and Euthanasia
Katja ten Cate


Medical Aid in Dying in New York State: Physician Attitudes and Impact of Framing Bias
Brendan Parent


Physicians’ Perceptions of Aid in Dying in Vermont
Ari Kirshenbaum


A New American Threat to Open Discussion of End-of-Life Issues
Robert Rivas


Demedicalised Assistance in Suicide
Martijn Hagens


The Human Rights Implications of the Blanket Ban on Assisted Suicide in England and Wales
Stevie Martin


A Year in Review: The Who, When, Why and How of Requests for Medical Aid in Dying in Quebec
Lori Seller and Veronique Fraser


Medical Aid in Dying: An Update from Québec
Michelle Giroux


Regulating MAiD: The Medical Regulatory Perspective
Andréa Foti


Patients with Parkinson’s Disease, Caregivers’, and Healthcare Providers’ Perspectives on Advance Care Planning on End-of-Life Care
Kim Jameson


‘You’re Going to Die.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Canada Today: End-of-Life Stories

In summary, this is a brief article consisting of multiple short stories. They particularly provide perspectives of patients in Canada who have faced end-of-life situations. Based on Catherine Porter’s article, there are various contextual motives behind these patients’ decisions to discontinue treatment or choose euthanasia. However, there is a common, general theme for such clinical practices. For example, a patient named June Vaile had been suffering from near-total blindness due to macular degeneration.

Subsequently, her learning of having colon cancer was a relief to her. Knowing this was an opportunity to attain medically-assisted suicide, Vaile sought this to end the misery associated with her inability to enjoy her life pursuits resulting from her former condition. Likewise, a patient named Eva McLeod was also diagnosed with cancer. Prior to such revelation, however, her mother had passed away. Already distraught, and fearing continued emotional pain from the onset, she viewed euthanasia as a palatable means to the end of suffering.

These two patients demonstrate that death is not always a immoral type of action in itself. The overall life circumstances of a patient may be too severe to warrant the continuation of a functional, healthy life. Therefore, death may be justified. This affirms the humanity through beneficence and non-maleficence in compliance with societal moral standards and our obligations to patients. Thus, patient narratives are very important. Such provides a personal, humanistic viewpoint to the identity that patients present in the clinical setting. Consequently, in the case of end-of-life situations, healthcare professionals are empowered to become more compassionate and prepared to serve the greater welfare of the patients and practices moving forward.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Good Death, or Assisted Suicide?

The Case of Mr. Perry and his Pacemaker

Tarris Rosell, PhD, DMin
Rosemary Flanigan Chair at the Center for Practical Bioethics

NOTE: Dr. Rosell, a bioethics consultant and educator, will present the case of Mr. Perry for ethics discussion and likely debate on Thursday, June 22, 2017 at 7:00 PM in the artfully rebuilt Westport Presbyterian Church, 201 Westport Rd, Kansas City, MO. Bring your perspectives, arguments, and personal stories of moral medical dilemma. Admission is free. All are invited and welcome.

Mr. Perry (not his real name) was 83 years old and had several medical problems. He had spent the past several months in and out of hospitals and rehab. Prior to that, he lived independently in a small Midwestern town. Widowed many years ago, he subsequently enjoyed the company of a lovely lady friend who lived down the street from the Perry home. He had five adult children and numerous grandchildren.

Life should have been relatively good for this octogenarian. But life was not good. Not anymore. “My body is all worn out. I’m worn out. Don’t want to do this anymore, Doc. They say I can’t go home and be safe. And I’m NOT going to a nursing home. No way! Just stop that little gadget that shocks me and the part that keeps my heart going. I want them stopped. Yes, the pacemaker, too. A magnet will stop it, right? Just do it. Please.”

Tired of Fighting

Mr. Perry had a cardiac resynchronization therapy defibrillator (CRT-D) implanted a few years ago. It included an electrical pacing component for heart rhythms, on which the patient was 100% dependent.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Controlling Direct Access to Personal Health Information

By Sarah Duranske

In 1978, for the first time, an American woman could take a pregnancy test in the comfort of her own home. Critics claimed that home pregnancy tests only would be used by promiscuous or immoral women who were too ashamed to visit their doctors, but the appeal to women was undeniable. [1] Today, eight out of ten women learn they are pregnant from a home pregnancy test.[2]

In the 1980s, as the AIDS crisis swept the nation, the FDA banned the use of at-home AIDS tests over fears of poor test reliability and insufficient counseling.[3] Advocacy groups bolstered these fears by highlighting the suicide of a man who jumped off the Golden Gate Bridge after testing positive for HIV.[4]  But with improvements in testing technology and treatment options – and stymied by a stubbornly high infection rate – the FDA reversed its stance.  It encouraged home test kit applications in 1990 and approved two home collection kits in 1996.[5]  Within a year, more than 175,000 people purchased kits, and the expanded screening was not associated with any increase in the suicide rate.[6]

In 2013, the FDA shut down 23andMe’s health-related genetic tests due to concerns that users would act, or fail to act, to their detriment based on incorrect test results or unsupported clinical interpretations. In spite of experts’ concerns, 23andMe had genotyped around 400,000 individuals between its 2007 market entrance and the FDA’s 2013 action.[7] Studies consistently demonstrate (for better or worse) that people don’t change their behavior based on genetic tests that report on disease risk.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Canada’s Biggest Health Problem: Indigenous Health

Alison Reiheld calls attention to André Picard’s assertion that Indigenous health is currently the most urgent issue in Canada.

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In a recent interview in Chatelaine with André Picard, a well-known Canadian health columnist for the Globe and Mail, Picard discusses the deficits and merits of Canada’s healthcare system. For anyone working on Canadian healthcare or on health policy anywhere, it is worth reading. He discusses dental care, home care, long-term care, the effect of an aging population, and more. One of his takeaway quotes no doubt is “Nearly 40 countries in the world have universal healthcare, and it’s all more universal than ours.” But something interesting, important, and under-attended is raised when the interviewer asks Picard, “What is the most urgent issue in Canada right now?” Picard’s answer:

Indigenous health. It’s been a problem for more than 100 years. There’s a real opportunity to make a dramatic difference, quickly. The indigenous community is young and the fastest growing by far – more than 50 percent of indigenous people in Canada are under the age of 15. This is the time to stop generation after generation of disaster, poverty, isolation, addiction and suicide – we’ve created all that. We have an apartheid system designed to oppress people and it’s given the exact results it was designed to produce. Take away their culture, their language, their ability to earn money, their ability to have land, and then, oh, we’re surprised they’re the most unhealthy people in our country? It’s not a surprise at all.

Island Lake, First Nations Community

The problems are many for Canada’s indigenous people (Aboriginals, including First Nations, Métis, and Inuit).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In Defense of a Physician’s Right of Conscientious Objection

Guest post by Cheyn Onarecker, MD

In their recent “Sounding Board” piece in the New England Journal of Medicine (subscription required), Ronit Stahl, PhD, and Ezekiel Emanuel, MD, PhD, denounce the rights of physicians and other health care professionals to opt out of certain procedures because of a moral or religious belief. The interests and rights of the patient, they state, should always trump those of the clinician. The only role for conscientious objection, in their view, is a limited one, when the appropriateness of a treatment or procedure is being debated.

Once a professional society determines that a treatment is acceptable, the physician must comply or get out of medicine altogether. Stahl and Ezekiel lament that the American Medical Association (AMA) and other medical societies support conscience rights, but, I believe the arguments they advance to eliminate such rights are not convincing and would jeopardize the future of medicine.

First, although the well-being of patients is one of the primary goals of medicine, there has always been a balance between the needs of patients and physicians. Otherwise, physicians would work 24 hours a day, with no time off for family, friends, or other pursuits. Physicians would be expected to respond to all patient requests, day or night. The question is not whether physicians should put patients’ needs above their own, but where the line should be drawn between the needs of the patient and the physician. In emergencies, a patient’s needs triumph, but other situations are not always so clear. When it comes to requests for treatments that violate a physician’s deepest moral convictions, no physician should be forced to cross over the line.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.