How legal euthanasia changed Belgium for ever

Thanks to MercatorNet for this fine reflection on where euthanasia law has taken Belgium culturally and ideologically:

The ideology of absolute self-determination has become sacred and unquestionable.

In 2002, Belgium became the second country in the world after its neighbour, The Netherlands, to legalise euthanasia. Over the next decade our country has become a living laboratory for radical social change. With many other countries debating legalisation at the moment, now is a good moment to stand back and take a good long look at the results.

In 2002 Belgium was governed by a coalition of Liberals and Social Democrats. The slightly more conservative Christian Democrats had been excluded. With blue as the colour of the Liberals and red of the left-leaning Social Democrats, the press dubbed it the Purple coalition.

The Christian Democrats took a dim view of euthanasia, but they were in opposition. The Purple coalition was free to pass an euthanasia law based on the view that an individual should always have a “free choice” to end his life. In absolutizing individual self-determination the left and the right found common ground.

The law states that doctors can help patients to die when they freely express a wish to die because they are suffering intractable and unbearable pain. The patient needs to consult a second independent doctor; for non-terminal illnesses an independent psychiatrist must approve. In practice, however, this independence is irrelevant. Belgium is a small country and compliant doctors are easy to find.

A string of recent cases leaves no doubt that the euthanasia law has fundamentally and drastically changed Belgian society. Last year 45-year-old deaf identical twin brothers who couldn’t bear the thought of going blind were granted euthanasia.Doctors granted their request because they “had nothing to live for” anyway.According to the doctor who gave the lethal injection it was not “such a big deal”.

In another case, a 44-year-old woman with chronic anorexia nervosa was euthanased. Then a 64-year-old woman suffering from chronic depression was euthanased without informing her relatives. The doctors defended their decisions by explaining that these extreme and exceptional cases were legitimate because all legal conditions were met.

Euthanasia is hardening from a medical option into an ideology. Belgium’s euthanasia doctors even believe they are being humane because they are liberating people from their misery. Fundamentalist humanists go further and describe euthanasia as the ultimate act of self-determination. The opinion of the patient’s family has no weight whatsoever. A doctor is entitled to give the mother of a family a lethal injection without offering any explanation to her children. Euthanasia is being promoted as a “beautiful” and positive way to die. Doctors are transplanting organs from patients who die in the operation. (This is said to make their lives meaningful.) The law may soon allow children and patients with dementia to be euthanased.

Since 2002 opponents of the law (like us) have been marginalised as rigid and heartless conservatives who feel ill at ease in a post-modern, pluralistic and progressive society like Belgium. (1) The Christian Democrats have repudiated their traditional values and support the law. Questioning it has become taboo because the absolute right of the individual might be violated.

There are still some significant critics, apart from the Catholic Church. The Belgian philosopher Herman De Dijn is an outspoken opponent. He describes Belgium as a “sentimentalist society” in which traditional values have been drastically minimized and replaced by subjective preferences. (2) A sentimentalist society no longer subscribes to ethical values other than those which are related to the search for individual happiness (autonomy and no-harm). Communal responsibilities and moral institutions are being discarded in the search for purely individual well-being; interdependence and connectedness are ignored.

De Dijn feels that this is the nub of the problem. A human being is not a bundle of individual feelings, opinions and preferences, but part of a species, a member of mankind, a vital link in the moral ecology where every individual has a unique symbolic value. Respect for human dignity includes not only respect for personal choices but also for connectedness to loved ones and society.  

Supporters of the euthanasia regime repudiate this secular critique -- as well as the baneful influence of the Catholic Church. (3) However, their ideology of absolute self-determination has become so strong that it is morphing into a theology, a quasi-religious fanaticism. They have invented comforting symbols and rituals to express their beliefs. A self-determination card describes a patient’s final wishes so that the social services know what to do in a terminal illness. There are centres where people can ask questions about how euthanasia can be performed. There is indoctrination in self-determination for doctors and volunteers who wear their euthanasia enabler certificates as badges of honour.

Nonetheless, we are hopeful. Surely it must be possible to convince the Belgian public that something is terribly, terribly wrong when politicians are debating whether parents can legally have their children put down. It is not humane and it is not scientific. There is no scientific scale of unbearable suffering. With advances in pain relief, euthanasia is not even needed.

The key insight of the green movement is that all living beings are interconnected – even us humans. Especially us humans. The job of politicians is to protect this connectedness. Otherwise, why should parents care for their dependent children? Why should children care for dependent parents? Once we lose the sense that each of us is bound to one another with invisible cords of fellowship, we will end by killing all those who are burdens on society. And at some stage, all of us are going to be burdens.

Euthanasia does not threaten religious dogmas. Churches will stay open no matter what happens in hospitals and nursing homes. What is threatened is humanism. Instead of standing strong, arms linked together as brothers and sisters, the dogma of self-determination separates us, places us in bubbles of isolation, and then offers to kill us – if we want. In today’s Belgium all of us are at risk.

Tom Mortier and Steven Bieseman teach in Leuven University College, in Belgium. They would like to thank Emeritus Professor Herman De Dijn for valuable discussions and Sylvia Statz for advice about translating the text.

Notes

(1) Burms A. and De Dijn H., De sacraliteit van leven en dood, Pelckmans Uitgeverij nv, Kalmthout, (2011), S. 71-89.

(2) De Dijn H., Taboes, monsters en loterijen, Uitgeverij Pelckmans, Kapellen (2003), S. 23-25.

(3) Burms A. and De Dijn H., De sacraliteit van leven en dood, Pelckmans Uitgeverij nv, Kalmthout, (2011), S. 91-99.

World Congress of Families Sydney May 2013

I was asked by the World Congress people to give a short address on the relationship between euthanasia & assisted suicide and family dysfunction.

The following text should be taken as observation and opinion.

Euthanasia: dysfunction – cause and effect by Paul Russell

We have a saying in our family that ‘The Russell’s put the fun back in dysfunctional’. I think we might all be able to identify with that in some ways.

One definition of dysfunction says that it is a ‘Deviation from the norms of social behaviour in a way regarded as bad'.

This encapsulates, I think, the problem with euthanasia & assisted suicide and the public discourse about this dark spectre in our midst.

End of life issues are almost always difficult for families, we know that. The way families interact in daily living will normally be a good indicator of how they respond/react to end-of-life discussions, but the addition of the ‘elephant in the room’ about an ‘early exit’ does nothing to enhance or support the family in such circumstances; on the contrary, it is dysfunctional precisely because it is a deviation from the norms of social behaviour in those circumstances.

What messages do our elders hear from society about aging and the end of life? Two main myths:

Myth one: you’ll be a burden on your family and on the system. To this, some respond with a healthy dismissal; while others will absorb the subtle and not-so-subtle message that indeed, they will be a burden.

Myth two: you’re likely to die in pain and discomfort. This is a complex matter. Some in the pro-euthanasia movement continue to make references and comments that re-enforce this. It’s a campaign of fear. Like the proverbial snake oil salesman, they convince people that they are in desperate need then they provide them with a ‘solution’.

I say that this is complex for a number of reasons. Firstly, if you get access to quality palliative care from the best trained people you will not die in pain. But access is not universal. So whilst, in a perfect world, we could say that pain is no longer the problem, even our peak palliative care bodies cannot say so absolutely – not because their craft cannot achieve this goal, but because there simply are not enough high quality trained professionals and simply not enough services to go around. This, I believe, is the real problem to be answered.

How is this both cause and effect of dysfunction?

It is so easy to re-enforce the negative message about an older relative being or becoming a burden. All it really takes is a little lack of attention, a deaf ear to the subtle requests for affirmation. God knows, we have funeral plan adverts on TV showing healthy vibrant seniors saying ‘we don’t want to be a burden on the kids’.

Yet at a time when the elder may be moving to a nursing facility from their home of many years with little in the way of personal comfort possessions and where their routines evaporate, it is often really only the constancy of the family in their visits, phone calls, outings etc. that can actually re-enforce and restore a sense of the worth of that person.

This is a very fragile period in a person’s life and it is something that no-one really offers any guidance to help with.

It is very easy to fall into the trap of patronising the elder, of not really listening to what they are saying. “Hit me on the head dear” is what my mother-in-law would say. This, from a woman who would never have contemplated an easy way out of anything in her entire life. What was she saying? What did she really want in reply?

The answer was simple. She was really saying that she didn’t think any of us were really aware of the difficulty she was having coping with her radically changed circumstances. She wanted re-assurance. She wanted to know from us that we cared, that we understood, that we would create a routine of family care around her and that she would be no stranger to the family and the grandkids.

In spite of many ‘near-death’ experiences, Mum lived a further 16 years in her nursing home. She certainly had a will to live and I hope that, if there’s a ledger somewhere, that we will have been known to have helped rather than hinder her sense of worth and purpose.

I think you know that it is not always like that. People often share stories with me because of my work. Terribly sad stories - many would shock you.

Neglect is probably one of the worst kind of abuse. Imagine my mother-in-law’s cry for help being met with disinterest or, even worse, agreement. It does happen. It would be easy to see this as strictly a sinister and perhaps criminal neglect; but it isn’t always so. Some people are so emotionally damaged themselves in this world that even their best intentions may never find concrete expression. There’s a fear of decrepitude and diminishing faculties that for some may mean that they cannot even face it in others. It can be hard, even in the strongest families, to get past the presenting circumstances and to love regardless of them.

Paul with Alex Schadenberg's book

And it is expression that is probably the most significant support. A gesture, a smile, a caress, a laugh, a song, a reminiscence.

I need to focus now on a phenomenon that is reaching epidemic proportions in many parts of the Western World. I’m referring to Elder Abuse. Elder Abuse is the physical, psychological, emotional, financial and even sexual abuse of elderly persons. In some reports I have read, jurisdictions in the U.S. and elsewhere estimate that up to 10% of the population over the age of 65 years are subject to such abuse in some form. This is deeply dysfunctional.

It is a classical situation of abuse in a power imbalance between a younger, able person (often a family member or carer) and an older person with diminishing faculties. It is grossly under reported precisely because the abused person is fearful of repercussions, has little or no access to any other person outside the abusive situation, or because they rely so entirely upon that person that they fear what might happen to them if they were removed.

If it is about power, then it is also about money. The two seem to go together. Financial Elder Abuse is a no brainer really.

The ultimate elder abuse, of course, would be the premature death of the elder and the assignment of the estate to the abuser. This is where the relationship between Elder Abuse and euthanasia becomes crystal clear.

Yes, bills we’ve seen recently in South Australia and elsewhere attempt to cover the possibility of coercion, but attempts at trying to address these very real concerns are essentially lip service: trying to assuage genuine concerns with almost useless safeguards.

I put it to you that euthanasia and assisted suicide does not happen in strong, functional families. Even with the celebrated cases in our media, there is often a hint of a back-story of some thing missing.*

What is happening deep down here is that we’ve become a society where we incessantly seek for the quick fix – the easy way out – the path of least resistance. This is as true for the individual thinking of themselves as it is for individuals’ thinking about others. We have become a society whose god is utility and function.

The spinmeisters of the pro-euthanasia movement have done their job playing on our natural fears about death and amplifying them to the point where they would have us all expect to die in excruciating pain and in horrific circumstances. As I said, theirs is a campaign of fear.

And what does that fear really say? It says, ‘I don’t want to end up in a wheelchair, I don’t want to end up with someone else wiping my bum, I don’t want to have to rely on others, I don’t want to experience the decrepitude of demise.’

It is less about dying than it is about living.  

Ultimately, what they’re really saying is that they don’t want to be disabled; they don’t want to be aged and infirmed. This promotes a subtle and not-so-subtle disdain of elders and of the disabled. “I don’t want to be like them” ergo “I am repulsed by them.” Little wonder that genuine disability activists are so incensed by the idea of euthanasia because they see themselves as targets.

And it doesn’t seem to me to be too much of a stretch to characterize these messages as a form of abuse writ large.

It is possible that in this kind of thinking we are seeing the birth of a new form of eugenics. The worship of the perfect and the disdain of anything imperfect.

This, friends is the real dysfunction that we should fear. It gripped and bedazzled Europe for two dark decades up until about 1940. And there are deep, subtle and resonant echoes of this horror right here in our midst.

And that, dear friends, becomes the challenge for us all. It’s a challenge about the preservation and restoration of a culture that is sorely in need of a functional vision of the family which includes and embraces those of us who are less-than perfect!

Yes, maybe we can put the fun back in functional!

*Here I am not referring to cases where someone is euthanased where the family was unaware and would have otherwise intervened. Unfortunately, this also occurs.

Fear of growing old - reason to die in Switzerland?

82 year old Swiss citizen Alda Gross wants to die by assisted suicide. She is simply growing old.

EU court finds Swiss assisted-suicide laws vague

JOHN HEILPRIN

Associated Press= GENEVA (AP) — An elderly Swiss woman who would rather end her life now than decline further in health found sympathy Tuesday from the European Court of Human Rights, which called on the Swiss to clarify their laws on so-called passive assisted suicide.

The Strasbourg, France-based court said Switzerland must specify whether its laws are meant to include people not suffering from terminal illnesses and, if so, spell out the conditions under which they can end their lives.

Alda Gross, a woman in her early 80s who lives outside Zurich, appealed to the court after she couldn't find a doctor to prescribe her a lethal dose of drugs and couldn't force Swiss authorities to order a doctor to grant her wish. An assisted suicide group also had advised her it would be difficult to find a doctor to give her a prescription because her illness wasn't terminal.

While she didn't suffer from any clinical illness, the court said, Gross argued that she shouldn't have to keep suffering from the decline of her physical and mental facilities. According to court documents, she attempted suicide and was hospitalized in 2005. Then she tried to get a lethal prescription of sodium pentobarbital through the assisted suicide group and by turning to the Zurich health board.

The vagueness of Swiss laws "concerning a particularly important aspect of her life was likely to have caused Ms. Gross a considerable degree of anguish," the court found. And while Swiss laws allow for the possibility of obtaining a lethal dose of a drug on medical prescription, it added, those laws "did not provide sufficient guidelines ensuring clarity as to the extent of this right."

Bernhard Sutter, vice president of the Zurich-based group EXIT, which Gross had consulted for help, said Tuesday the court ruling for now would not change the fact that his group cannot help healthy people, only those with a hopeless clinical prognosis or who suffer from intolerable pain. But he welcomed the court's call for more legal clarity.

Passive assisted suicide has been legal in Switzerland since 1942; the law allows someone to give another person the means to kill themselves, provided the helper doesn't personally benefit from the death or aid in the actual act of death. Most people who avail themselves of the law are terminally ill, but some have cited depression or blindness for wanting to end their lives, and some are young but may have a permanent disability or severe, debilitating mental disorder.

Other countries such as the Netherlands and Belgium, and U.S. states such as Oregon and Washington, have passed laws allowing the incurably sick to consult a doctor who can speed their death, under special and tightly regulated circumstances. Switzerland's reputation as a relatively trouble-free place for suicide has led to what critics call "suicide tourism" by foreigners, pushing the boundaries of medical ethics and public opinion.

The court said it recognized the issue is a difficult one, but that more specific Swiss laws would help doctors make better informed decisions free of fear of litigation or bad publicity.

The Swiss government said in 2010 that sodium pentobarbital could be used in exceptional cases for severe psychological illness.

A year later, the Swiss government dropped plans to impose stricter rules regarding "passive assisted suicide." The government said the current rules strike a balance between protecting vulnerable individuals and safeguarding their right to self-determination, and new laws could infringe on people's personal freedoms.

Gross, who lives in a village on the shore of Lake Greifen in northern Switzerland, was turned down by the Zurich health board when she tried to force her doctors to prescribe her a lethal dose of sodium pentobarbital. The Swiss Federal Supreme Court in 2010 upheld the health board's decision.

Gross did not submit a claim for damages to the European court, which did not take a stand on whether she should have been given the lethal dose.

AMA (SA) chief slams SA euthanasia bill – again

In February this year we reported that the South Australian branch of the Australian Medical Association (AMA) had written to all South Australian lower house MPs roundly criticising this and another end-of-life related bill proposed by The Hon Bob Such MP.

The February letter was unprecedented in as much as it used very direct and unambiguous language that seemed to this writer to contain an element of some frustration at yet-another euthanasia bill.

The letter, in referring to both bills jointly said that, “(T)he AMA(SA) strongly opposes both Bills, considering them to be fundamentally and irretrievably flawed.”

They further observed:

“It is of significant concern that these Bills appear to have major elements that are ill-conceived, indicate a fundamental lack of understanding of current concepts in end-of-life care, and show a confusion in understanding of the critical difference between palliative care and euthanasia. They have the potential to confuse and compromise the provision of good end-of-life care, with resulting distress to patients and their families. We do not believe that these Bills have been the products of an acceptable level or period of informed community and stakeholder consultation and engagement and consider that they would bring divisiveness and confusion.”

One would have thought that this would have sealed the bills fate. Apparently not.

Such was quick to defend his bill, calling into question various aspects of the AMA statement. One comment was to observe that the letter was signed by the AMA’s Chief Executive Officer – a lawyer – and not the AMA President. This is perhaps a little lame given the fact that the AMA nationally have a policy opposing euthanasia and that the CEO is hardly likely to issue an edict without referral both to the policy and the state executive.

It is not exactly clear why the AMA decided to communicate to MPs via a second letter at this time. However, if there was any doubt about the AMA’s strident opposition after the first letter, this latest missive should leave no room for question at all.

Signed on this occasion by the AMA(SA) President, Dr Patricia Montanaro, in addition to repeating the statements already quoted, please consider the following:

“Even for individuals who may support euthanasia, the AMA(SA) regards these Bills to be in the realms of dangerous folly which have the potential to damage the basic tenets of clinical practice in ethical and compassionate end-of-life care. We recognise that there are divergent views on euthanasia and that the voluntary euthanasia bill proposed may go to a conscience vote. However, these Bills would simply create bad, and damaging, legislation.”

“The assistance that good palliative care can provide is not well understood, and we have a crucial need for good, well-resourced palliative care. Euthanasia must not be the end point of poor resourcing of end-of-life care.

“We urge Members of Parliament to turn your valuable attention, time and advocacy in the House to the critical need for a health system that strongly supports good end-of-life care.

Introducing fundamentally flawed voluntary euthanasia legislation is not the way to do this and in fact will produce the opposite effect, with resulting distress and harm.”

The letter also made reference to interventions by the SA Law Society and the Palliative Care Association of South Australia who clearly raised similar concerns.

What more needs to be said? If the medical association is saying that they don’t want euthanasia laws to be passed (and especially not this bill), why is the debate continuing and why do some MPs still support such legislation?

Firstly, there should be no real objection (apart, perhaps from fatigue!) in having these debates. Mr Such is as entitled as any MP to table bills. As a consequence, MPs should be entitled, if the opportunity arises, to speak on the bill (note: something that was denied them in Such’s previous bill in 2012) Well-researched and well-crafted speeches can definitely enhance understanding and can raise to tone of debate.

And of course, there are those who really do want to see such legislation passed.

But what kind of legislation would it be if the medical body representing doctors across the state say that they don’t want it? After all, it will be these doctors who will be asked to carry out a patient’s request.

It reminds me of a story told by eminent Australian academic, Margaret Somerville in her book Death Talk where she suggested to an audience of her colleagues that perhaps euthanasia should be performed by lawyers rather than doctors; adding that at least the lawyers would understand the law!

The question remains to be answered in the debate on Such’s euphemistically titled Ending Life With Dignity Bill 2012. Will the parliament impose a system which is clearly not wanted or will they continue to endorse the status quo in the knowledge that to do so protects the vulnerable as it always has done. Moreover, will they continue to look for ways of improving end-of-life patient care in the knowledge that, as the AMA suggest, it is really an either-or situation; that euthanasia acts to undermine patient-centred care.

New right to die bill sparks row - says UK Mail online

The UK Mail online article refers to the long awaited assisted suicide bill promoted into the House of Lords by assisted suicide campaigner, Lord Falconer. It is highly critical of both the terminology and the intent.

New right to die bill sparks row as peers condemn 'Orwellian spin' and say it would not 'pass public safety test'

• By STEVE DOUGHTY

A new attempt to persuade MPs and peers to back a right-to-die law has been branded ‘Orwellian’ by one of the country’s leading lawyers.

Lord Falconer, the former Labour Lord Chancellor, wants to legalise ‘assisted dying’ for terminally ill patients.

But he has been accused of using ‘Orwellian spin’ by attempting to distinguish between ‘assisted suicide’ and ‘assisted dying’. Critics say there is no difference between the two.

Lord Alex Carlile QC, left, said the terms of Lord Falconer's, right, bill are based on 'euphemisms' and criticised an attempt to call doctors helping a patient to die as 'assisted dying' rather than 'assisted suicide'.

Among his critics was leading Liberal Democrat peer Lord Carlile, who said that giving doctors power to help terminally ill people to die ‘would not pass the public safety test’.

Lord Carlile, a prominent QC, said in a newspaper article: ‘Advocates of such a law tell us that they are not talking about suicide. They say that helping people who are terminally ill to end their lives is not assisting suicide because they are expected to die.

‘This is, of course, nonsense. In law, as in the English language, if you take your own life, whatever your state of health, that is suicide; and a doctor or anyone else who supplies you with the means to do so is assisting suicide.

‘Sound lawmaking demands clarity. It cannot be based on euphemisms, verbal evasions or Orwellian spin.’

Lord Falconer was also accused of exploiting the impact of right-to-die court cases involving terribly disabled people to win support for the proposal.

Critics said its timing had been ‘carefully planned’ to coincide with the hearing of the case of Paul Lamb, 57, a severely disabled former lorry driver, who is seeking permission for a doctor to kill him by lethal injection.

Jane Nicklinson, the widow of Tony Nicklinson, pictured together, will go to the Court of Appeal to fight for legal protection from murder charges for doctors if they help a patient die.

Dr Peter Saunders, a campaigner against euthanasia, said: ‘Lord Falconer is using the emotions generated by hard court cases, but his agenda is very dangerous for disabled and elderly people.’

Lord Falconer is planning to table his Private Member’s Bill before peers on Wednesday. It will allow adults with six months or less to live to request a doctor’s help to commit suicide, and supporters say it is bound around with safeguards to prevent abuse.

His Bill follows a report produced last year under his leadership which made a similar call for assisted suicide for the terminally ill. The report said help to die should be available for anyone with 12 months to live, but following widespread criticism that has been cut down to six months.

It will be the third Parliamentary attempt in seven years to legalise assisted dying. Peers rejected calls for legalisation in 2006 and 2009.

This week, judges in the Court of Appeal will begin hearing Mr Lamb’s case, and the case of a man known only as Martin, a victim of locked-in syndrome. Mr Lamb, who is quadriplegic, has taken over the claim of Tony Nicklinson, another locked-in syndrome victim, who died shortly after losing his case in the High Court last year.

Martin is claiming that assisted suicide laws – which set a maximum sentence of 14 years in jail for helping someone kill themselves – break Article Eight of the European human rights charter, which protects the right to privacy and family life.

Dr Saunders said: ‘The timing has been carefully planned. Off the back of media coverage of this case, Falconer, who is being backed by Dignity in Dying, the former Voluntary Euthanasia Society, will argue that his proposal is modest in comparison.

‘Lamb is not terminally ill and wants a doctor to give him a lethal injection. Falconer, however, is only asking for people who are terminally ill to have the right to receive help to kill themselves – assisted suicide.’

Dr Saunders added: ‘The last thing we need is a change in the law to put more pressure on people who already feel themselves to be a burden to others.’

Assisted suicide laws were effectively reformed without any Parliamentary vote by Keir Starmer, the director of public prosecutions, in 2010. Following instructions passed down in one of the last cases heard by the Law Lords, Mr Starmer issued guidelines that said no-one is likely to be prosecuted for helping someone to die if they are a family member or friend, rather than a professional, and if they act out of compassion and not greed.

Between 150 and 200 people are thought to have gone to the Dignitas clinic in Switzerland to be helped to commit suicide. But no family member who helped has ever been prosecuted.

Doctors’ Words Influence End-of-Life Decisions Made By Patients' families

This is an important article from TIME's Alexandra Sifferlin. It highlights how critical the doctor is in shaping and influencing a family's decision in regards to treatment at the end-of-life for a loved one.

Whilst the study only looked at the influence a doctor can have on a family int he throes of making a decision whether or not to resuscitate, it does point to the role of the doctor in general terms when dealing with a patient and presenting a patient with his or her options.

A doctor is not and never should be simply a presenter of options and a dispenser of a patient's decisions. He or she has a vital role in assisting a patient to shape their decisions precisely because of their training and experience.

Making the decision to approve heroic measures to save a loved one’s life can be fraught with emotion, so anxious family members tend to turn to the doctor for guidance, according to the first study to analyze the role that doctors’ language plays in end-of-life decisions.

Researchers from the University of Pittsburgh School of Medicine conducted a novel study to investigate how a doctor’s choice of words, or how his empathy and personal experience, can impact family members’ decisions to approve or not approve cardiopulmonary resuscitation (CPR) to save a critical patient’s life. They recruited 250 people with living parents or spouses in Boston, Atlanta, New York, Los Angeles, San Francisco, Dallas, Denver and Pittsburgh.

The study participants were presented with an online survey in which they were asked to imagine a hypothetical situation: one of their loved ones was in an intensive care unit with a 40% chance of dying from sepsis, a severe bacterial infection. Some of the participants were also shown pictures of their family members or loved ones on the screen to intensify the emotional impact of the experience.

The volunteers were then confronted by a doctor, played by an actor, who held a meeting with the family member online. During the simulation, the “doctor” asked the participants whether or not they wanted CPR administered to their loved one. However, the participants heard different versions of the CPR explanation.

Some of the men and women were asked whether they wanted their family member to receive CPR, which had a 10% chance of saving their loved one’s life, if the heart stopped, or if they wanted to issue a “Do Not Resuscitate” (DNR) order. About 60% opted for CPR. However, when the doctors changed the language of the DNR choice to “allow natural death,” only 49% chose CPR.

In some cases, the doctor also talked about his or her own experience and discussed what the majority of people facing similar situations generally chose. When this happened, the participants tended to go along with the majority opinion, and opt for the choice that others had taken.

“Simple changes of words and perceptions about social norms resulted in large differences in CPR choices,” said study author Dr. Amber Barnato, an associate professor of clinical and translational science at the University of Pittsburgh School of Medicine in a statement. “This study suggests that the change isn’t just window dressing — it makes a real difference in the choices that people make. We expect that it also may reduce feelings of guilt for choosing against CPR by making family members feel like they are doing something positive to honor their loved one’s wishes at the end of life, rather than taking something away from them.”

The fact that doctors’ words have such influence on end-of-life decisions highlights how critical the doctor-patient relationship is, and how conflicted family members feel during these difficult situations. Studies have shown that one way to ensure that such critical decisions aren’t being made under duress would be to have conversations, as difficult as they are, about what those closest to you would want early on during a long-term illness, or prior to a life-threatening health crisis. Preparing for such events can make transitioning into end-of-life care, or making emergency decisions, less stressful and less traumatic. Last May, Malene Smith Davis, CEO of Capital Caring, told TIME, “It’s all pre-planning really. People really do cope well if they have a conversation about care with their families early. When families don’t have the conversation, that’s when there’s turmoil because no one is prepared and it’s inevitable.”

Already, says Barnato, hospitals in Texas have asked their physicians to drop the DNR language from their discussions with patients and their families and to ask them whether they would prefer to “allow natural death.” There’s no denying that making these decisions can be challenging, and physicians, she says, should be aware of the role they play in influencing those difficult choices.

The study is published in the journal Critical Care Medicine.

Read more: http://healthland.time.com/2013/05/10/doctors-word-choice-impact-whether-patients-families-choose-cpr/#ixzz2TFmKHFjp

Vermont (USA) legalises assisted suicide

The Vermont legislature passed their assisted suicide bill today in what is a first for the USA. In Washington State and in Oregon, assisted suicide became possible via citizen initiated referenda of the type that was defeated in Massachusetts last November.

Wesley Smith comments below on the passage of this bill. Included below are his earlier observations about the bill:

Vermont Legalizes Assisted Suicide

May 13, 2013 10:08 PM

Alas. Today, the Vermont Legislature passed a bill that legalizes assisted suicide in the state. The governor has promised to sign it into law and it will take effect immediately. In three years, the protective guidelines will sunset and VT will have essentially no rules assisted suicide. 

This is very bad news disguised as compassion. Nor, in the long run, will the death agenda be limited to the terminally ill. Eventually, Vermont will end up off the same vertical moral cliff as Belgium, the Netherlands, and Switzerland.

Vermont's Coming "No Rules" Assisted Suicide

May 9, 2013 12:28 AM

Vermont seems poised to enact assisted suicide into state law. For the first three years, it will be a law with even fewer “protective guidelines” than the ephemeral Oregon rules. Then, the guidelines sunset and doctors would seem to be able do pretty much as they please. From the Burlington Free Press story:

The alternative grants doctors immunity from prosecution for providing a lethal dose of medication if they follow a list of rules, including making sure the patient is terminally ill and making a voluntary, informed decision. The list includes some, but not all, the rules Oregon requires in its 15-year-old law. In 2016, that list of rules expires, with the idea that doctors will have established their own protocol.

Please notice the trajectory: As the doctor-prescribed death movement advances, its proffered restrictions get progressively weaker. That’s happening in slower motion in the USA than in euthanasia havens like the Netherlands and Belgium because there is still resistance to the culture of death here–as Massachusetts voters showed by defeating a legalization referendum in November. But whether here or overseas, the death-on-demand ultimate destination is the same.

Next step: A campaign to persuade Vermont doctors to refuse all participation in doctor-prescribed suicide and for hospitals and nursing homes to keep the suicicde agenda outside their doors! How about signs that say, “This is an assisted suicide free zone.”