Peaceful Pill Blog
June 5, 2022
Legalising assisted suicide is a slippery slope says Dr Anthony Latham
Legalising assisted suicide is a slippery slope says Dr Anthony Latham in the Scotsman. Not so fast says Exit!
When an opinion piece appears in the right to life press, my tendency is usually to dismiss it.
Because it is written for a specific, one-eyed readership, it is to be expected that the arguments will be built upon lies and untruths.
But this is not the case when an opinion article appears in the mainstream press.
That is why last week’s piece in The Scotsman by retired GP Dr David Latham cannot be let pass.
Must have been quite a coup for the pro-life lobby to get the article up!
Note – Dr Latham is also Chair of the pro-life Scottish Council on Human Bioethics.
It is more than ironic that the stated first core purpose of the Council is:
‘To collect and evaluate evidence and information relating to ethical issues from which to inform public debate.’
Dr Latham is entitled to be concerned about, and opposed to, assisted suicide for terminally ill people.
What he is not entitled to do – especially in The Scotsman – is to invent lies and bullshit to put his argument forward.
The following takes issue with just a few of the many untruths he puts forward as ‘facts’ in his opinion editorial.
Dr Latham opens his article with the contention that in countries where assisted suicide has been legalised, euthanasia follows soon after.
While he does not explain what he means by these terms, it can be assumed that the act of voluntary assisted dying quickly becomes non-voluntary dying.
Or does he mean that voluntary euthanasia replaces assisted suicide.
If assisted suicide means a doctor prescribing a drug that the patient must then take themselves and that voluntary euthanasia means a lethal injection, Dr Latham is wrong.
No country, state or place that has ever legislated for assisted suicide has then legislated for voluntary euthanasia. It simply has not happened.
Legalising assisted suicide is a slippery slope says Dr Anthony Latham
Nor has there been a slippery slope of those who seek help to die being replaced by people who do not want to die.
The slippery slope is a historic argument, long used by Christian right, to do what Dr Latham says he is not doing, namely ‘scaremongering’.
In the Netherlands, Dr Latham says that assisted suicide is now allowed for the ‘over-70s who are “tired of living”’.
A quick look at recent media would have educated the good doctor that this is precisely what is NOT (at least not yet) lawful.
Indeed on 20 May 2022, the Dutch Council of State sent the proposed legislation back to the drafters of the bill, saying that more safeguards needed to be included before the bill could come before the Dutch Parliament.
This is not just slopping writing, it is dishonesty.
Dishonesty has no place in a respected newspaper such as The Scotsman.
Dr Latham also argues that ‘increasingly, euthanasia requests in the Netherlands are from people with dementia’.
But did he bother to look at the statistics.
In 2021, around 7500 in the Netherlands received euthanasia. Of those, six had advanced dementia.
There is no tidal wave of demented people being put down in Amsterdam, no matter what Dr Latham would like to think.
And no, David, infants can’t get euthanasia in the Netherlands. You have to be over the age of 12 in the Netherlands and have your parents’ consent.
You are confusing the Netherlands with Belgium.
For heaven’s sake man, do some basic research before you put those fingers to the keyboard. Or did your secretary do the typing for you?
And, then there is the vexed issue of making a voluntary euthanasia request part of one’s advance health directive.
While a person in the Netherlands can make a written request ahead of time that they would like to receive euthanasia at an unspecified time in the future (should they become, for example, demented), this is controversial.
The case which Dr Latham refers to in his desperation to prove that this is a clear sign that the Netherlands has ‘gone too far’ actually cleared the doctor of any wrong doing.
In 2020, the Dutch Supreme Court ruled that doctors can provide voluntary euthanasia to demented patients, even when the patient can no longer express an explicit wish to die.
The woman was held by her family, not the doctor. There was no forced lethal injection.
21st Century Netherlands is not Nazi Germany and to suggest otherwise, is deeply offensive.
Finally, Dr Latham is unhappy about people with psychiatric illness having access to assisted suicide.
He says these situations are very similar to “traditional suicide”.
By traditional suicide, it is intimated to the reader that we are talking about irrational suicide.
Such as when a young person jumps in front of a train or falls from a tall building?
But let us be clear, there is no comparison between a person with mental illness’ making considered decision for a lawful, assisted suicide and the irrational act described above.
This is because the countries that allow mentally ill people to get help to die all have strict safeguards.
A mental illness does not, by definition, strip a person of their capacity to make decisions.
Assisted suicide for the mentally ill is permitted in Switzerland, the Netherlands, Belgium and Luxembourg. It will also be permitted in Canada from March next year.
None of these countries have a slippery slope.
All of these countries mandate mental capacity as the first qualifying criteria before a person can use their end of life laws.
In my mind, this opinion article by Dr David Latham should serve as a wake-up call.
The medical profession has an exclusive pedestal which it uses to preach to the rest of us.
Sometimes this is abused.
Such blatant lying by medical professionals – even if they are retired – is a consequence of this exulted status.
Dr Latham has breached the professional standards and ethical obligations of his profession.
Whether by incompetence or malice, the outcome is the same with lies, confusion and a dumbed-down public debate.
May 22, 2022
The Swiss Option Just Got Harder
The Swiss Option Just Got Harder in what some say is a veiled attempt to stop foreigners having a VAD in Switzerland.
This week the Swiss Medical Association (SAMS) tightened its grip over when and how Swiss doctors can provide assisted suicide.
While, from a legal point of view, anyone in Switzerland can provide assisted suicide to another (as long as their motives are altruistic). Because all the Swiss organisations use Nembutal, the cooperation of a doctor is required.
It is this condition alone (the use of the controlled drug Nembutal) which brings assisted suicide into the orbit of the Swiss Medical Associations.
Swiss assisted suicide law says nothing about Nembutal and nothing about doctors helping.
What is Changing?
This week, the Swiss Academy of Medical Sciences has both clarified and published new ‘medical and ethical’ guidelines on death and dying.
Their policy paper which includes new guidelines on assisted suicide can be viewed in full here
SAMS state that a Swiss doctor can now only provide assisted suicide (by way of a prescription for Nembutal) if the following four conditions are met.
- Capacity: The ‘patient’ has capacity in relation to assisted suicide … It must be documented that incapacity has been carefully excluded by the physician
- Autonomous wishes: The patient’s desire is well-considered, not due to external pressure and enduring. For purposes of assessment, the physician must conduct at least two detailed discussions with the patient, separated by an interval of at least two weeks;
- Severe suffering: The severity of the patient’s symptoms and/or functional impairments is to be substantiated by an appropriate diagnosis and prognosis. (Ironically, perhaps, they state, ‘since intolerable suffering is not objectively determinable, the physician cannot be required to make such a determination)
- Consideration of alternatives: Medically indicated treatment options and other types of assistance and support have been sought, discussed with and offered to the patient. They have proved ineffective or been rejected by the patient …
The first 2 of these 4 requirements (capacity and autonomous wishes) must now be ‘confirmed by an independent third party (who need not be a physician).
What about these Changes that mean the Swiss Option Just Got Harder?
The requirements which will make it more difficult for a foreigner to be approved for a VAD in Switzerland are ‘Autonomous Wishes’ and ‘Severe Suffering’, requirements 2 and 3.
1. Autonomous Wishes
While Swiss doctors have long needed to ensure that a person seeking a VAD in Switzerland is not subject to external pressure (by a spouse, family member or friend), the requirement that the doctor must now undertake a consultation with the person not once, but twice over a set period of time, will inevitably make the whole process more difficult.
The worst case scenario is that the person seeking the VAD will need to now spend 2+ weeks in Switzerland (thereby increasing the difficulty and expense of the whole process).
The best case scenario is that the first interview would be able to be able to be undertaken by Zoom by Facetime; if this were possible it is only the doctor’s workload that is significantly increased.
SAMS has not yet stated the conditions under which these ‘two detailed discussions’ must be undertaken but there are red flags everywhere.
2. Severe Suffering
The second change to these guidelines concerns definitions of ‘severe suffering’.
Under the Swiss Criminal Code a person does not need to be sick, let alone terminally ill, in order to get a VAD in Switzerland.
As far as the involvement of Swiss doctors is concerned, this has now changed.
This is the medicalisation by stealth of a hitherto non-medical Assisted Suicide law.
Under the new guidelines, it is stated that it is ‘not ethically justifiable’ to provide ‘assisted suicide in persons who are healthy’.
Furthermore, the guidelines state that given a doctor cannot objectively determine intolerable suffering, an ‘abstract justification based on a diagnosis is not in itself sufficient’.
However, if the course of illness is documented and the individual’s situation described in detail, then the doctor’s judgement to proceed with a VAD may fall within the SAMS guidelines.
3. Confirmation of Capacity and Autonomous Wishes by an Independent 3rd Party
The third change that makes a VAD in Switzerland more difficult is the need for a so-called ‘independent third party’ to confirm that the person has the capacity to ask for help to die, and is making their decision voluntarily and of their free will.
The new guidelines do not define who the third party might or must be. Nor do they state the nature of the confirmation required. Is it verbal, written, signed by a public notary etc?
In regard to the need for the third party to be ‘independent’, one could reasonably guess that this is a quest by SAMS for the involvement of the applicant’s regular doctor in their home country (a disclosure that many would see as worrying and which could raise yet more red flags in terms of perhaps even being prevented from leaving their country).
Or perhaps a home town attorney or solicitor would suffice as the independent third party. Who knows?
Analysis & Summary
In summary, a VAD in Switzerland will now involve:
2 interviews with the doctor from the Swiss clinic, at least 2 weeks apart
Vastly more qualification criteria for those who are not ill (eg. for elderly people with polypathology – lots of small niggling things wrong but nothing that qualifies one as terminally ill) in order to prove ‘intolerable suffering’
A seeming blanket ban on people cannot show illness (eg. people such as 104 year old David Goodall who was old but was not sick)
Interestingly, in the preamble to these new guidelines, SAMS state:
Assisted suicide is not a medical action to which patients could claim to be entitled, even if it is a legally permissible activity.
In Section 6.2 they continue:
Requests by patients with capacity to support their intention to bring about their own death pose challenges for medical professionals’ understanding of their role in terms of professional ethics.
The formulation of objective medical criteria for the acceptability of assisted suicide is problematic since, firstly, such criteria would give rise to difficult questions of demarcation…
However, in order to justify why assisted suicide should be considered a medical matter at all, medically definable symptoms of disease or functional impairments must be present.
SAMS acknowledge that seeking to define a group within the community who are deserving (eg. the terminally ill) of medical help to die while implying that other groups are not (eg. the seriously old) is problematic, not to mention discriminatory and unfair.
SAMS acknowledge also that there is nothing inherently medical in helping someone to die.
Indeed, they go as far as to say that assisted suicide poses a challenge to the ‘true role of physicians in the management of dying and death … [which] involves relieving symptoms and supporting the patient’.
There can be no doubt that the Swiss Medical Associations are trying to medicalise their assisted suicide law.
They know that they cannot change the Swiss Criminal Code, so these new regulations are the next best thing to ensure that Swiss assisted suicide is made as medical (and as difficult) as possible, especially for foreigners.
That the Swiss groups all use the controlled drug Nembutal has left the way wide open for the medical establishment to colonise assisted suicide in this country; despite what the law allows.
The Future of Assisted Suicide in Switzerland
In some ways those who advocate for end of life rights in Switzerland are their own worst enemy.
Nothing forces the assisted suicide groups of Switzerland to use Nembutal (despite it being one of the best ways to bring about a peaceful and reliable death). The groups could equally, for instance, use sodium nitrite or sodium azide and have none of the problems that they are now facing.
They could also use nitrogen gas, as Dignitas sensationally tried and quickly discarded back in 2008 (due to the extraordinary bad publicity they received).
But what if a palatable, elegant, non-drug method of assisted suicide did exist for foreigners in Switzerland?
What if something like the Sarco capsule were available?
Where would the SAMS guidelines sit then?
As Sarco needs no controlled drugs, the group providing the Sarco needs no doctor.
Qualification to use the Sarco would still be based on ethical guidelines (as currently being developed by Exit International), but these would be based on capacity and the social surrounds of the applicant (eg. is the decision a considered one?) rather than on a medical assessment of disease.
The Swiss Criminal Code is a true departure from the medical-model laws that are being rolled out in countries such as Australia, the US, New Zealand and Canada, just to name a few.
It is a great pity that the Swiss find themselves caught up on the medical-model wave, rather than other jurisdictions seeking to replicate Switzerland’s progressive and inherently fair and egalitarian legal option.
March 6, 2022
Cancel Culture gets Uncancelled with Podcast Published
In January 2022 Exit Director Philip Nitschke was contacted by the ‘Let’s Get Psyched’ radio show and podcast series which is hosted by a group of psychiatrists/ psychologists at the University of California, Riverside with an invitation to take part in their program.
Let’s Get Psyched wrote:
‘The hosts at ‘Let’s Get Psyched’ would be honored to have you as an expert guest’
‘We would like to invite you to join us for a future recording!’
Philip accepted the kind invitation. A Zoom interview call was subsequently held and the Podcast recorded.
The show aired on the non-commercial college radio station KUCR 88.3FM shortly thereafter.
Around the same time, the team posted the podcast to their regular Podcast platforms (the same as used by Exit) including Anchor, Google, Apple etc.
Philip tweeted the Podcast.
On 16 January 2022, he received the following kinda sweet ‘thank you’ note.
However, within days, the link to the Podcast with Philip’s interview stopped working.
Indeed, on closer inspection, not only was the link faulty but the whole episode had mysteriously disappeared only to be replaced with an interview with a medical ethicist from the University of Nevada, Las Vegas.
Initially, Exit thought the link that the team had posted an incorrect link on Twitter. An innocent enough mistake.
But then something more nefarious emerged.
When Philip queried the link with Let’s Get Psyched, he received the following reply.
Thank you for reaching out. We apologize for the delay in response. We really appreciated the conversation you had with us and your candor. We aired both episodes on our radio station KUCR and had the first episode up online for about a week, but over that time period, our group became divided about the episode. We also received listener feedback expressing concern about the episode. We decided to take it down while we try to come to an agreement. We wanted to resolve the disagreement amongst ourselves before proceeding further. We apologize for not notifying you about the change and the confusion that has caused.
Hello Let’s Get Psyched team,
Thanks for the background
I have heard no more over the past 10 days
Does that mean attempts to ‘try to come to an agreement’, and ‘resolve the disagreement amongst yourselves’ have failed?
Could you please provide me with some detail It would be very much appreciated
The Team wrote again:
I hope you’ve been well.
I sincerely apologize for how long we are taking with this process. I did feel bad both this time and last time about how long we took to get in touch with you. We have been working on it consistently. We have never dealt with an issue like this before, so its a bit of a discovery process. Each matter has to be discussed and agreed upon between us before we advance it, but due to our disagreements on it, and wanting to make sure we do the right thing by you and by our audience, we have involved two bioethicist mentors, one of whom has not gotten back to us yet. We are a tiny operation consisting of residents and a psychologist, with no funding and our medical jobs to attend to first.
If you desire, I’d be happy to do a phone call with you to discuss your thoughts on the matter and your preferences as well as update you on the details of our concern.
We really enjoyed meeting with you and hearing your ideas, appreciate the time you took, and are hoping to have an end to this soon for all of our sake.
Thank you for your patience with us! I think it will make more sense once we share more about our conclusions and thought process. I forgot if i mentioned this, but it takes us a long time because coming to a consensus on things we all care about (like the topic of this episode) requires waiting for each of us to have the time to convene and complete our action items, etc. We like to process with various phone conversations and such, and are still sort of figuring out our own feelings as we go. Thought provoking stuff you brought us. We’ll be in touch.
The following day, Philip replied:
Appreciate the information.
No need to call – somewhat resigned… although surprised, I imagine my views on these issues would have been known and..
I’m a little unclear what it is about the discussion that requires the involvement of 2 bioethicists. In what capacity? but..
What we would really appreciate is a short statement re the basis of the decision so that we could provide it to our members who have been asking – possible?
12 days later, the team wrote:
We appreciate your patience as we continue to work on this. I have been emailing people multiple times a week since mid January in an effort to conclude this matter. We imagine you are pretty busy and would appreciate a quick resolution.
Cutting the Crap
At the time of publication – today 6 March 2022 – it is around 2 months since the Podcast was recorded.
This is more than enough time – surely – to sort out internal editorial censorship issues.
Philip Nitschke is a known quantity.
Why invite him to speak if his ideas are so dangerous that the podcast will not be able to be published?
Why waste his time?
If one were to accept that his views are dangerous (to some ears), where does this leave the First Amendment?
Why have Let’s Get Psyched turned to censorship?
What is it that their ‘bioethicist mentors’ could have brought to their decision-making process that they themselves were seemingly unable to agree on?
Is this conflict resolution between disagreeing psychiatrists?
Or is this children in the playground who need parental supervision about how to dig their way out of their self-made sandpit?
Or – more cynically – is the medical profession showing itself incapable and unwilling to countenance any point of view that challenges medical supremacy (and paternalism) in the assisted dying debate?
Either way, and with due respect to the team of psychiatrists, psychologist and registrars involved, this does not give one much faith (or hope) in the mental health profession.
On a brighter note, Exit preserved a copy of the Podcast interview and is pleased to publish it on the Exit website.
We apologize to those who reached out to Exit with complaints about the faulty link and the inconvenience of not being able to access the tweeted podcast.
But as you can see from the above, the matter was out of Exit’s hands.
Listen Now to the (Un)Cancelled edition of the Let’s Get Psyched Interview with Philip Nitschke.
And decide for yourselves just how dangerous the podcast really is …
February 6, 2022
Marie Fleming & Exit International Ireland
The Backstory of Marie Fleming & Exit International Ireland
I first met Marie Flemming in 2011, a few years before she died.
Having only recently become acquainted with Tom Curran, Tom had invited us down to his stone cottage in countryside Arklow for an evening meal.
At that time Marie was still able to speak so the evening was warm, friendly and convivial. I will never forget the generosity of Tom in inviting us to his home (something that he has done for few others, in his efforts to guard Marie’s privacy). In addition to cooking a fantastic meal, he attended to Marie’s every need.
Some might say he was run ragged, but it was a marathon in the name of love.
And here we are 11 years later with an organisation in Ireland that is dedicated and works in the memory of Marie Fleming.
When Marie died at home in December 2013, she had advanced MS. Marie had lost nearly all bodily movement and certainly most of her dignity. This was not the life she wanted. Neither of them wanted the anxiety of not knowing if/ when Marie would wake up each morning choking on her own saliva because she could no longer clear her lungs or her throat.
The running joke in the household was Marie ‘not dying on your watch’. But it really wasn’t very funny. Rather, it was terrifying.
But Marie Fleming was so much more than her disease.
As she herself said:
All people see now is a woman in a wheelchair who can’t speak very well, who can’t move at all. But I lived. I loved. I am somebody.
Marie had been a University College Dublin lecturer who taught, amongst other things, gender studies. She had two children, her first Corinna was born in a mother and baby home and was almost removed from her at birth.
Marie’s fight to save her daughter is a book in its own right.
Born one of five children in Donegal to parents who endured an especially dysfunctional marriage, Marie’s mother left home abruptly when she was 14, running off with the local hotelier and Irish Senator, Paddy McGowan.
Marie’s father would later take a High Court case against McGowan alleging ‘criminal conversation’ with his wife and for enticing her away from ‘his house and society’. But this did not stop her mother leaving home, a total of five times.
Marie Fleming’s story – told in the book An Act of Love – is about so much more than taking a landmark case to the Irish High and Supreme Courts even though that is how she is perhaps now best known.
Marie Fleming & Exit International Ireland. See: www.exitinternational.ie
The Court Cases
As Marie Fleming’s MS got worse, so did the paralysis until she could no longer lift her arm, sit up unassisted or even talk. And she certainly couldn’t take her own life (put an end to her suffering).
If she had had another condition (eg. cancer) it would have been more likely that she would still have had movement and she could have lawfully taken her own life as suicide is no longer a crime in the Irish Republic.
Marie’s initial case concerned a request for a declaration and orders that because she was paralysed from the MS, she needed help to die. Marie argued that she was discriminated against as a result of her illness. As Tom was willing to help her die it should have been QED.
Marie’s lawyers argued that the ban on assisted suicide was unconstitutional and incompatible with her rights under the European Convention on Human Rights (ECHR).
Marie also sought an order directing the Office of the Director of Public Prosecutions (DPP) about the issuance of guidelines (along the same lines as the Starmer guidelines in the UK) that would force the State to consider certain factors in deciding whether or not to prosecute an person for assisting or aiding another to end their life.
However the court disagreed.
So Marie appealed to the Supreme Court.
Again the Court disagreed with Marie Fleming & Exit International Ireland.
Chief Justice Mrs Justice Susan Denham, concluded that the right to life does not import a right to die and that there is no express right in the Irish Constitution to commit suicide.
Judge Denham continued that there is no constitutional right to commit suicide or to arrange for the termination of one’s life.
Judge Denham added, however, that there was nothing in the judgment to prevent the Government from introducing legislation in the future to deal with cases such as Ms Fleming’s.
Current Legislative Moves in Ireland
Ever since 2013, Exit International Ireland director, Tom Curran, has been lobbying for a change in the law so as no other people need go through what he and Marie went through.
As Tom himself has said:
‘law reform is a long and hard road but we must not give up. And we must not settle for the narrowest of laws that only help the terminally ill. This would be a mistake. Let us look to the Swiss model of assisted suicide’.
Since 1942, anyone can help anyone else to die in Switzerland as long as their motives are altruistic, and as long as the person receiving the help has mental capacity and can do the action themselves.
(In Marie’s case this might have meant administering lethal drugs via a cannula that allowed an eye-blink for activation or the new 3D-printed Sarco which is still in production).
The point is that Marie Fleming started the right to die movement in Ireland. It is only proper (and logical) that people like her would be able to be assisted by any change in the law.
On 15 September 2020, TD Gino Kelly (People before Profit) introduced a private member’s bill to the Irish Dáil. By 7 October the bill passed its 2nd phase with majority support (81 to 71).
The Bill was intended to legalise Voluntary Assisted Dying (VAD) only for the terminally ill.
Despite receiving broad public support, the joint Committee on Justice did proceed (due to alleged insufficient safeguards for the elderly and vulnerable; concerns highlighted in some of the submissions considered).
Almost a year later in July 2021, the Justice Committee stated that the Voluntary Assisted Dying Bill should be examined thoroughly by a a Special Committee. Some say this move is nothing but a stop-gap measure, aimed at buying time and doing nothing.
As of 2022, the Special Committee is yet to be established by the Oireachtas Business Committee. Should it be established it will be a cross-party committee comprised of 12 TD’s, representing all the parties.
It is interesting that in December 2021, the Irish Government announced a new €10 million in funding for palliative care services.
Call me cynical, but perhaps this was a smart move by the Government to rule out the old argument that we don’t need choice at the end of life, only better funded palliative care.
In the coming months Exit will be holding a free public meeting at which we review the global state of play of right to die laws and explain why the Swiss do it better and why, in the name of Marie Fleming and countless others, Ireland is best placed adopt the Swiss legal model.
In 2023, Exit shall convene a major, international conference on the right to die.
Exit Conference in 2023
Exit International is currently planning for a major international right to die conference to be held in Dublin in May-June 2023.
To register your interest in any/ all Exit Ireland activities, you are invited to subscribe to our free Email List now.