France approves terminal sedation legislation

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By Alex Schadenberg, International Chair - Euthanasia Prevention Coalition

Politicians in France have been debated the legalization of euthanasia for many years. 

In January 2011, the French Senate rejected a euthanasia bill by 170 - 142. During the 2012 election President François Hollande promised to legalize euthanasia but since then Hollande has faced strong opposition to his plan. In June 2015, France's Senate rejected a bill that permitted euthanasia by dehydration and in October 2015, a French court decided that Vincent Lambert should continue to receive food and fluids.

The Associated Press has now reporting that French lawmakers approved a bill that allows "terminal sedation" but not euthanasia. 

According to the media report the French government approved a bill that allows doctors to sedate a person, upon request, who is nearing death, and withdraw life-sustaining treatments including nutrition and hydration (food and water). According to the article:

The new law will allow patients to request "deep, continuous sedation altering consciousness until death" but only when their condition is likely to lead to a quick death. Doctors will be allowed to stop life-sustaining treatments, including artificial hydration and nutrition. Sedation and painkillers will be allowed "even if they may shorten the person's life." 
The bill will also apply to patients who are unable to express their will, following a process that includes consultation with family members. 
The methods can involve medicating patients until they die naturally of their illness or until they starve. Some doctors, however, say it may be more human to euthanize.

I have not read the bill, but if the bill allows doctors to intentionally cause the death of a person by dehydration, when the person is not otherwise dying, then the act is "slow euthanasia" or euthanasia by dehydration. If the bill clearly limits sedation and dehydration to people who are actually nearing death, then the act is closer to palliative sedation.

Link to the full article

Assisted Suicide: Nurses in the Line of Fire

Nancy Valko

Nancy Valko

This article was published by Nancy Valko on her blog on November 5, 2015

By Nancy Valko

Years ago, the newly legalized Oregon physician-assisted suicide law caused much discussion at my St. Louis hospital. Some of my fellow nurses said that they supported such a law but when I asked them if they would participate, they were shocked. “No, of course, the doctor would have to do it!”, one exclaimed. Some nurses, like perhaps most people, thought assisted suicide would only occur at a patient’s home with his or her family sitting with the patient watching the drinking of the lethal overdose.

I explained that in hospitals or hospices, would we expect the assisting doctors to be present when the patient ingested the lethal overdose, not to mention staying with the patient and family during the time it could take for the patient to die? My colleague agreed that nurses, not doctors, would probably bear the brunt of the “dirty work” of assisted suicide.

Back in 2000 and three years after Oregon legalized physician-assisted suicide, I saw an article from Nursing Spectrum magazine titled “Assisted Suicide: What Role for Nurses?” that stated:

Initially, when the law was designed, the assumption was that physicians would be the first ones to explore PAS with patients,” says Pam Matthews, RN, BSN, administrator for Evergreen Hospice, Albany, OR, “but in reality, nurses are usually the ones in the line of fire…. Much of nurses’ roles lies behind the scenes long before the drama of PAS unfolds. Home care and hospice nurses actively help patients understand their rights, acting as advocates for those who are considering PAS.”

How many nurses are really willing to “advocate” for physician-assisted suicide? The article states:

“Before PAS became law, it was publicly debated, and we performed surveys of our hospice teams’ feelings on the issue,” Matthews says. “We found that most nurses felt strongly that patients should have the choice of PAS, although most said they would not participate in the event.”

Recently, I spoke to a nurse in Washington State who is against physician-assisted suicide law about nurses’ experience with physician-assisted suicide in her state. She referred me to a 2014 study in the Journal of Pain and Symptom Management titled “Dignity, Death, and Dilemmas: A Study of Washington Hospices and Physician-Assisted Death”. (click on link and click PDF to read the full text)

While 21% of the Washington hospices in this study, mostly religiously-affiliated, refused any involvement in assisted suicide, this study sadly confirms the how legalization has affected both hospices’ and nurses’ role in assisted suicide.

Link to the full article.

Montreal Euthanasia Symposium: Theory and Reality about Euthanasia

Media Release - October 30, 2015

The Physicians’ Alliance against Euthanasia, the Living with Dignity network and the Euthanasia Prevention Coalition (EPC) are coming together for a one day conference on Saturday October 31, 2015 at the Best Western Ville Marie hotel in Montréal, to discuss our common concerns and directions.

The Quebec euthanasia experiment is scheduled to begin on December 10. The vast majorityof physicians around the world have always rejected euthanasia, above all because it is a public safety hazard: it can drive people to throw away years of their lives and provide caregivers and heirs with enormous power. Although it gives an illusion of control, the option of euthanasia will undoubtedly erode medical diligence and creativity in the medical care of people both chronically disabled and acutely disabled by illness.  

Most patients fear suffering at the end of life. This has always been the case. But we must find a less dangerous option than the constant availability of “death on demand” to address these fears. In extreme cases, i.e. for the small minority of patients for whom other options are not completely effective, palliative sedation can answer all symptom control problems.

Quebec has the only law in the world which attempts to coerce doctors to refer patients for euthanasia. Such pointless authoritarianism, of which we already had a taste in September, is a dangerous precedent which must be formally rejected.   

From a logistical point of view patients do not need help from their treating physician to access euthanasia: the government could easily set up a system of self-referral to voluntarily licensed doctors who are willing to practice euthanasia. This would avoid trampling on the professional judgment and conscience of the rest of the medical profession. 

We reject the concept that euthanasia is any kind of health care. We reject bullying physicians into referring their patients for death. And we reject the concept that intentional death is a solution to human distress.

Dr Catherine Ferrier – President, Physicians Alliance Against Euthanasia (514) 623-5737
Dr Will Johnston – Chair, EPC - BC (604) 220-2042
Dr Margaret Cottle – Vice President, EPC (604) 222-0288
Dr Marc Beauchamp – President, Living with Dignity Network.
Alex Schadenberg - Executive Director, Euthanasia Prevention Coalition (519) 851-1434

Not Dead Yet Denounces California Governor’s decision to sign Assisted Suicide Bill

This article was published by Not Dead Yet on October 5, 2015.

Diane Coleman

Diane Coleman

By Diane Coleman, the President and CEO of the disability right group Not Dead Yet.

Today, NDY was devastated and disgusted to learn that California Governor Jerry Brown signed into law the assisted suicide bill that proponents rammed through a “special” session of the legislature convened to address the state’s Medicaid budget.

Governor Brown’s message accompanying his action states that he “carefully read” materials from opponents such as “those who champion disability rights,” but he nevertheless seems to have missed key facts.

For one, he says that “the crux of the matter is whether the State of California should continue to make it a crime for a dying person to end his life . . ..” Suicide is not a crime under California law (nor in other states), but assisted suicide proponents love to confuse people about that. The crime is when physicians and other third parties, such as the individual’s heirs, assist in suicide.

When confronted with that fact, proponents then often argue that old, ill and disabled people need help to commit suicide, which is another falsehood. As proponents promote on their website, any old, ill or disabled person can already commit suicide legally and peacefully in any state. So it is not a crime for a dying person to end his or her life peacefully, and Governor Brown’s stated “crux of the matter” is therefore mistaken.

Near the end of his short statement, Governor Brown said:

“In the end, I was left to reflect on what I would want in the face of my own death. 
I do not know what I would do if I were dying in prolonged and excruciating pain.”

This reveals that he didn’t really learn very much about the advances in palliative care when it comes to physical pain. At this point in time, palliative care physicians are able to relieve physical pain, even if that may in some instances require palliative sedation. Some people may feel that they don’t want to be made unconscious to relieve pain, but that’s a psycho-social issue. The implication that assisted suicide is needed to relieve physical pain is mistaken.

The Governor’s stated reasons are based on fallacies and his action must be denounced. When held up alongside the factually based and well considered reasons that disability rights organizations oppose legalization of assisted suicide – mistaken prognoses, insurance denials, family coercion and abuse, among others – his failure to veto the bill amounts to a breach of his duty to protect all Californians, not just the privileged few who can count on high quality health care and the support of a loving family.

Wesley Smith: France debates slow euthanasia

This article was published on Wesley Smith's blog on June 16, 2015.

By Wesley Smith

Wesley Smith

Wesley Smith

Sigh. If the euthanasia pushers can’t get people dead one way, they try another.

The French Senate is debating legalizing terminal sedation for the terminally ill who want it. From the Yahoo story:

France’s debate over end-of-life care goes to the Senate, with a bill that would allow doctors to keep terminally ill patients sedated until death comes, but stops short of legalizing euthanasia and assisted suicide. 
Euthanasia is currently legal in the Netherlands, Belgium and Luxembourg, and recent polls show a large majority of French people favor legalization. But French lawmakers haven’t been willing to go quite that far, in a debate that is arising at the same time as the wrenching family dispute surrounding Vincent Lambert, a Frenchman in a coma since a car accident seven years ago.

But terminal sedation is “that far,” just via a slower process than lethal injection, as this part of the story makes clear:

The new bill would give people “the right to deep, continuous sedation until death.” Some doctors say it can mean patients are sedated for weeks, and that euthanasia may be more humane.

That’s killing by slow motion because it involves putting a patient into a coma and depriving them of food and fluids so they dehydrate to death.

Link to the full article

Deep Sedation: France is in danger of buying a deadly illusion

Dr Kevin Fitzpatrick OBE, is the director of EPC International and lives near Avignon, France.

Dr Kevin Fitzpatrick

Dr Kevin Fitzpatrick

France is in danger of buying a deadly illusion: that terminal sedation is neither assisted suicide nor euthanasia. In the Netherlands it can be both, and the numbers of people being terminally sedated there are growing at an alarming rate. From the minute the Assemblée Nationale should pass any such legislation, terminal sedation will become the lie to hide the practice of euthanasia throughout France too.

On Tuesday March 17, 2015 the French parliament overwhelmingly voted to give people the right to demand terminal sedation – that is, for them to be made unconscious in their last hours and days. We have been warning about the steep rise in the use of terminal sedation in the Netherlands, as a form of ‘back-door’ euthanasia.

In the Netherlands, only informed adults who meet all the criteria of the Dutch law are counted as euthanasia deaths. None of those who are unable to give informed consent, a key element of the Dutch law, are counted. So no neonates killed because of their disabilities, no older people with dementia, or those in persistent coma, no-one who finds some doctor willing to ‘grant’ them a euthanasia death because they fail to meet Dutch legal criteria. Those who die through terminal sedation are not generally counted either, but the rise in their numbers is frightening.[1]

Even in those cases where deep sedation is a serious consideration, for those few individual people whose refractory symptoms cannot be managed by modern palliative medicine, profound questions remain to be answered. But in the 1990s this group was estimated at below 5% of all cases.[2] Today palliative care specialists, and advances in their field, mean that fewer than 2% of patients are faced with terminal sedation as their only option.[3] Of course every individual deserves our best response, but if their numbers are falling why then should terminal sedation be on the rise at all? In the Netherlands or anywhere else?

Link to the full article

France is establishing rules for terminal sedation

By Alex Schadenberg, International Chair - Euthanasia Prevention Coalition

The President of France, François Hollande since the election in May 2012, has stated on several occasions his intention to legalize euthanasia. 

Hollande has faced strong opposition to legalizing euthanasia

Instead of legalizing euthanasia, Hollande has announced that his government will introduce a bill to legislate rules for terminal sedation and to update (Leonetti law) the rules related to the withholding and withdrawal of medical treatment.

Link to the full article