Sunday 20 November 2016

A foetal homicide law in Western Australia?

In a joint media release dated 11 September 2016 from the Attorney General of Western Australia, the Hon Michael Mischin and the Minister for Police, the Hon Liza Harvey on the introduction of the Restraining Orders and Related Legislation Amendment (Family Violence) Bill 2016 the introductory bullet points included a reference to “Up to 20 years jail for intentional foetal homicide”.

The Restraining Orders and Related Legislation Amendment (Family Violence) Bill 2016 passed its third reading in the Legislative Assembly of Western Australia on 17 November 2016 having passed in the Legislative Council on 15 November 2016.


Bodily harm to an unborn child


The Bill contained an ancillary amendment to the Criminal Code of Western Australia which inserted a new provision into section 1 which addresses bodily harm to an unborn child, grievous bodily harm to the woman’s unborn child and causing the loss of a woman’s pregnancy.

The new provision reads as follows:

 In this Code, unless the context otherwise indicates —

(a)   a reference to causing or doing bodily harm to a person includes, if the person is a pregnant woman, a reference to causing or doing bodily harm to the woman’s unborn child; and

(b)   a reference to intending to cause or intending to do bodily harm to a person includes, if the person is a pregnant woman, a reference to intending to cause or intending to do bodily harm to the woman’s unborn child; and

(c)    a reference to causing or doing grievous bodily harm to a person includes, if the person is a pregnant woman —

(i)                  a reference to causing or doing grievous bodily harm to the woman’s unborn child; and
(ii)                a reference to causing the loss of the woman’s pregnancy; and

(d) a reference to intending to cause or intending to do grievous bodily harm to a person includes, if the person is a pregnant woman —

(i) a reference to intending to cause or intending to do grievous bodily harm to the woman’s unborn child; and

(ii) a reference to intending to cause the loss of the woman’s pregnancy.

This is a significant step forward in recognising in the criminal law of Western Australia that an assault on a pregnant woman that causes the death of an unborn child, or other bodily harm to the child, regardless of any other harm occasioned to the woman herself should be punishable by law.

Falling short of a true foetal homicide law

However, the new provision falls short of a clear offence of “foetal homicide” which would require intentional unlawful acts leading to the death of an unborn child to be punished with the same penalty as other homicides, namely life imprisonment.

Nonetheless the Criminal Code of Western Australia now clearly recognises that it is a crime to “cause or do bodily harm to an unborn child” or “to intend to cause or to do bodily harm to an unborn child”.

“Bodily harm” is defined in Section 1 of the Code as “any bodily injury which interferes with health or comfort”.

Furthermore the Code recognises that it is an even more serious crime to “cause or do grievous bodily harm to an unborn child” or to “intend to cause or do grievous bodily harm to an unborn child”.

“Grievous bodily harm” is defined in Section 1 of the Code as “any bodily injury of such a nature as to endanger, or be likely to endanger life, or to cause, or be likely to cause, permanent injury to health”.

Finally the Code explicitly makes it an offence to unlawfully “cause the loss of a woman’s pregnancy”, that is to say, the death of an unborn child.

It is somewhat unsatisfactory to treat these offences, by a kind of legal fiction, as a species of bodily harm or grievous bodily harm to the mother of the unborn child rather than as, what they are in reality, direct harms to the unborn child as a separate individual human being.

An inherent tension in the law on the status of the unborn child: disposable or protected?

Nonetheless these new provisions are to be welcomed for two reasons:

Firstly, the provisions go some way towards a just recognition of the real harm done when the life of an unborn child is taken by an unlawful act, such as an assault on a pregnant woman.

Secondly, the provisions introduce a creative tension into the law of Western Australia which now, on the one hand treats acts intentionally causing the death of an unborn child – at any stage of pregnancy – as a serious crime while on the other hand, under Section 334 of the Health Act 1911 making it lawful for a medical practitioner to intentionally cause the death of an unborn child, subject to specified conditions, at any stage of pregnancy.

While these laws can exist side by side in formal law, the inherent contradiction between them can be pointed to by those who see it as self-evident that the very same unborn child can’t be rightly treated as disposable at will in one set of circumstances and worthy of full legal protection in another.


Hon Nick Goiran MLC: A champion for the unborn child

The Hon Nick Goiran MLC has worked persistently over the past few years to persuade the Barnett government to introduce a clear foetal homicide provision to the criminal law. 

While he is naturally disappointed that earlier promises to do so have not been fulfilled, he is to be congratulated on his vital contribution in achieving even this more modest step in the direction of greater justice for children who are killed before birth.

An extract from his second reading speech on the Bill, delivered in the Legislative Council on 15 November 2016 follows below.

(Dr Graham Jacobs MLA is also to be congratulated for addressing this issue forthrightly in the Legislative Assembly on 17 November 2016. Mr Peter Abetz concurred with his remarks.)

I remind members of the event that first led to our consideration of this provision, which is more commonly referred to as the foetal homicide law in Western Australia.

In October 2009, Matthew Silvestro was driving dangerously in a Nissan Pulsar and his heavily pregnant girlfriend, Vanessa De Bari, was in the passenger seat, and their two-year-old son was in the back seat. He turned the car into the path of a Jeep on Wanneroo Road in Woodridge, causing a collision that resulted in severe injuries to Vanessa and the tragic death of her unborn child. Fortunately, the toddler survived. Vanessa spent eight and a half months recuperating in hospital, learning to walk again, and she has permanent brain damage from the collision. The clear injustice in the Silvestro case with regard to this person who had a history of domestic violence offences and had seven restraining orders against him by six different partners is that he received only an $8 000 fine for dangerous driving occasioning grievous bodily harm. This was because currently under Western Australian law no penalty exists for the harm or death of an unborn child as a result of an unlawful assault or dangerous driving.

The former Attorney General, Hon Christian Porter, was rightly outraged by this loophole and the inadequate penalty and he announced plans to strengthen and clarify Western Australia’s foetal homicide laws by creating a new offence of causing death or grievous bodily harm to an unborn child through an unlawful assault on its mother. This offence, he stated, based on one in operation in Queensland, would carry a maximum penalty of life imprisonment. In regard to dangerous driving offences that cause the death of an unborn child, such as in the case of the death of Vanessa De Bari’s unborn child, the then Attorney General announced that this would be dealt with in the District Court and carry a maximum period of imprisonment of 20 years. Additionally, when there was a history of domestic violence against the mother by the offender prior to them harming or causing the death of an unborn child, the offender would face a presumption of imprisonment.

I need to draw to the attention of members of this house that those intentions, as I understand, have not been realised through the inclusion of clause 97 in this bill. It will not achieve what shadow Attorney General John Quigley said at the time, which was that any unlawful act that caused the loss of a child, even if it caused no other injuries to the mother, should attract a charge of grievous bodily harm and be defined as being in aggravated circumstances so that it will attract the higher maximum penalty. No clause in this bill attracts a higher maximum penalty for the death or harm of an unborn child when caused by a person with a history of domestic violence, or by upgrading the grievous bodily harm to being in aggravated circumstances. For the sake of clarity, clause 97 will amend section 1(4) of the Criminal Code by inserting as bodily harm or grievous bodily doing harm to a pregnant woman’s unborn child. This provides recognition of the harm or death of the unborn child as bodily harm or grievous bodily harm to the pregnant woman, and in some circumstances this may increase the penalty. Even though this Restraining Orders and Related Legislation Amendment (Family Violence) Bill achieves something meaningful for pregnant women who suffer the tragic loss of an unborn child through an unlawful assault or dangerous driving, it does not achieve what was intended following the clear injustice suffered by Vanessa De Bari and her unborn child.

Whilst I acknowledge that this amendment to the Criminal Code is a step in the right direction, I believe that consideration needs to be given to honouring the original intent of this reform by providing greater clarity to Western Australia’s foetal homicide laws by stating in law the reality of what has occurred and providing an appropriate penalty. Would any member of this house dispute the medical evidence that Vanessa De Bari’s unborn child was killed as a result of this car crash? I very much doubt it. We use the phrase “killing an unborn child” because, simply stated, that is what has occurred. That is the fact of the matter, yet out of fear of contradicting other laws in Western Australia, we deny the facts and call the killing of an unborn child grievous bodily harm to the mother. The law has a compounding effect.

It began in 1913 when the Western Australian Parliament passed the Criminal Code, which states in section 269 that a child becomes a person capable of being killed when it has completely proceeded in a living state from the body of its mother, whether it has breathed or not and whether it has independent circulation or not and whether the naval string is severed or not. Perhaps in the past, before ultrasound technology, it was difficult to confirm the death of a child in utero, and, without confirmation, it was perhaps impossible to prove cause and effect. That is understandable. However, in 2016 a woman can have an ultrasound in the morning showing a moving, unborn child sucking its thumb, and the woman could then experience an assault to her womb, and the medical team could quickly assess the effect on the unborn child, thus placing beyond reasonable doubt that the assault caused the death of the unborn child. A post-mortem examination could further confirm these things. There was perhaps once an issue of cause and effect that led to the creation of section 269.


However, in 2016 we can understand and even prove that an unborn child is capable of being killed. Indeed, I might say that when a martial arts expert kicks the womb of his pregnant girlfriend with the intention of harming the unborn child, as occurred in Queensland in 1996, and the unborn child dies as a result, is this not killing the unborn child? Would the woman not grieve the death of her unborn child? According to our proposed amendment, her grief is misplaced and her grief should be directed towards the grievous bodily harm she has suffered. I am entirely uncomfortable with that notion. The grievous bodily harm she suffered would be of minimal significance to her compared to the loss of her unborn child. Yet our proposed amendment provides no greater significance to her own harm and no separate recognition of the death of the child that once lived within her. What might be of interest to members is that the Queensland Parliament recognised this misdirected justice and changed the law as a result. Twenty years ago, its state’s Criminal Code was amended to recognise that a child that is capable of being born alive is also capable of being killed, and the penalty for intentionally killing an unborn child is the same as murder—imprisonment for life. That, of course, is what the former Attorney General meant when he referred to basing our foetal homicide laws on Queensland’s law. However, in going this far, he would have had to recognise, and he did, the elephant in the room, which is legal abortion; yet he justified that foetal homicide laws could co-exist with legal abortion by stating that the proposed legislation would be drafted to require an unlawful act to be done to the mother before any penalty could apply. Obviously, in Western Australia, performing an abortion within the defined parameters of the law is not an unlawful act, and hence would not be affected by this new offence. I hasten to add that I am not attempting to ignite a debate about the right of women to have an abortion. 

I am simply attempting to draw to members’ intention the original intention of this law reform and to ask that we remain true to that intent to afford women who experience the tragic loss of a child in utero the dignity they deserve by acknowledging the gravity and the reality of the crime that occurred, that being the killing of her unborn child.

Tuesday 25 October 2016

Assisted suicide for "completed life": the State showing mercy?

Euthanasia was formally legalised in the Netherlands in 2003 after several years in which it was practised openly after court decisions allowing it in certain circumstances. 

Assisted suicide for “completed life”


On 12 October 2016 the Netherlands Government formally reported to the Parliament its response to the February 2016 report of a commission on assisted suicide for “completed life”.[1] The report considered the possibility of expanding the law to specifically provide for legalised assisted suicide for people who felt their life was complete but who did not qualify under the existing law because there was no medical basis for the feeling that life was an unbearable burden. The report suggested that in most cases such people could be accommodated under the existing law by the increasingly broad interpretation being given to its requirements.

However, the government’s response, cosigned by Edith Schippers, Minister of Health, Welfare and Sport and Ard van der Steur, Minister of Security and Justice, proposes a new law – to be drafted in 2017 – to specifically legalise assisted suicide for those who feel that their life is complete and who wish to die in cases where there is no underlying medical basis for this feeling.

The government proposes the creation of a new category of community worker – stervenshulpverlener – a death worker

The role of a death worker would be to assess whether the person’s request for assisted suicide was voluntary and persistent and that there were no reasonably available medical or social measures to relieve the feeling that life was a burden.

The government response points out that the existing law on euthanasia is premised on a doctor being confronted with a patient who has unbearable suffering that cannot be relived other than by deliberately ending the patient’s life. Euthanasia is portrayed as an act of mercy.

The government response suggests that for persons who feel that they have completed their life and that to continue living it is a burden the State also can facilitate an act of mercy – namely after approval by a death worker and confirmation by a second death expert, facilitating assisted suicide.

There is a suggestion that as this feeling of completed life is most common in elderly people it would be in order to impose a minimum age limit but no indication is given as to what this might be.

Complications


Technical problems, complications and problems with completion in the administration of lethal drugs for euthanasia have been reported from the Netherlands.

Technical problems occurred in 5% of cases.  The most common technical problems were difficulty finding a vein in which to inject the drug and difficulty administering an oral medication.

Complications occurred in 3% of cases of euthanasia, including spasm or myoclonus (muscular twitching), cyanosis (blue colouring of the skin), nausea or vomiting, tachycardia (rapid heart beat), excessive production of mucus, hiccups, perspiration, and extreme gasping.  In one case the patient’s eyes remained open, and in another case, the patient sat up. 

In 10% of cases the person took longer than expected to die (median 3 hours) with one person taking up to 7 days.[2]

Increasing number of deaths


The number of reported deaths from euthanasia and physician assisted suicide has risen sharply from 1815 in 2003, the first year under the new law, to 5516 deaths reported in 2015.[3]

This represents an increase of 204% in raw number of reported deaths from euthanasia between 2003 and 2015.  

In other words the number of euthanasia deaths has more than trebled in the first 13 years of legalisation.  

In 2003 some 1.28% of all deaths were brought about by reported acts of euthanasia or physician assisted suicide.  In 2015 this had risen to 3.75% of all deaths.[4]

Failure to report cases of euthanasia


According to a 2012 paper only 77% of deaths by euthanasia or physician assisted suicide were reported in 2010, that is there were 914 unreported acts of euthanasia as well as the 3136 reported acts of euthanasia making a total of 4050 or 2.8% of all deaths resulting from euthanasia or physician assisted suicide in 2010.[5]

The authors of this study speculate that the temporary decrease of euthanasia deaths following the enactment of the law may have been a result of doctors being uncertain about how the law would be applied.  It is clear now that the codification of the law has not led to any lasting decrease in the rate of euthanasia and the trend has increased steadily for the past 13 years.

Grounds for euthanasia


As is usually the case when legalised euthanasia is first proposed supporters in the Netherlands initially focussed solely on unbearable and unrelievable physical suffering associated with a terminal illness.

Even before formal legalisation the grounds for euthanasia were expanded by the courts well beyond physical suffering allowing psychiatric conditions such as depression, anorexia, and anxiety associated with asymptomatic HIV to be are sufficient grounds to justify a physician granting a request by a person for the administration of lethal drugs.[6]

One of the requirements of careful practice, under which physicians performing euthanasia and assisting with suicide were assured freedom from prosecution, required that the patient be suffering.  Doctors with patients who were suffering physically were not subject to prosecution, but it was not yet clear whether they would be treated the same in cases involving patients with non-somatic suffering.  The psychiatrist and general practitioner of a woman suffering from depression decided to assist the woman with suicide.  Although they were acquitted, the Rotterdam District Court noted that in cases of non-somatic suffering the consultation of another independent physician is preferable.

In another case, the Almelo District Court held that although the suffering of a 25 year-old anorexia nervosa patient was not primarily physical, it was unbearable and therefore sufficient to dismiss the indictment against the pediatrician who had assisted in the patient’s suicide.

The Supreme Court addressed the issue of non-somatic suffering in the landmark 1994 case of Chabot.

Dr. Boudewijn Chabot was a psychiatrist who supplied lethal drugs to a patient who had recently experienced a series of traumatic events that had left her with no desire to live. Although offered treatment for her condition, the patient refused.  The Court began by affirming its earlier holdings that euthanasia and assisted suicide can be justified if:

the defendant acted in a situation of necessity, that is to say … that confronted with a choice between mutually conflicting duties, he chose to perform the one of greater weight. In particular, a doctor may be in a situation of necessity if he has to choose between the duty to preserve life and the duty as a doctor to do everything possible to relieve the unbearable and hopeless suffering of a patient committed to his care.

The prosecution argued that the defense of justification should not be available to doctors who assist with suicides in cases where the suffering is non-somatic and the patient is not in the “terminal phase.”

The Supreme Court rejected this contention, and held that in such cases the justification can be rooted in the autonomy of the patient herself.  The Court noted that,“the wish to die of a person whose suffering is psychic can be based on an autonomous judgment.”[7]

Euthanasia is now legally permitted in the Netherlands for dementia patients and for persons with depression or other mental health issues in the complete absence of any physical illness or suffering.[8]

In 2015 there were 56 notifications of euthanasia or assisted suicide involving patients with psychiatric disorders (four times the 14 cases in 2012) and 109 notifications involving dementia (more than two and a half times  the 42 notifications involving dementia in 2012). These cases were in the absence of any other condition justifying euthanasia.[9]

More than half (33) of the 56 cases of euthanasia for psychiatric disorders in 2015 were carried out by doctors from the Levenseindekliniek (End of Life Clinic).[10]

Psychiatric conditions for which euthanasia was performed in 2015 included personality disorder with post traumatic stress disorder and self-mutilation; and obsessive compulsive disorder.[11]

In its June 2011 publication The role of the physician in the voluntary termination of life the Royal Dutch Medical Association (KNMG) states that as the elderly experience “various other ailments and complications such as disorders affecting vision, hearing and mobility, falls, confinement to bed, fatigue, exhaustion and loss of fitness take hold … The patient perceives the suffering as interminable, his existence as meaningless and – though not directly in danger of dying from these complaints neither wishes to experience them nor, insofar as his history and own values permit, to derive meaning from them.” The KNMG considers that “such cases are sufficiently linked to the medical domain to permit a physician to act within the confines of the Euthanasia Law.”[12]

The 2015 report cites 183 cases of euthanasia involving “multiple aging disorders”. These cases probably represent the kind of “tired of life” cases discussed by the KNMG.[13]

In its first year of operation (1 March 2012 to 1 March 2013) the Levenseindekliniek (End of Life Clinic) granted euthanasia to 11 out of 34 cases of persons who requested on the sole grounds of being “tired of living” without any other medical (physical or psychological) condition.[14]

Euthanasia on wheels


In March 2012 the Dutch Right to Die organisation launched the Levenseindekliniek (End of Life Clinic) with six mobile teams of doctors to “end their lives free of charge in their own homes”.[15]  By the end of 2014 there were 29 mobile teams and the clinic dealt with 1035 requests for euthanasia in 2014.[16] This approach bypasses any need for the person’s regular physician to be involved in the decision making about euthanasia.

Loneliness


In nearly half the cases where the Levenseindekliniek (End of Life Clinic) granted a request for euthanasia in its first year of operation (1 Mar 2012 to 1 Mar 2013) loneliness was listed as a type of unbearable suffering in nearly half (49.1%) the cases.[17]

Euthanasia “experts” trump physicians giving care


On 22 April 2015 a woman with dementia, Cobi Luck, was euthanased by a doctor at the Levenseindekliniek (End of Life Clinic), after a court ruled that doctors from the clinic had an expertise in euthanasia leading him to prefer their testimony to that of the doctors and staff from the nursing home who were providing her with daily care.

They testified that Ms Luck only spoke about euthanasia after her family had paid a visit. She still appeared to enjoy life and made comments which were not consistent with a desire for euthanasia. The nursing home staff knew her well and believed that she was not competent to make such a momentous decision. They stressed that people like Ms Luck were very vulnerable.[18]


Review is too late for the dead patient


The review committees in the Netherlands are required to consider whether all the conditions of the euthanasia law have been met in each case.  In case 15 of the 2011 annual report the Regional Euthanasia Review Committees conclude that the attending physician failed to achieve an accurate diagnosis of the woman’s back pain and only prescribed limited pain relief medication.  Consequently it could not be said that the woman’s pain was definitively unrelievable. 

Of course the woman can get no relief from this finding of error on the part of the doctor who failed her and then euthanased her as she is already dead by euthanasia.[19]

The same lack of remedy applies to the two cases of people with dementia who were euthanased in 2012 in relation to which the Review Committees found “not to have been handled with due care”.[20]

In 2015 there were four cases where the Review Committee found a lack of due care before euthanasia was carried out. These included:

·         Case 2015-01 where euthanasia was carried out on a woman with a history of stomach pains from an undiagnosed cause, who was reluctant to be examined by a geriatrician; [21]

·         Cases 2015-28 and 2015-29 where the doctor failed to give an adequate dose of propofol to induce coma before administering rocuronium, a neuromuscular blocker that causes paralysis of all muscles except the heart and brings on respiratory arrest. Consequently these people may have experienced the distress of suffocation;[22]

·         Case 2015-81 where, after the person was still breathing with a full pulse 25 minutes after being given thiopental to  induce coma and rocuronium to cause respiratory failure, the doctor administered a second dose of rocuronium without adequately ensuring the person was in a full coma.[23]

Even where the Review Committees identify failures and report the cases to the Public Prosecution Service action is seldom taken apart from “counselling” the offending doctor. In Case 2014-02 a doctor performed euthanasia on a woman with aphasia after a stroke solely based on a twenty year old living will in which she expressed a desire for euthanasia if she ever had to live in a nursing home. The doctor subjectively concluded that she would be experiencing unbearable suffering simply from being in the nursing home despite the woman being unable to communicate. There were no signs of distress. Both the  and the Council of Attorneys-General recommended no prosecution.[24]

Euthanasia without request


In the Netherlands between 500 and 1000 adults each year are given lethal injections without making an explicit request.[25]

Pressure from family members


Professor Theo Boer, who served on a regional euthanasia committee for 9 years says that ‘In some instances there is pressure from the family.’ From the 4,000 case files that have crossed his desk, Boer estimates that “ the family is a factor with one in five patients. The doctor doesn’t want to put it in the dossier; you need to read between the lines. Sometimes it’s the family who go to the doctor. Other times it’s the patient saying they don’t want their family to suffer. And you hear anecdotally of families saying: “Mum, there’s always euthanasia”.’

Dr Ruben Van Coevorden, an Amsterdam physician who has performed euthanasia, believes Boer’s figure of one in five is realistic: ‘There was one case where a woman was dying and had terrible stomach pains, her doctor was tearing his hair out, and when I turned up at the house the family practically pinned me to the wall and said: “You need to give mum the jab now, she’s in agony!” ‘I discovered that her treatment wasn’t working, she was on the wrong type of laxatives and was terribly constipated. I organised a palliative regime that made her more comfortable, and afterwards the family were extremely grateful. She was close to dying anyway, but it allowed them to say goodbye in a better way.’[26]

Euthanasia by family members


On 13 May 2015 the Arnhem-Leeuwarden Court of Appeals, in acquitting Albert Heringa of assisting the suicide of his stepmother by feeding her a cocktail of pills, ruled that for lay people as well as doctors the defence of force majeure applies.[27] It was court decisions, beginning in 1973, ruling that this defence was available for a doctor who euthanased a patient if “no reasonable alternative was available”, that led to euthanasia becoming widespread in the Netherlands well before it was formally legalised by Parliament in 2003.

Moek Heringa was aged 99 and not seriously ill. Her doctor refused to give her euthanasia as she was not eligible under the law. 

The Court of Appeals found that there was no reasonable chance of finding another doctor who would agree to perform euthanasia so that, faced with his stepmother being “tired of life”, Albert Heringa was morally forced to help her by killing her. 

This judgement opens the door to assisted suicide by family members as well as to assisted suicide or euthanasia on the grounds of being “tired of life” or having “completed a life”.

Child euthanasia


Children as young as 12 years of age may be given euthanasia under the euthanasia law. 

For 12 to 15 year olds the parents must agree with the child’s request for euthanasia. For 16 and 17 year olds the parents must be involved but the decision is for the child alone. A total of seven children have been given euthanasia, including one 12 year old child in 2005, a 16 year old in 2015 and five 17 year old children.[28]


[2] Groenewoud J, et al.  (2000) “Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands”, New England Journal of Medicine, Vol 342, p.  551-556, http://content.nejm.org/cgi/reprint/342/8/551.pdf
[3]Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 4 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[4] Denominator for calculations for percentage of all deaths (141,936 in 2003; 147,134  in 2015) from Centraal Bureau voor der Statistiek; http://statline.cbs.nl/StatWeb/publication/?DM=SLEN&PA=37943eng&D1=1,21-46,438-439,442-443&D2=(l-16)-l&LA=EN&VW=T
[5] Bregje D Onwuteaka-Philipsen et al., “Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey”, The Lancet, Published online July 11, 2012, http://press.thelancet.com/netherlands_euthanasia.pdf
[6] “Choosing Death,” The Healthcare Quarterly, WGBH-Boston, aired March 23, 1993.
[7] Smies. Jonathan T. “The legalization of euthanasia in the Netherlands”, Gonzaga Journal of International Law, (2003-4) 7, p. 19-20, http://www.gonzagajil.org/pdf/volume7/Smies/Smies.pdf
[8] Regional Euthanasia Review Committees, Annual report 2010, p. 10, 13, 22-23,  http://www.euthanasiecommissie.nl/Images/JV%20RTE%202010%20ENGELS%20(EU12.01)_tcm52-30364.pdf 
[9] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 7, 9 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[10] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 7 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[11] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 50-52 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[12] KNMG [Royal Dutch Medical Association], The role of the physician in the voluntary termination of life, June 2011, p. 23, Available at: http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/Position-paper-The-role-of-the-physician-in-the-voluntary-termination-of-life-2011.htm
[13] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 10 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[14] 6 cases where the person died before a decision was made or withdrew the request are excluded. Marianne C. Snijdewind et al., “A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherland”, JAMA Internal Medicine, Published online 10 Aug 2015, Table 2: Outcomes of Requests to the End-of-Life Clinic for Euthanasia or Physician-Assisted Suicide, According to Medical Conditions, http://archinte.jamanetwork.com/article.aspx?articleID=2426428
[15] Tony Paterson “Euthanasia squads offer death by delivery”, The Independent,  5 March 2012, http://www.independent.ie/health/health-news/euthanasia-squads-offer-death-by-delivery-3039420.html
[16] Marianne C. Snijdewind et al., “A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherland”, JAMA Internal Medicine, Published online 10 Aug 2015, http://archinte.jamanetwork.com/article.aspx?articleID=2426428
[17] Marianne C. Snijdewind et al., “A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherland”, JAMA Internal Medicine, Published online 10 Aug 2015, Table 3:  Outcome of Requests for Euthanasia or Physician-Assisted Suicide According to Patient Characteristics and Other Circumstances http://archinte.jamanetwork.com/article.aspx?articleID=2426428

[18]Vrouw (80) krijgt euthanasie tegen wil van haar behandelaars [80 year old woman receives euthanasia against the will of her carers”, nrc.nl, 3 April 2015, http://www.nrc.nl/nieuws/2015/04/23/vrouw-80-krijgt-euthanasie-tegen-wil-van-haar-behandelaars/
[19] Regional Euthanasia Review Committees, Annual report 2011, p. 17 http://www.euthanasiecommissie.nl/Images/RTE.JV2011.ENGELS.DEF_tcm52-33587.PDF
[20] Regional Euthanasia Review Committees, Annual report 2012, p. 13 http://www.euthanasiecommissie.nl/Images/JV.RTE2012.engelsDEF2_tcm52-39100.pdf
[21] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 28-31 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[22] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 44-46 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[23] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 47-48 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[24] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 68-69 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf
[25] Allen, Mason L, (2006) “Crossing The Rubicon: The Netherlands’ Steady March Towards Involuntary Euthanasia”, Brook Journal of International Law, 31:2, pp 535-575; www.brooklaw.edu/students/journals/bjil/bjil31ii_allen.pdf ; van der Heide, A et al. (2007)  “End-of-Life Practices in the Netherlands under the Euthanasia Act”,  New England Journal of Medicine, Vol 356:1957-1965, http://content.nejm.org/cgi/content/full/356/19/1957
[26] “Rise in euthanasia requests sparks concern as criteria for help widen”, DutchNews.nl, 3 July 2015,  http://www.dutchnews.nl/features/2015/07/rise-in-euthanasia-requests-sparks-concern-as-criteria-for-help-widen/
[27] J Smits, “Dutch court acquits man who euthanized his mother after doctor refused”, LifeSite News, 21 May 2015, https://www.lifesitenews.com/opinion/dutch-court-acquits-man-who-euthanized-his-mother-after-doctor-refused
[28] Regionale Toetsingscommissies Euthanasie, Jaarverslag 2015, p. 14 https://www.nvve.nl/files/8414/6166/0719/RTE_jaarverslag2015DEF.pdf

Monday 15 August 2016

Assisted suicide deaths in Washington State up 31.7%

Washington State’s Death With Dignity Act, based on Oregon’s, came into operation on 9 March 2009.

Lethal prescriptions up 22% in one year - more than doubled since 2010

In the first full calendar year of operation, 2010, some 87 prescriptions for lethal drugs were provided under the Act. By 2015 this had increased by nearly two and a half times (244.8%) to 213.[1] Prescriptions for lethal drugs increased by 22% from 2014 to 2015.[2]

Deaths from assisted suicide up 31.7% in one year - more than tripled since 2010

Deaths from lethal drugs prescribed under the Act have increased three and a quarter fold (325%) from 51 in 2010 to 166 in 2015, increasing by nearly one third (31.7%) from 2014 to 2015 alone.
Not all of those who are prescribed lethal drugs end up taking them. Some die of natural causes. 

285 doses of lethal drugs unaccounted for in the community 

There is no tracking of lethal drugs that are not used by those for whom they are prescribed so these lethal drugs are available in the community and could be used accidentally or intentionally to cause death. Of the 936 prescriptions for lethal drugs issued since 2009 only 651 (71%) have been reported as used leaving up some 285 doses of lethal drugs unaccounted for in the community.

Main concerns are loss of autonomy and burden on family rather than pain control 

Some 65% of those for whom a prescription for lethal drugs was provided did not cite any concern about pain control as a reason for asking for the prescription.

However, 86% cited concerns about loss of autonomy and 52% cited concerns about being a burden on family, friends or caregivers.

Assisted suicide to save money

Significantly, 13% of those for whom a doctor wrote a prescription for lethal drugs cited concerns about the financial implications of treatment.[3]

Very few referrals for expert psychiatric evaluation

Only 4% of those given a lethal prescription were referred to a psychiatrist or psychological for evaluation. 

Doctors who barely know the patient but are prepared to assist suicide

In some cases the prescribing doctor knew the patient for less than a week before writing the prescription, and in just over half the cases (51%) the doctor knew the patient for less than 25 weeks.[4]

Doctors getting the prognosis wrong and assisting suicide for people with years to live

Although the Act specifies that only persons with “six months or less to live” may request lethal doses of medication from a physician, the data shows that in each year between 5% and 17% of those who die after requesting a lethal dose do so more than 25 weeks later with one person in 2012 dying nearly 3 years (150 weeks) later, and one person in 2015 dying nearly two years later (95 weeeks).[5]

A peaceful death - what about the complications?

In 2013 one person took 3 hours to lose consciousness after ingesting the lethal dose and one person took 41 hours (1 day and 17 hours) to die after ingesting the dose. In 2015 one person took 72 minutes (1 hour and 12 minutes) hours to lose consciousness after ingesting the lethal dose and one person took 30 hours (1 day and 6 hours) to die after ingesting the dose. In 2009 two people awakened after initially losing consciousness. At least 9 patients have regurgitated the lethal medication. In 2014 one person suffered seizures after ingesting the lethal medication.[6]

In 226 cases we do not who gave the person the lethal drugs or even if they struggled

There is no requirement under the Act for a physician or any other person to be present when the lethal dose is ingested. Since 2009 there have been 175 cases where no health-care provider was present when the lethal dose was ingested and a further 51 cases where it is not known if a health-care provider was present.[7] In other words in some 226 cases people have died ingesting a dose of lethal medication, legally prescribed under Washington law, and nobody knows whether the person freely ingested the lethal dose or they were cajoled, coerced or forced to do so by another person.


Assisted suicide may increase the overall suicide rate

Proponents have claimed that legalising physician assisted suicide would actually prevent, or at least delay, suicides by giving those faced with a terminal illness an assurance that the means for obtaining  peaceful death was legally available. However, a study of comparative rates of suicide in US states found that for the states, like Oregon and Washington, which had legalised physician assisted suicide there is an increase in the overall suicide rate of 6.3% compared to all other states and of the suicide rate of those aged 65 and over of 14.5%. There is no reduction in either the rate of non-assisted suicides or in the mean age of suicide.[8]

Victoria should avoid going down this path

Recommendation 49 of the Report of the Legal and Social Issues Committee’s Inquiry into End of Life Choices, which is currently being considered by the Andrews Labor Government in the Australian state of Victoria would make it lawful for a doctor to prescribe a lethal drug for certain patients, enabling the patient to commit suicide by ingesting the lethal drug.

The majority report falsely claims that all is well in places like Oregon (see the earlier Defend Human Life blog in March 2016) and Washington State.

As the above analysis shows it is far from well.


[1] Washington State Department of Health 2015 Death with Dignity Act Report, p. 4, http://www.doh.wa.gov/portals/1/Documents/Pubs/422-109-DeathWithDignityAct2015.pdf
[2] Ibid.
[3] Ibid., Table 2 on p. 7
[4] Ibid., Table 3 on p.8
[5] Washington State Department of Health, Death with Dignity Act Reports, 2009-2015 available at: http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct/DeathwithDignityData
[6] Ibid.
[7] Ibid.
[8] David Albert Jones and David Paton, How does legalization of physician-assisted suicide affect rates of suicide?, SMJ: Southern Medical Journal, Vol. 108, Issue 10, p. 599-604, http://sma.org/southern-medical-journal/article/how-does-legalization-of-physician-assisted-suicide-affect-rates-of-suicide/