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PATIENTS IN DANGER

"A demonstration against the guidelines was held outside the BMA headquarters in Central London by SOS-NHS, a group formed by relations of non-terminally ill patients who died after drips were withdrawn or withheld. (The Times, 24 June 99) "A spokesman said: 'With more relatives challenging the health professionals, the BMA has recognised the dangers facing their members who have become careless and callous in their calling but have so far escaped prosecution. We believe the true agenda behind these BMA guidelines is to legitimise what is taking place illegally in our NHS hospitals. 'A terminally ill patient, with weeks, months and even years to live, would not benefit from having their death hastened for the convenience of medical staff."'

New Court of Protection to condemn patients to death

Setting aside the BMA's bid for doctors alone to decide on death-by-dehydration, the Lord Chancellor's Dept. on October 27th issued its response entitled "Making Decisions", to 4,000 letters of protest against the former draft Mental Incapacity Bill. A new "Court of Protection" is to issue the order to remove food and fluids from incapacitated patients who are not dying. This is not yet a White Paper, but would form the basis of a Government Bill. Only one real concession: It was proposed last time that people who could not give valid consent should be used as guinea pigs in medical research. This at least has been scrapped. Compulsory sterilisation is still included. SPUC commented: "Although the Government has said it is not `appropriate to legislate at the present time to give statutory force to advance statements (living wills) it is a concession which flatters to deceive. The other measures included in this policy statement make this apparent concession meaningless. "By giving statutory force to the Tony Bland judgement, which determined that assisted food and fluids are medical treatment, the Government will give those who support euthanasia one of their most cherished goals and put onto the statute book the deliberate ending of life." Dr. Peggy Norris, chair of ALERT, said in a statement: "For the Government to introduce a Death Bill for the mentally incapacitated is a national scandal. The new so-called `Court of Protection' will be empowered to remove protection from our most vulnerable citizens - and doctors are to be the killers." "Some of the victims will be those old soldiers who saved us in World War II," said Dr Norris, "Labour prides itself on being the Party of the people, but now people who are helpless are to be condemned to death." Write to Simon Vinogradoff, Family Policy Division, Lord Chancellor's Dept. Room 5.16, Selbourne House. 5460 Victoria Street. London SWlE 6QW, e-mail address: svinogradoff@lcdhq.gsi.gov.uk. Tell him we don't want any more helpless people murdered, either by maverick doctors or by order of the Court.

BMA "Ethical Guidance" on Withdrawal of "Treatment"

The main focus of the new guidance is decisions about patients who are likely to live for weeks months, or possibly years, if with treatment is provided but who, without treatment, will or may die earlier. It covers patients of all ages ... (BMA Press Release, 23 June 99) Doctors should not routinely be obliged to seek court approval before withdrawing artificial nutrition and hydration from medical patients with no prospect of recovery but should seek an independent review by a senior clinician tom outside the treatment team, the BMA confirms today... 'The classification of artificial nutrition and hydration as medical treatment is now established common law but the BMA recognises that this definition is not universally accepted..." Too right. In case the BMA didn't recognise it in spite of responses from doctors to its Consultation Paper, ALERT supporters sent them a lot of postcards on the subject. As we don't all accept it, doctors are recommended to persuade the patient's nurses and relatives to agree to the dehydration death.

Life Unworthy Of Life:

It was with precisely this phrase that the Nazis justified the slaughter of the mentally ill and handicapped. Now Professor Raanan Gillon, co-author of the British Medical Association's controversial report just published, Withholding and Withdrawing Life-prolonging Treatment, tells us 'staying alive is no good unless it is a means to a flourishing life." Food and water may therefore rightly be denied to those deemed to be terminally unconscious: for they are indeed leading that life which the Nazis considered unworthy of life and costing our hospitals a lot of money into the bargain. Dr. Anthony Daniels Sunday Telegraph, 27 Jun 99

Dissidents form "Medical Ethics Alliance"

An ethical backlash by doctors opposed to euthanasia is emerging in the wake of the British Medical Association's new guidelines on refusing food and water to patients," The Times reported on 12 Aug. 99. More than 6,000 doctors are expected to support the launch of the Medical Ethics Alliance, an umbrella group that aims to fight the proposals and galvanise what it calls "the silent majority" of doctors. "Many doctors, who affirm under the oath that they will `first do no harm' to their patients, are dismayed that a debate and vote on the issues were denied them at the BMA's annual representative meeting in Belfast last month. "The Medical Ethics Alliance is drawing up a constitution and hopes to set up its own website to test opinion." The Times. 12 Aug. 99.

Opinion Poll: Fewer than one in three back the BMA Guidelines

New Petition

On 24th June the Daily Mail reported: "The Department of Health would not comment on the guidelines. It was content to let the BMA have its say." An ALERT petition to the Prime Minister asking him to speak out against the BMA advice to doctors was signed by Lord Ashbourne, Lord Jakobovits - before his recent death -, and Lord Longford and over 3,500 others, and is being delivered to Downing Street in November.

Backdoor Euthanasia

On 6th and 28th January 99 Michael Horsnell in The Times reported tragic cases in Derby, Kent, Sussex, Stockport, Surrey and Eastbourne (see "Danger in Hospital"). This was front-page news.

Letter to The Times from Lord Ashbourne: printed 14 Jan 99

Sir, Your reports of January 6 show the anguish that can be caused to families when patients' lives are shortened by the withholding of food and fluids. A change of official policy may be needed to prevent many more such tragic cases. The House of Lords judgement in the well-known case of Tony 8land (1993) defined food and water as "medical treatment" if given through a tube, which allowed them to be withdrawn. The Department of Health solicitor, when giving evidence to the House of Lords Select Committee on Medical Ethics in 1993, was reported in the British Medical Journal of May 1 93, as saying that this judgement "greatly clarified the position and laid down legal principles which point a way forward for the public and the medical profession". He declared that it was "now open to the courts to leave it there and let doctors get on with the business of applying it". Patients in so-called PVS (persistent vegetative state) are not the only ones affected. The BMA's 1998 consultation paper, Withdrawing and Withholding Treatment, asked for opinions on withholding water from victims of a stroke. If patients are to feel safe in hospital, we should restore to our common 1aw the principle that those who have another person in their care may never exercise that care in a manner intended to bring about that person's death. Yours faithfully, ASHBOURNE House of Lords

SPUC's Mass Lobby

"Cardinal Winning led a 500-strong `Tartan Army' of pro-lifers to Westminster in a massive protest against the government's planned introduction of `living wills'." The Universe reported on 21 Jun 98. "The leader of Scotland's 750,000 Catholics met the Lord Chancellor, Lord lrvine, and most of Scotland's 72 MPs to put the case against relaxing the law on euthanasia."

MENTAL INCAPACITY BILL Petition

'There is no disease for which food and water are treatment; both are basic necessities of life." Dr. Michael Jamulowicz, Hon. Secretary, Guild of Catholic Doctors. Letter in Catholic Times, 3 Aug. 99

WELFARE ATTORNEYS

The Scottish Law Commission proposed to create "Welfare Attorneys" and guardians with sweeping powers. The English equivalent is "Continuing Power of Attorney". Robin Haig, a solicitor used to dealing with existing arrangements for Power of Attorney, wrote in a 'Guide' to the Government's Consultation Paper "Who Decides?"* after discussing Living Wills. "I believe that C.P.A.s, which involved placing one person directly in control of another person's life and death, present an even greater threat to the inviolability of each individual's life and would provide a strong move forward towards the introduction of euthanasia, if they should become legalised."

*Available free from ALERT

Over 14,000 people signed ALERT's petition against the Law Commission's draft "Mental Incapacity Bill," following Baroness Ryder, founder of the Sue Ryder Homes. The petition was started on the initiative of Mrs. Josie Kelly of Camden Town, London. Simon FitzGerald, seen here handing in the first 2,000 signatures at No. 10 Downing Street on 23 July, said in a statement: "As a spinally injured man, since 1995 I have been fighting the obscenity of a legal system that seems determined to devalue human life. "People with disability, and those who care for them and for the chronic sick, are living in a situation which is increasingly frightening, as recent reports in national newspapers have confirmed. The Mental Incapacity Bill would license doctors to kill frail patients by cutting off tube feeding and fluids, thus changing members of the medical profession into executioners." Dr Norris said: "We commend Lord McColl, the Bishop of London and their distinguished co-signatories in The Times of July 21 1998 for their broadside against this proposed legislation. "The draft Bill would permit research which is not for their own benefit on incapacitated people who cannot give valid consent. The German Minister of Justice, Judge Edward Schmidt-Jortzig, has condemned similar proposals in the Council of Europe's new 'Convention on Human Rights and Biomedicine." (German Press Agency, 6 July.) "Such experiments contravene the Nuremberg code, adopted in 1947."

IF YOU CAN'T COMMUNICATE you lose your right to live

This could happen because of head injury in a road accident, or if you had a stroke. The proposed new Court of Protection can sentence you to death by dehydration if you can't easily swallow - or don't drink because you are sedated. Best interests (para 1.1) Deciding it is in your best interests to die, the Court can accept "the views of other people whom it is appropriate and practical to consult" about your past "wishes and feelings" even if they benefit from your death. ("I heard him say he'd hate to be disabled," "She never wanted to be a burden on anyone," etc. - see the case of Christine Busalacchi and others in the U. S.A.) The Court can also take into account "the factors the person would consider if able to do so." (Like: what the Health Service would save if you were dead?) A wide range of organisations can be asked to make a report on you (para 4.16). Secrecy (Para 4.1, referring to Chapter 9 Of "Who Decides") Newspapers will not be able to print details which might identify your case to ensure your "privacy" even after your death. They may be able to report how long it takes the anonymous you to die from lack of water. If there are very many cases (the Court is to have "regional presence") they may not bother.

House of Commons Early Day Motion No. 340 tabled by Sir Teddy Taylor MP

Involuntary Euthanasia That this House notes recent reports that deaths have occurred in hospitals because assisted nutrition and hydration were deliberately withheld from patients who were not terminally ill; and calls on Her Majesty's Government to make this practice clearly illegal. The status of the motion is OPEN. 48 MPs from both sides of the House have signed the Motion.

New Scots Bill threatens stroke victims

The Adults with Incapacity (Scotland) Bill issued by the Scottish Executive on 8th October makes only ONE concession to widespread protests at the previous draft: medical research on people who cannot give informed consent must only be for their own possible benefit. The "Advance Directive" excuse for starving and dehydrating patients is still there in another form. "Welfare Attorneys" may request doctors to withhold food, fluids and medication from patients who (perhaps temporarily) cannot communicate. The Scottish Council on Human Bioethics (2, Royal Exchange Court, Glasgow G1 3AB) notes: "Under the Bill, proxies would have the power to refuse artificial food and fluids on behalf of any incapable person to whom they were appointed and so deliberately cause the death of a non-dying incapable person (bear in mind that incapacity can be temporary as well as permanent). They could also refuse other treatments (e.g. insulin for a diabetic patient or asthma medication) with the intention of harming the patient or bringing about their premature death. This is highly significant when one considers that some of these proxies may have a financial interest in the death of the patient e.g. as the beneficiaries of wills or insurance policies. The frail elderly would be particularly at risk where nursing home fees may be eating into the beneficiary's inheritance."

Scottish case for Court of Session

William Grant, aged 40, has prepared a petition which will go before the court of Session in Edinburgh, to allow doctors at Raigmore Hospital in Inverness to withdraw tube feeding from his 34-year-old wife Lyn. She has been in a coma since giving birth to daughter Emma by Caesarean section three years ago - an anaesthetic accident.

The Scottish Daily Record (7 Jul 99) reported: "While Lyn told husband William and mother Helen of her fears of ever being kept in a persistent vegetative state, she did not reveal them to her father. He says "I accept that what is happening now is what would have wanted. But it's one thing sitting here and saying this and another thing sitting beside Lyn and seeing her in hospital... She looks so peaceful and robust. You would hardly think there was anything wrong with her at all."

"Legalised murder is coming by stealth"

Kwasi Kwarteng, discussing the Green Paper, "Who Decides" on the "Mental Incapacity" proposals, Dally Telegraph (12 Dec. 97) wrote: "A back-bench bid to allow doctors to assist terminally ill patients to end their lives was rebuffed on Wednesday [10 Dec.]. MPs voted 234 to 89 to deny the Doctor Assisted Dying bill a formal first reading. This is as clear a signal as any to the 'Right to Die' advocates. And yet we are told that the issue needs 'clarification'..." "The issue of euthanasia goes to the heart of the sort of society, I could almost say the kind of civilisation, we have. It would be a shame for a vocal minority to press its view not through open debate, but by clandestine technicalities. If this happens it would be a sad reflection on the apathy and mental fatigue of the majority."

EUTHANASIA TO SAVE MONEY - It's started already

"Police are investigating growing numbers of hospital deaths following claims by relatives that doctors are ready to speed up the process for patients who they believe have no chance of recovery. Relatives fear doctors might have been acting under pressure to save money." Lois Rogers, Sunday Times, 19 Jul. 98.

DANGER IN HOSPITAL

"THE DEATHS OF AT LEAST 50 HOSPITAL PATIENTS AROUND BRITAIN ARE BEING INVESTIGATED BY THE POLICE AND HEALTH OFFICIALS AMID ALLEGATIONS OF A CREEPING TIDE OF BACKDOOR EUTHANASIA." (The Times, 6 Jan. 99) "Seven separate inquiries are looking into claims that doctors have withheld intravenous drips from dehydrated patients, often while they were under sedation, and left them to die from thirst. The patients involved were suffering from strokes, asthma, other common medical conditions and dementia." In one of the cases, "police are investigating 40 deaths at the Kingsway Hospital in Derby, where nurses claimed that dementia sufferers on a psycho-geriatric ward were starved and dehydrated until they became so weak that they died from infections." "The cases of patients in persistent vegetative state (PVS) such as the Hillsborough victim Tony Bland, must be referred to the courts. But a grey ethical area allows doctors to 'exercise their clinical judgement in other cases. Some patients "who have had a momentary choking fit, for example, have then been put on a nil-by mouth regime, sedated and left to dehydrate." On 2 Sept. 99 Michael Horsnell followed up: "Detectives have filed a report, said to run into several thousand pages, to the Crown Prosecution Service after a 22-month inquiry. It is expected that lawyers at the CPS will spend months studying the police files before making any decision on murder or manslaughter charges . . . "The BMA wants doctors to be allowed, without fear of prosecution, to authorise withdrawal of nutrition and hydration in cases involving stroke victims and the confused elderly, even when the patient is not terminally ill. In cases where relatives object, they would have to go court to prevent withdrawal of hydration by tube."

The New Way of Premature Death

From some who have contacted ALERT we have heard how doctors try to persuade unsuspecting parties to agree to the planned death of their relatives. The programme goes ahead anyway, but if the next of kin can be got to agree it's a bonus.

Euthanasia-speak

She will just be a vegetable - Rehabilitation is expensive and may take some time He is totally unaware of his surroundings - We need the bed She will just slip away - She will die from lack of fluid Official Definitions: Medical treatment, to be withdrawn Food and fluids, if given through a tube Basic care, not to be withdrawn - Combing the patient's hair

"Older doctors are shocked at the idea of deliberately dehydrating patients and the problem is that whereas to a young doctor the quality of life of these patients may seem so low as to be not worth keeping, most of the patients are very grateful for what Life they have." "Medical Briefing" by Dr. Thomas Stuttaford, The Times 23 Jul 99

Living Wills: "If you doubt them, prove it"

Health Service Circular No. 1 HSC 1999 / 031 to hospital doctors, dated 19 Feb. 99, states: "Where the patient has given an advance directive before becoming incapable, treatment and care should normally be subject to the advance directive. However if there is reason to doubt the reliability of the advance directive (e.g. it may sensibly be thought not to apply to the circumstances which have arisen) then an application for a declaration may be made." MEAMNG: You MUST obey an Advance Directive and leave patients without food and water if they have trouble swallowing, even if you think they didn't know what they were signing up for unless you want to take time off from work and argue it out in court. The burden of proof is on you.

Economics

"In the final analysis economics will drive assisted suicide to the plateau of acceptable practice," writes Derek Humphry in the new book "Freedom To Die" (Why? Has the west lost all its money?) I.A.E.T.F. In the USA reports "When asked on ABC's Good Morning America what he meant by that, Humphry said 'Why waste valuable health money on people who want to go, when the money could be better spent on children or poor people or medical experimental testing and so forth?"

'My belief is that it would be foolish for a society wishing to enhance the stability of the whole globe to continue using resources on people who don't want to continue to exist " Dr. Richard Nicholson, editor of the Bulletin of Medical Ethics quoted in the Daily Telegraph, 23 Jun. 97.

Healthcare rationing not a matter for GPs

In a letter to the Daily Telegraph of 26 Nov. 99, Dr. Jonathan Peggler wrote: "Rationing decisions in the NHS will now be taken by primary care group boards. The Government will blame a reduced service on these decisions, rather than on their continued underfunding of the NHS. "Because GPs will elect the majority of members of each board, they will become the key to the rationing process. The GP's most important role is as his patient's advocate. A GP cannot fight for a patient's needs whilst at the same time cutting access to the care the patient requires".

"Some press reports said the decision was a financial one. In a sense it was because every penny spent on keeping someone alive who cannot benefit is a penny that is not being spent on someone who could." Dr. 7im Howe, Tony Bland's doctor, commenting on the decision to end his life, Mail on Sunday, 11 Apr 99.

COST SAVINGS

Ezekiel J. Emanuel and Margaret P. Battin, in "What are the Potential Cost Savings from Legalizing Assisted Suicide?" examine the question. Their argument assumes that (1) 2.7 percent of patients who die each year (62,000 Americans) would choose physician assisted suicide, (2) these patients would forgo an average of four weeks of life, and (3) the medical costs in the last month of life for each patient who dies are $10,118 (in 1995 dollars). From this the authors estimate that legalising physician assisted suicide and euthanasia would save approximately $267 million in 1995. This amount is less than 0.07% of total U.S. healthcare expenditure. (National Right to Life News, 15 Mar 99)

Involuntary "suicide" Dr. Michael Jarmulowicz, speaking at the LIFE conference in Coventry on 20 Mar 99 noted: "Interestingly the authors of the paper recognise that a further 4.3% of Dutch patients; are given euthanasia without their consent. They therefore calculate that if these also got physician assisted suicide (sic) "in the USA, this would amount to a saving of $1.63 billion."

*New England Journal of Medicine 1998: 339; 1789-90

Care for Alzheimer's Patients "The time will come when we say that this costs money and if you are demented for one year, we will kill you. "I see it not as the answer to the growing elderly population but as the exercise of the right of self determination." (Dr. Pieter Admiraal, pioneer of euthanasia in Holland, quoted in the Spectator, 21 Nov. 98).

LETTER IN Hospital Doctor (We feel this is important)

"Dr Michael Irwin is very wrong when he says `doctors worldwide... give patients painkillers with the intention of relieving pain... As you build up the dose to a lethal level it is unlikely the patient will survive" (24 Jul., p.8). "Throughout the world, the hospice movement teaches the correct use of painkillers, using the `ladder' technique publicised by the World Health Organisation (Cancer Pain Relief, WHO Geneva, 1986). "The dose of appropriate analgesic is increased to the level which removes the pain - but doctors then cease to continue `building up the dose' unless or until pain again breaks through. "This allows patients to remain free of pain and alert, with the aim of fulfilling their potential, even during the advanced state of their illness. "We have frequently seen patients live considerably longer than expected once their pain and overwhelming symptoms have been relieved or controlled. Indeed, we have been surprised at how resistant patients are to large doses of opioids used appropriately for pain relief. "If the aim was to shorten people's lives, doctors would not use pain killers to do so. "Dr Irwin's reported statement harms the proper practice of palliative care in terminal illness. "Anxious members of the public have asked me for reassurance that our use of painkillers in the hospice is not euthanasia, since they had read some of these comment in the press. "I am glad to be able to give this reassurance, but it is precisely this anxiety, particularly among the elderly, that the proponents of euthanasia are stirring up" Dr Anthony Smith, Medical Director Pilgrim's Hospice, Margate Kent Hospital Doctor, Jul. 98

Public Reject BMA Guidelines for Death

The controversial "Ethical Guidance" on withdrawing food and fluids from certain categories of patients, issued by the British Medical Association on 23rd June, is supported by less than one-third of the public, according to a CAPIBUS opinion poll published on Wednesday 22nd September. 56% of 2,042 adults aged 15+ in England, Wales and Scotland thought doctors should NOT have a legal right to withhold food and f7uids from patients who are not dying but might be permanently disabled, while only 30% supported the BMA guidelines. Opposition to the BMA policy is greatest in the north of England (65%), Yorkshire and Humberside (64%) and East Midlands (60%): among young people aged 15-17 (65%); respondents with children in the household (60%) and the west three income groups (59%-62%). The poll was carried out between 1Oth and 14th September for "First do No Harm", a doctors' action group opposed to euthanasia which is affiliated to the recently formed "Medical Ethics Alliance". CAPIBUS is available each week in France, Germany, Italy and Spain. The CAPIBUS team may be contacted about this survey at 0151 861 8009. "Patients even more worried if they knew the whole truth" Dr Gregory Gardner, a Birmingham G.P who is on First Do No Harm's committee, commented on the poll result: "This indicates large amounts of unease, if not fear amongst patients. This fear is of doctors and health care teams deciding on whether selected vulnerable people should live or die. Trust between patients and the medical profession is beginning to break down as organisations such as the BMA are used to subvert the ancient principles on which that trust is based. Ethical principles are quietly removed and new ones put into place. The meaning of basic care is gradually altered. The new ethics replaces trust with a dangerous and paternalistic medical autonomy."

"When Morphine fails to kill"

An article by Gina Kolata in the New York Times (23 Jul 97) concluded that caring doctors are not killing patients with morphine. (The Dutch use curare as well, to paralyse the lungs and heart.) "One study by Dr. Frank Brescia of Calvary Hospital in the Bronx and his colleagues, examined pain, opiate uses and survival among 1,103 coma patients at that hospital, which is for the terminally ill. "'The patients had cancer that was very far advanced' said Dr. Portenoy, an author of the paper. But to his surprise, he said, the investigation found no relationship between doses of opiates a patient received and the time it took to die. Those receiving stunningly high doses died no sooner than those taking much lower doses."

Euthanasia Advice

"A heavyweight panel has been set up by the Royal College of General Practitioners, to provide clear guidance for doctors on euthanasia. The working party will meet every two months and expects to complete its report in 18 months' time". Hospital Doctor, 15 Oct. 98. At the first meeting on 7 Oct. 98 the following terms of reference were agreed: 1. To identify to the RCP/RCGP the kinds of conduct which constitute euthanasia, and to advise how far they can be justified on moral grounds. 2. To describe and evaluate the current situation and consider the implications of change. 3. To advise on the part the health professions should play in public debate and policy-making.

"The United Kingdom is very privileged in having the best hospice care in the world. A patient with a terminal illness in the UK can be given the personal treatment he needs to deal with his symptoms. He then can go home and lead an almost normal life till the day he dies. He can be sure that the hospice staff will always be at his disposal. "Why should the UK be among the first nations to legalise euthanasia?' From a statement by the World Federation of Doctors Who Respect Human Life. 30 Aug. 99

GP ON MURDER CHARGE

A doctor who inherited the bulk of a widowed patient's £350,000 estate was charged with her murder last night, and detectives now plan to dig up six. more bodies" The Times reported on 8 Sept 98. (Later, another 12 deaths were being investigated.) "Harold Shipman, who has a general practice in Hyde, near Manchester, will appear in court today accused of murder, perjury and attempted deception."

AMA Backs Chance of Life

"On March 10 the Council on Ethical and Judicial Affairs of the American Medical Association (AMA) the association's official body for establishing ethical guidelines, issued a policy for dealing with cases in which patients or their proxies want lifesaving medical treatment but their doctor or hospital instead wants to let him die. "The policy generally emphasizes the primacy of patients' value judgements, and supports the fight of patients whose health care providers want to deny life saving treatment to be kept alive as long as somewhere in the United States another provider can be found who is willing to treat them.... AMA Council report is particularly strong in rejecting the use of futility policies to implement rationing. The authors of the Houston hospitals policies wrote that appropriate stewardship of institutional resources may be the basis in some cases for the judgement that provision of the disputed intervention is inappropriate." In diametric opposition to that position, the AMA Council report states, "Efforts to understand futility should not make use of resource saving criteria, and rationing needs should not motivate declarations of futility. "Public opinion strongly rejects the view that doctors should be able to force patients to die against their wishes or those of their family. According to a February 1999 national survey by Wirthlin worldwide with a 3.08% margin of error, 79% of Americans say that a family should be able to choose life support for an unconscious patient even though the doctor thinks the patient's quality of life is too low. Nineteen per cent say the doctor should be able to withhold life support while 2% don't know." National Right to Life News, Mar. 15 99, p.5

"Like Concentration Camp Victim"

The Daily Mail on 27 Mar 99 reported: "A doctor who ordered nursing staff to let an 85-year old stroke victim starve to death was found guilty of serious professional misconduct yesterday. "Dc Ken Taylor, 53, was suspended from the medical register for six months after a committee of the General Medical Council found he had withdrawn food and fluids from widow Mary Ormerod. "The professional conduct committee heard how Mrs. Ormerod wasted away 58 days after the GP' told staff at the Oxford Place Nursing Home in Preston, Lancashire, to withdraw her food supplement. She weighed just 3 st. 12 lb. and according to one staff member, looked like a concentration camp victim. "The decision to suspend the GP, rather than strike him off, was criticised by anti-euthanasia campaigners as giving 'tacit approval' to so-called mercy killing." Postscript: "Added suspension for no-show doctor" was the headline in Preston's Evening Post on 5 Oct. 99. Dr. Taylor is now demanding that the GMC readmit him unconditionally to the medical register, six months having passed since he was suspended. He has been told to reapply in three months' time, giving references.

FIRST DO NO HARM Doctors' Action Group

"'First Do No Harm' so called because of the pledge contained in the Hippocratic Oath, has been set up to counter what members describe as euthanasia propaganda'" (Daily Telegraph, 15 Oct. 98). This doctors' group, an offshoot of "Doctors Who Respect Human Life", was launched on the fiftieth anniversary of the World Medical Association's Declaration of Geneva 1948, the postwar version of the Hippocratic Oath. First Do No Harm is a founder organisation of the new Medical Ethics Alliance (page 1). ADDRESS: Doctors Federation, P O. Box 17317 London SW3 4WJ. Web address: www.donoharm.co.uk

BMA Website on Physician Assisted Suicide Opponents' views not wanted

"Instead of a single event, we are providing opportunities, between now and the conference next spring, for any interested person to contribute to the process of identifying potential areas of consensus," wrote Dr. Michael Wilks, chair of the BMA's Medical Ethics Committee, in the debating pack accompanying this website. However "the number of contributions supporting a particular argument will not necessarily influence the weight given to it, if it does not appear conducive to consensus:' Just a shade touchy? ALERTs postcard to the BMA on this subject read, in part: "Assisted Suicide" will not be offered to the young and healthy, but to citizens who are considered better dead. People who need care can be made to feel dying is their duty. To legalise assisted death would be to discriminate against the people most in need of protection." The protesters (not ALERT) outside the BMA on 23 Jun 99 were asked by two young men who emerged: "Are you the people who sent the thousands of postcards?"

Dr. Moor No Martyr

Dr David Moor, charged with murder for allegedly assisting the death of a patient, was acquitted on 11 May 99 after a 3-week trial. Before it began, he had claimed to have helped about 300 terminally-ill people "on their way". The darling of the Voluntary Euthanasia Society, he was treated in court "like an honoured guest" according to one observer. The judge disallowed the pathology evidence. The Daily Telegraph commented (12 May 99) "There is a real danger that the medical profession and the public will interpret this trial as a step towards the decriminalisation of euthanasia. "It was, in fact, nothing of the kind. Rather than be a martyr to the cause of euthanasia, Dr. Moor pleaded 'Not Guilty' using the familiar defence of 'double effect': the drug was intended to relieve pain, but had the side-effect of shortening life."

"Euthanasia is barbarous"

Dr. Richard Lamerton, a Hospice doctor, commented in a letter to The Times on 22 May 99: "The question is, did Dr. Moor mislead journalists when he claimed he was in the habit of helping patients to die, or the court when he pleaded not guilty to murder? "The court may have acquitted him but any suggestion that doctors help to kill people on the quiet would be cruelly irresponsible. The trust which doctors enjoy has taken centuries to build. This could so easily be destroyed by assertions from journalists or renegade doctors that (nudge, nudge) `they do it really, you know.' "Most doctors know that if they killed people whom they found it difficult to treat or whose condition they found distressing, no one would feel safe with them again. In the Netherlands, where some do kill patients with or without their consent, I have heard of elderly people refusing medical attention or hospitalisation for fear of falling foul of the physician. "Mr. Justice Hooper went to extraordinary lengths to tell the court what a caring man Dr. Moor was. Perhaps so, but a good doctor knows his limits. If he cannot control a patient's pain he may call in a colleague who can control it. There are specialists and hospice teams everywhere available. Doctors who feel omnicompetent and keep patients away from specialists who might offer better help seem to me both uncaring and incompetent. "The correct use of strong pain-control drugs and tranquillisers does not involve lethal doses. Good pain control, listening to distress and support of the family ensure that death comes gently. Euthanasia is barbarous."

Organ Donors need anaesthesia

Following Professor John Harris' well publicised demand for compulsory removal of organs to be possible as soon as "brain stem death" is diagnosed in a patient, Dr. David Hill wrote in the Independent on 22 Feb. 99: Sir: Post-mortem examinations are carried out on dead bodies; organs are harvested from living ones, in spite of Professor Harris's use of the term "cadaver". He should know what most of those carrying donor cards do not. At the time of harvesting they will remain on life-support, be warm, pink and breathing with a ventilator, have a heart beat and pulse, and have some brain activity. They will also be responsive to pain, requiring paralysing drugs, blood transfusion and anaesthetics for surgery. Horrifyingly, not all will receive anaesthesia. This is a far cry from the cold, white, stiff lifeless body undergoing post-mortem examination. Presumed consent (now supported by the BMA) or Professor Harris's wish for compulsion would remove any need for such awkward explanations. Dr. David J. Hill, Consultant Anaesthetist, Huntingdon, Cambridgeshire

Presumed consent rejected

"A call by doctors for a review of the organ donation system has been flatly rejected by the government," BBC online network reported on 16 July 99. "The British Medical Association voted at Its annual conferences last week to lobby ministers to introduce a system of presumed consent. Under such a system all dead" [sic] "patients would be assumed to have given permission for the use of their organs in transplants unless they had lodged an objection in advance. "But junior health minister John Hutton rejected the idea during a Commons debate on Friday... A recent Health Dept. survey found 50% of the public were in favour of the current system compared with 28% in favour of an opt-out system."

Communicating Again

1. Los Angeles As pregnant Maria Lopez, in a coma for six months, was being given the last rites, she opened her eyes, coughed and lurched forward. Her husband Antonio reversed the decision to remove her from intensive care. Three weeks later she sat up in bed, and after another six days her twin girls Arigandy and Brianna were born. On July 8th she left hospital for a rehabilitation centre and will soon return home. (Sun, Daily Mail, 9 Jul 99) 2. Gloucestershire "A teenage rugby player who had been in a coma for six months reached out and grabbed a trophy that his team-mates brought to his hospital bedside," The Times reported on 22 Apr 99. Up to then, Tim Bendall had shown little progress. "His parents, Haydn and Pam Bendall from Lydney Gloucestershire, said that his condition had since improved greatly".

"WHY I WANT THE DOCTORS TO STARVE MY WIFE TO DEATH" (Sun, 2 Sept 99)

Conveniently for the BMA's new Guidance on patients with "minimal" awareness, Neil Lane, aged 44, is applying to the High Court for permission for tube feeding and liquids to be withdrawn from his wife Loraine aged 42. In a coma following a stroke six months ago, her brain shows electrical activity when her name is called. Loraine's mother Irene Thorley supports Neil Lane's application but the hospital does not.

Step by Step

"At the 1984 meeting of the `Right to Die' societies, Helga Kuhse, a philosophy professor from Monash University, Australia, said "If we can get people to accept the removal of all treatment and care - especially the removal of food and fluids - they will see what a painful way this is to die, and then, in the patient's best interests, they will accept the lethal injection." This was quoted by Fr. Francis Marsden in the Catholic Times, 18 Jul 99. "Unfortunately, Professor Kuhse's strategy appears to be working..." With the new guidance "the BMA has effectively taken the role of legislator away from Parliament" Will the High Court now act on cue?

To Remind

"It is only necessary for some secret edict to order that the method developed for the mentally ill be extended to other 'unproductive' people, that it should be applied to those suffering from incurable lung disease, to the elderly who are frail or invalids, to the severely disabled soldiers. Then none of our lives will be safe any more. Some commission can put us on the list of the 'unproductive', who in their opinion have become worthless life." Sermon by Count van Galen, Bishop of Munster in August 1941

LIVING WILLS: SIGN UP THE DEMENTED

"Despite legislation in the United States aimed at encouraging the completion of advance directives, less than 10% of healthy Americans have completed one," a recent article in the British Medical Journal complains. * "It is difficult for healthy people to imagine the whole range of situations that might befall them. It seems more worthwhile for advance directives to be completed at a time when people already have some disease or disability, enabling doctors to give realistic guidance" [sic] "about possible future situations." The authors recommended that if slightly demented people can answer 6 out of their 10 questions they should be encouraged to opt for death by starvation, if they should suffer a stroke. "Your doctor explains that 'in order to feed you adequately and safely, he needs to use a feeding tube which passes through your nose into your stomach. This is likely to make you live longer but you need the tube all the time.' (You've got an ignorant doctor; you could have a gastrostomy tube). "The other alternative is that you are kept comfortable" (kept under sedation) "but without a feeding tube." You may get to look like a skeleton before you die (no, that's not part of the briefing). Assessment of competence to complete advance directives: validation of a patient centred approach: by Seena Fazel, Tony Hope and Robin Jacoby B.M.J. 20 Feb. 99, pp.493-497.

Bravery

A crash victim who was so badly hurt that doctors advised the family to switch off his life support system has learned to walk again two years after the accident," the Daily Mai1 reported on 6 Oct. 98. "Jon Burke's bravery was matched every inch of the way by the determination of his mother Kathy, a district nurse, who refused to bow to medical opinion that there was no hope. Mrs: Burke said the fact that she was a nurse was a mixed blessing. 'But if I didn't know a lot of things as a nurse, I would have been gullible and believed what people kept telling me.'" Jon was in a coma for 12 months before there was even a flicker of life. He says "It feels so good to be walking. " He has completed a computer course.

WAR ON THE DISABLED up to date (see ALERT newsletter No. 5)

Senate of Surgery Guidelines

"Surgeons are justified in withholding treatment from patients if they are so permanently injured as to have a 'demonstrably awful life', new ethical guidelines for doctors said yesterday." - Daily Telegraph, 10 Dec. 97.

David Glass was brought home from hospital by his family Daily Telegraph, 23 Apr. 99

No right to live for disabled boy

"A mother failed yesterday to obtain a declaration that doctors had acted illegally in refusing to try to keep alive her 12-year old son," The Times reported on 22 July 99. "They had acted against her wishes and without the authority of the courts, she claimed. But Lord Woolf, Master of the Rolls, and two other appeal judges made clear that if doctors and relatives could not agree on treatment for a gravely ill patient, they should take the matter to the court." No mention of a patient's right to live. Lord Woolf described David, who is severely disabled, as "dearly loved and cared for most effectively by his mother and her family", who wished him to live out his natural lifespan. When he was admitted to St. Mary's Hospital, Portsmouth, with a chest infection in October 1998, he was given only terminal care. Mrs. Glass and family pulled out the diamorphine drip and revived David. After the first case under Judge Scott-Baker, The Independent (29 Apr 99) reported Carol's comment: "This little boy had a chance. He wanted to fight. If David had wanted to die, he would have died - nothing we did could have saved him. He wanted to come back to the family." His l3th birthday party was held in the garden. For resisting hospital staff in saving David's life, two of Carol Glass's sisters have been charged with assault and told that their trial will take three weeks.

Dr. Jim Howe, Tony Bland's doctor, on patients with severe head injury: `If you ask them, they may tell you they want to be kept alive, if you believe they are competent to tell you these things. But I, for myself, would not want to be kept alive like that." Mal1 on Sunday 11 Apr. 99

"When disabled kids can die"

The Royal College of Paediatrics and Child Health has outlined five situations where it would condone allowing sick children to die. Disability Now reported in Nov. 97. "Report, Withholding or Withdrawing Life Saving Treatment for Children: A Framework for Practices" includes the scenarios: when a chlld is in persistent vegetative state, or has a severe disease and treatment could delay death but not stop suffering; when treatment would leave the child with an unreasonable" (sic) "disability or when further treatment is more than either the child or the family could bear." Richard Brewster, the chief executive of Scope (formerly the Spastics Society), made a protest. The Dally Mail on 25 Sept. 97 reported "Every day Kirsty Cassidy relives the moment when a director said her newborn daughter should be left to die. Rebecca, born prematurely at between 23-25 weeks and weighing just 1 lb. 4 oz. was deemed by the paediatrician to have no chance of survival." But her mother had hoped she would be given special care.

`Just Die Quietly Dear...'

"Disturbing information regarding the medical profession's attitude toward disabled people is becoming increasingly common at the DAA offices. One woman, who reluctantly contracted DAA, has obviously been deeply affected by a young doctor's decision to refuse resuscitation when she was admitted to a British hospital with pneumonia. Although the individual involved is a successful businesswoman, who has a wealth of experience in promoting the situation of disabled people, the decision appears to have been made that she should be left to die, rather than commit health-service resources to resuscitating her." Disability Awareness in Action Newsletter Apr. 99 No. 71

FIGHT TO KEEP SON ALIVE

"A mother who refused to give doctors permission to let her son die faces a second battle for his life today," reported The Times, 11 Mar. 99. "Health officials who are reluctant to fund vital treatment are meeting to reassess the case. "Theresa Dygas said that Gregory, 17, who slipped into a coma during an asthma attack last April and suffered two cardiac arrests has made remarkable progress since receiving treatment in the past four months at a unit dealing with traumatic brain injury." The following day The Times reported that Lincolnshire Health Authority would continue treatment.

Down's Babies are "treated as second class"

The campaign to end medical discrimination against people with Down`s Syndrome is launched today with a report highlighting 'heartbreaking' treatment by health professionals. (Sunday Telegraph 7 Mar 98) "The report 'You'll never join the Army' commissioned by the Down's Syndrome Association includes details of doctors refusing Down's Syndrome patients potentially life-saving treatment and viewing them as second-class citizens. A six-month-old baby was refused painkillers after a heart operation." Following publication of the report, Mary Eyre, of Salisbury, wrote to the Sunday Telegraph 14 Mar 98, "It illustrates how far society has slid in the last twenty-five years". "0ur Down's son was born in 1971, and we did not meet one health professional that who did not encourage us or help with positive information. That was partly due to Rex Brinkworth, who had founded the (then) Down's Babies Association only four years earlier..."

"Dr. Death" sentenced

Dr. Jack Kevorkian, responsible for 129 "assisted suicide" deaths in the USA and convicted of the murder of Thomas Yorik, was sentenced to 10-25 years prison in Pontiac, Michigan on 13 Apr. 99. Judge Jessica Cooper told him: "This trial was not about the political or moral correctness of euthanasia. It was about lawlessness. It was about disrespect for a society that exists because of the strength of the legal system. No one, sir, is above the law. (The Times, 14 Apr. 99) "You had the audacity to go on national TV and show the world what you did and dare the legal system to stop you. Well sir, consider yourself stopped." "Critics of Jack Kevorkian had previously held an all-night vigil outside the courthouse," the Pro-Life Internet reports. "Diane Coleman, president of the disability rights group 'Not Dead Yet' described Kevorkian as a 'sociopathic killer'. They displayed a quilt with squares representing the 130 Kevorkian has helped to die. 'Give him life', she said, 'That's more than he gave his victims.'"

Euthanasia 'Detrimental to medicine'

Euthanasia in the Netherlands is proving detrimental to the practice of medicine and is usually avoidable, Dutch palliative care physician Dr. Ben Zylicz told a meeting at the United Kingdom's House of Lords last week, reported the British Medical Journal on 12 Dec. 98. "The practice of non-voluntary euthanasia in which the patient is unable to give consent is becoming widespread, in contravention of Dutch guidelines, warned Dr. Zylicz. He suggested that the fact that there were only 70 specialist palliative care beds in the country was a reason why doctors and patients often resorted to euthanasia."

"GUIDELINES' again

Dr. Michael Irwin, a former medical director of the United Nations, and vice-chairman of the UK's Voluntary Euthanasia Society, told Doctor magazine (11 Feb 99): "If doctors had better guidelines and it was out in the open the risk of abuse would be lower than the current situation". (See "Dutch Lose Grip").

Dr. Simon Halstead, chairman of First Do No Harm, says "killing your patient is murder. We would not accept that a doctor is ethically able to give active assistance in dying."

"Dutch lose grip of Mercy Killing"

The Times Medical Correspondent reported on 16 February 1999: "Euthanasia in the Netherlands is 'beyond effective control' according to a report which shows that one in five assisted deaths is without explicit consent." The myth of "strict guidelines" for euthanasia fn Holland had been dispelled at last by the publication in the Journal of Medical Ethics of a study by Henk Jochemsen of the Lindeboom Institute for Medical Ethics and Dr. John Keown of Cambridge. ABSTRACT 1996 saw the publication of a major Dutch survey into euthanasia in the Netherlands. This paper outlines the main statistical findings of this survey and considers whether it shows that voluntary euthanasia is under effective control in the Netherlands. The paper concludes that although there has been some improvement in compliance with procedural requirements, the practice of voluntary euthanasia remains beyond effective control. Keywords: Euthanasia the Netherlands, regulation; slippery slope (Journal of Medical Ethics 99; 25: 1621)

Card that says: Don't kill me doctor

"More than 10,000 people in Holland have started carrying anti-euthanasia passports because they are frightened of being killed prematurely by over enthusiastic doctors if they fall ill, " the Sunday Telegraph reported on 18 Oct 98. The move comes as the newly elected Dutch government presses ahead with a proposal to legalise `assisted suicide' by doctors, the first of its kind in Europe. The `declaration of life' cards, as well as requesting no life-ending treatment included the words `I request that no medical treatment be withheld on the grounds that the future quality of life will be diminished, because I believe that this is not something that human beings can judge."

"A Land Without Limits"

"Recently in Holland an Alzheimer patient was saved at the last moment by a family from death through dehydration one week after he was taken to a nursing home for a 1oca1 inflammation. He recovered rapidly on receiving sufficient fluids and was still alive six months later. The nursing staff claimed that the patient had indicated not to want food and fluids any more. But nothing was mentioned on the patient's records. In an official letter the Dutch cabinet decided that dehydration and starvation are part of normal medical treatment. The family charged the nursing home with attempted murder, but, though 19 similar complaints were lodged against the staff; the case was dismissed by the Ministry of Justice. Was it really the patient who opted for euthanasia or was it the doctor who decided? "Recently also the case of two male nurses who were suspected of having killed 23 residents of service flats, was dropped. In five cases the lower court had considered the killing through an overdose of morphine was insufficiently proven. In one case a 94 year old millionairess had died shortly after having married one of the two nurses, who had also stolen jewels and objets d'art, but the Higher Court decided that there was insufficient proof." Letter from Dr. Karel Gwming Rotterdam, 18 Apr. 99

Age Concern England's "MILLENNIUM DEBATE OF THE AGE"

The Liverpool Catholic Pictorial reported in June 1998: "Age Concern has been sharply criticised for their involvement in what has been dubbed the "Millennium Debate of the Age". Dr. Peggy Norris asked 'Why is Age Concern mixed up in this squalid campaign?'" The "Values and Attitudes in an Ageing Society" Working Party proposes, among rather vague helpful-sounding plans, · Support for the Law Commission's recommendation of a continuing Power of Attorney · According a legal status to Living Wills · Consideration of a Euthanasia Act · Consideration of a Physician Assisted Suicide Act The report of this Working Party - chaired by Professor John Harris, now of organ removal fame - alleges that if departures from the euthanasia guidelines in the Netherlands exist, "they are extremely difficult to substantiate empirically." The "Debate of the Age", mainly financed by BUPA and the Legal and General Insurance Company, was launched with a video appearance by the Prime Minister. It will publish its conclusions in the year 2000, after claiming to have consulted two-thirds of the population on future work, lifestyles, health and care. A "Citizen's Jury" in Telford decided on physician assisted suicide by 7 votes to 6 after being given a preliminary briefing prepared by the Voluntary Euthanasia Society.

"A Modest Proposal for Universal Health"

Debra J. Saunders, in the San Francisco Chronicle of 6 Jun 97 noted "It is only a matter of time before the Right to Die - actually the right to get someone else to kill you as you don't have to do it yourself - would be transformed into the Duty to die. "Call it progress. The Hastings Centre Report is one of the most pre-eminent journals on medical bioethics, not a fringe rag. In its lead article in a recent edition, John Hardwig (professor of philosophy and medical ethics) answers "Yes, yes, yes", to the question "Is there a duty to die" ". Hardwig argues that old folks have a duty to die `because society is derelict in its responsibility to provide for the incapacitated. "As we shift the burden of care on to families and away from government and insurers, we also dramatically increase the number of Americans who will have a duty to die."

"We cannot avoid a number of ethical issues, although they are mainly the responsibility of the Study Group on Values and Attitudes." Para 2.13, Millennium Paper Paying for Age, interim report.

Older Patients Choose Quantity Over Quality of Life

The Lancet (7 Feb. 98) reported: "Given the choice, would frail and elderly people prefer to live as long as possible, or would they choose a shorter but healthier life? A new study suggests the former." 69% of the 414 patients aged 80-98 investigated at the University of Cincinnati Medical Center, USA "were unwilling to trade more than one month of life in 12 in exchange for excellent health" (JAMA 1998; 279: 37175). But surrogate decision makers were not always aware of their charges' preferences.

On a grand scale

Mrs. Mary Kearns, a Scottish solicitor took up the matter of the "Values and Attitudes" proposals with the charity Commissioners (Catholic Herald, 4 Jun 99), saying "We are extremely concerned that the charity should be pursuing this course in a way that is not balanced or responsible and that it should be doing so on such an apparently grand scale." But "Age Concern England, the campaigning arm of the charity, which acts independently from the local branches, insists it is neutral on the issue of euthanasia." Simon Caldwell's article in the Herald on the same day revealed more facts, and gave rise to correspondence which continues.

Suggestions in "Paying for Age":

A "Citizen's Pension" with married couples as second-class citizens - para 7.13 Means testing for hospital accommodation costs - para 7. 19 (lose your savings if you get ill) "The use of housing wealth" - para 7.21 ("Devouring widows' houses" was a related idea)

WATCH OUT for the "Agenda for the Age" in the year 2000

MICHIGAN, USA

"On 3 November 1998 in what can only be described as a trouncing, voters in Michigan overwhelmingly defeated Proposal B, the ballot measure which would have made it legal for doctors to intentionally prescribe lethal drugs to kill certain patients. If passed, the proposal would have overturned Michigan's newly enacted assisted-suicide law banning the practice. Instead, voters soundly rejected Proposal B by a vote of 71% to 29%.(IAETF Update Nov/Dec 98). The "Citizens for Compassionate Care" coalition which campaigned against Proposal B, spent $200,000 on TV air time after the referendum informing the public about alternatives to physician-assisted suicide. Kevin Kelly, managing Director of the Michigan State Medical Society, called the new campaign theme "Physician-Assisted Living".

OREGON, USA

One year after the nation's only law permitting assisted suicide took effect, state officials in Oregon have adopted a policy to cover the costs of legally ending the lives of low-income patients, reports IAETF Update, Nov-Dec 98. To counterbalance such generosity, a major palliative care medication has been removed from the list of state funded medicines (National Right to Life News 15 Mar 99). 'The fact that the State of Oregon will not properly fund our personal attendant services, yet will pay for us to die, amounts to nothing less than cultural genocide' said Ric Burger a diabetic, wheelchair user and President of the Oregon chapter of the American Disabled for Attendant Programmes Today (ADAPT) (Oregonian, 24 Nov 93). 15 assisted suicide deaths have been reported in Oregon, but others may have taken place, as the process is shrouded in secrecy.

New Bill pushes Dutch law further

A Dutch Government Bill published during the Parliamentary recess would allow doctors to perform euthanasia on incurably ill children, so long as the parents agree. The Daily Telegraph (11 Aug. 99) reported that 'In exceptional circumstances' a doctor would perform a mercy killing even without parental consent if a child twelve years or older requested ii. The idea was welcomed by Dr. Philip Nitschke, Australia's Dr. Death (The Age, 12 Aug. 99). The Bill would also give legal force to advance requests for euthanasia from Alzheimer's patients at the start of their illness. Will residential care homes suggest patients sign such requests on admission? If not, why not?

The Bill does not offer autonomy to the patient but to the doctor Statement by the World Federation of Doctors Who Respect Human Life, 30 Aug. 99

Singer's Move

Peter Singer, the Monash University professor and International Association of Bioethics president, is moving from Australia to the U.S. to join the faculty of Princeton University as a tenured Professor of Bioethics at the University Center for Human Values. (The Age, 28 Apr 99, quoted in the IAETF newsletter, April/June). "Killing a disabled infant," Singer has written, "is not morally equivalent to killing a person. Often it is not wrong at all." (Practical Ethics, p.191). The Age concluded: "The truth is that Melbourne has not lost by Singer's move. America most certainly has."

"Pain Relief Promotion Act of 1999"

By 64% to 31%, Americans say `no' when asked whether federal law should allow use of federally controlled drugs for the purpose of assisted suicide and euthanasia," National Right to Life News (6 Jul 99) reported, quoting a Worthlin Worldwide poll of June 1999. "The Pain Relief Promotion Act of 1999 has been introduced in the Senate as S1272 and in the House as HR2260. This critically important legislation will stop the federal government from facilitating euthanasia, while promoting good pain management and palliative care as positive alternatives." The Bill would authorise $5 million annually to foster pain management and palliative care, and reverse US Attorney General Janet Reno's ruling that the federal Controlled Substances Act allows drugs to be used to assist suicides in any state, such as Oregon, which allows it. "The National Hospice Organisation and American Medical Association have endorsed the new Bill. It has also been endorsed by, among others, the American Academy of Pain Management, the American Society of Anesthesiologists, and the Hospice Association of America.

Ending Life in South Africa

The Government Bill "to regulate end of life decisions and to provide for matters incidental thereto" proposes as an option "active voluntary euthanasia" and physician-assisted suicide even for patients whose illness is not terminal. Dr Claude Newbury, President of Pro-Life South Africa, states: "Because the Bill does not require strict reporting procedures in such cases, doctors who perform euthanasia on their own authority are accountable to no-one. In the case of those who perform euthanasia on the authority of an `ethics' committee, a `confidential' report is to be made to the Director General of Health. The general public will therefore never know the extent of such practices and the number of cases of abuse." The Bill also equates tube feeding with medical treatment, empowers guardians (where they exist) to stop the feeding, gives legal force to advance directives and classifies "brainstem death" as death.

NEW ZEALAND

"A New Zealand court has given doctors the authority to switch off the life support of a severely handicapped baby, even though her parents wanted her kept alive" (Irish Independent, 26 Sept 98.) "The case of the baby was published on the Internet this week when the patents and their lawyer set up a website in an appeal for help from international experts."

Euthanasia for Dementia

"A doctor in the Netherlands has not been prosecuted for helping a patient with vascular dementia to die,' the British Medical Journal reported on 10 Jul. 99. 'The psychiatric patient was considered to have been competent to request assisted suicide and the procedure was judged to be medically and legally sound.'

CANADA

"The Supreme Court of Canada will hear this winter an appeal from Robert Latimer, a Western Canadian farmer convicted of murdering his 12-year old daughter Tracy, who suffered from cerebral palsy, in 1993" He is still free on bail. His lawyers are pressing for a "constitutional exemption." (IAETF Update).

FRANCE

After an electricity black-out In Lyons caused the death of hospital patients, the Health Minister, Bernard Kouchner, called for an inquiry saying, "l don't want people to think of hospitals as places which deal out death " Susannah Herbert reported in the Daily Telegraph, 3 Oct 98. "Unfortunately for Dr. Kouchner, it s a bit late for such statements. He is involved in a high-profile and expensive campaign to persuade France that some people - the terminally ill, for example, really are better off dead." This follows several euthanasia cases, including that of Christine Malevre, a 28-year-old nurse who admitted finishing off 33 elderly patients, and Dr. Jean-Paul Duffaut who had 'shortened the life' of a 92 year old patient with potassium chloride. He was praised by the local medical council. It was left to relatives to start proceedings against the nurse.

"How to Die" Clinic Opens

"Euthanasia campaigner, Dr Philip Nitschke will open Melbourne's first "How to Die' clinic today". the Herald Sun (Australia) reported on 27 Apr. 99. "The clinic, expected to offer free advice to people considering euthanasia, will be funded by donations." Right to Lie Victoria president, Margaret Tighe. said the police should investigate it. "Dr. Nitschke is engaged in a cloak and dagger operation visiting patients in their homes and is contactable only by mobile phone. He would love us there protesting and we do not want to satisfy his craving for publicity"