• FUNDACIÓN JUAN JOSÉ LÓPEZ-IBOR (www.fundacionlopezibor.es ). Creada en 2005 por el doctor en psiquiatría Prof. Juan José López-Ibor Aliño, tiene por objetola asistencia, docencia e investigación en el campo de la psiquiatría, la salud mental, la neurocienciay otros campos relacionados de las ciencias de la salud. Desarrolla sus actividades tanto enterritorio nacional como en el ámbito internacional. La Fundación integra a prestigiosos expertosnacionales e internacionales en el campo de las enfermedades mentales.
Right to Die Society of Canada Vol. 4 No. 1-2 (Jan. 2012 - Jun. 2012) hearings throughout Quebec since late 2010 releasedits report on March 22. The recommendations are "Life needs an ESC (Escape) key." notable for their compassion and courage. They also (Newsletter editor Ruth von Fuchs, and probably show a practical turn of mind, and awareness about many others as well) the ways of the world.
Of primary interest for the right-to-die community is the recommendation that medical aidin dying be recognized as appropriate end-of-life care,provided certain conditions are met. Rather than The number: 4%
imposing do-it-yourself responsibilities on people whoare weak and tired (as in places where assisted What it is:
suicide is al owed but euthanasia is not), the Quebec 60% minus 56%. In a survey of1669 California thinkers propose that people should be able to receive adults, 60% of respondents said it was "extremely service, from members of the profession that has important" to make sure their families weren't burdened served them all their lives. by tough decisions about their care, but 56% had not With respect to qualifying conditions, the expressed their wishes to the person who would be recommendations move bravely and humanely outside making those decisions.
the mainstream by including people who haveconstant and unbearable psychological suffering that cannot be relieved by any method they could tolerate.
The person with the wishes may not be solely The committee's "practical turn of mind" responsible for the disconnect. Spouses or offspring or shows in several parts of the recommendations about other potential proxies may have deflected attempts to advance directives: start a just-so-you-know conversation, in a misguided – Such directives should appear in patients' medical effort to spare the "worrier". The situation often calls files and be recorded in a register for persistence or even a bit of craftiness.
– Doctors should be required to look for patients' directives – Directives should be allowed to include an instruct- February 14, 2012 (Valentine's Day!) in San ion that medical aid in dying is to be provided if certain circumstances prevail– Facilities' quality-and-complaints personnel should NEWS IN CANADA
regularly check that advance directives for medical aid in dying are being honoured Report of Quebec Committee
– An expert committee should be created to look at the possibility that someone who has developed a The all-party committee which had been holding dementing condition such as Alzheimer's disease could express a desire to receive medical aid in dying sedation may relieve the suffering of many, for some (presumably at a fairly-distant future time, when the persons it may be unavailable (due to the nature of person's decline has reached a specified stage).
their il ness) or unacceptable to them (because they Practicality is also evident where the committee value maintaining consciousness and the ability to notes changes that should be made to prosecutorial communicate, feel that death while under palliative guidelines and to the ethics codes of medical- sedation wil be difficult for their families to observe, professionals' associations. And in the ultimate touch worry that they wil in fact maintain consciousness, or of realism, the committee sets a deadline for the tabling for other reasons). Thus, they may be required to of a bill in the National Assembly: "no later than June undergo physical pain or psychological suffering or both, possibly exacerbated by terrible fear about whatis yet to come.
Wise Decision in BC
Fifth, they are required to undergo stress. The non-availability of physician-assisted death means that After listening to ten expert witnesses, and patients cannot obtain an ‘"insurance policy" that they pondering thousands of pages of written submissions, may never use but that gives them some peace of Judge Lynn Smith announced her ruling in the Carter mind and relieves their fear." case, on June 15.
Smith wrote "I find the conclusion inescapable She had been quite persuaded by the that the Criminal Code provisions regarding assisted arguments of the plaintiffs (who included Lee Carter, suicide have a more burdensome effect on persons ALS sufferer Gloria Taylor, and the British Columbia Civil with physical disabilities than on others." This violates Liberties Association). They asserted that Section their equality rights as established by Section 15 of the 241(b) of the Criminal Code of Canada, which makes it an offence to assist with a suicide, is unconstitutional Overall, Smith concluded that "the benefits of because it violates two sections of the Charter of Rights the impugned laws are not worth the rights limitations and Freedoms: Section 7, establishing the right to "life, they create." She agreed with the plaintiffs' claim that liberty and security of the person", and Section 15, the blanket prohibition on assisted suicide is overbroad prohibiting discrimination on the basis of disability.
and has effects which are grossly disproportional to its In Sections 1324 - 1329 of her decision, Smith presents a deeply-thought account of how the current New laws could achieve the desired objectives law harms people, especially people like Taylor: by setting out conditions under which exceptions "First, they experience a shortened lifespan if would be made, along the lines of the policies in they take steps to end their lives sooner than they places such as Belgium and Holland and Oregon. would feel it necessary to do if they were able to Several expert witnesses had described the exper- receive assistance.
ience of those jurisdictions and Smith was convinced Second, they are denied the opportunity to that effective safeguards can be designed and make a choice that may be very important to their sense of dignity and personal integrity, that is con- In Section 1393 of her decision she indirectly sistent with their lifelong values and that reflects their presents her sketch of what a new law might say: life's experience. Further, their ability to discuss and "(the impugned provisions) are of no force and effect receive support in this choice from their physicians is to the extent that they prohibit physician-assisted suicide by a medical practitioner in the context of a Third, for persons who are physically disabled, physician-patient relationship, where the assistance is they are deprived of a measure of self-worth in that provided to a fully-informed, non-ambivalent they are denied the same degree of autonomy as that competent adult patient who : (a) is free from coercion afforded to others.
and undue influence, is not clinically depressed and Fourth, while palliative care including palliative who personally (not through a substituted decision- maker) requests physician-assisted death; and (b) has Indeed, the national society has had less-than-national been diagnosed by a medical practitioner as having a jurisdiction for quite some time; many of the regional serious illness, disease or disability (including disability medical societies have declared themselves not bound arising from traumatic injury), is in a state of advanced by its dicta.
weakening capacities with no chance of improvement,has an illness that is without remedy as determined by reference to treatment options acceptable to theperson, and has an illness causing enduring physical or psychological suffering that is intolerable to that personand cannot be alleviated by any medical treatment Theoretically, Dutch citizens have access to acceptable to that person." To protect people like medical aid in dying if they meet the legal require- Taylor, by ensuring that Section 15 would be respected, ments. But in practice, qualified applicants have often physical disability (present or impending) should be been rejected, because doctors are the gatekeepers of seen as an important additional indicator.
Although Smith ordered a selective suspension For instance, one of the requirements is of the offending law, she allowed a one-year stay of unbearable suffering, but a doctor who is reluctant execution, so that Parliament would have time to draft (perhaps on personal ideological grounds) may decide a suitable replacement.
that the suffering cannot be considered unbearable, To Taylor, however, Smith granted an regardless of what the patient feels and says. As immediately-effective constitutional exemption. "She another example, the doctor may be uncertain about wil be permitted to seek, and her physician wil be how to interpret the law with respect to a given case, permitted to proceed with, physician-assisted death and decide to err on the side of caution.
under specified conditions." People in the Dutch right-to-die movement have long deplored this situation, in which innocentpeople suffer merely because of having Doctor X NEWS OUTSIDE CANADA
instead of Doctor Y.
For some patients, a right-to-die group can solve the problem by connecting the person with adifferent doctor, one who would know and respect the A Step in the Right Direction
law. But this approach does not work for patients wholive in a rural area where the obstructive doctor is Berlin doctor Uwe-Christian Arnold believes that "the only game in town". a patient who is approaching death should be able to Finally one of the groups, the one called NVVE choose when and how to meet it. Over the last 15 for short, decided that something more had to be years he has supported about 200 patients by pro- done. They set up six teams, each composed of a viding them with drugs which they could use to end doctor and a nurse, that could go wherever a needy their life when they felt the time had come.
patient happened to be. March 1 was the start date The German Medical Society objected to this of the service.
practice, stating that if Arnold did not abandon it he In their initial contact with a patient, the team would forfeit his medical licence and be fined $60,000. will begin a process of getting thoroughly informed Arnold lodged an appeal with Berlin's Admin- about the patient's history and prognosis. They may istrative Court. On April 2 the court announced it had also connect with the patient's original doctor, in case decided in his favour, saying that to ban doctors from a bit of "continuing education" might lead to a change helping the terminally ill would be "against freedom of of mind. Team members themselves will have access conscience", and ruling that the Society's threat was to an independent consultant (the Netherlands has a invalid because the organization had no legal standing. service called SCEN that gives doctors guidance regarding euthanasia cases).
Good News for Final Exit Network
Eventually, if it is verified that the patient does indeed meet the requirements, the team wil make a A February 6 ruling of the Georgia Supreme final visit and will administer life-ending treatment Court meant that the four Final Exit Network vol- according to the normal procedure, usually in the unteers who were arrested in 2009 (in connection patient's home and with family members gathered with the suicide of John Celmer) will not have to stand trial. The charges against them will be dismissed.
Georgia does not criminalize assistance with suicide. What it did try to criminalize, in a 1994 lawaimed at preventing a Kevorkian-style atmosphere, is Report of Falconer Commission
making a public advertisement or offer to assist. Butthe Supreme Court judges unanimously struck down After a year of investigation and deliberation, that law, saying it violated freedom-of-speech rights Britain's Commission on Assisted Dying presented its established by both the Georgia Constitution and the report to Parliament. The 415-page report was made US Constitution.
available on January 4.
It proposes that assisted suicide (but not Doctor Uses Law He Helped Create
euthanasia) be made legally available, in cases meetingcertain requirements: (Article based on a tribute written by Derek Humphry) 1) The person is within a year of dying from theirdisease; British-born Peter Goodwin began his medical 2) Two independent doctors are satisfied with the career in South Africa, then emigrated to the US in 1962. In his work with patients he was struck by how 3) The person has been made aware of all their powerless they were. In 1990 he joined the Hemlock alternatives (in the way of social and medical help); Society, then in 1992 became chair of the Oregon 4) The person has not been pressured or been made to Right to Die Committee.
feel that they are a burden; The laws proposed during earlier US cam- 5) The person's illness is a physical one, not one that is paigns, in California and in Washington State, had currently classified as "mental"; and included euthanasia (e.g. lethal injection) as well as 6) The person can self-administer the necessary drugs.
assisted suicide (e.g. prescribing a fatal dose of a There are obvious similarities to laws that exist drug). Goodwin's understanding of his fellow phys- in other jurisdictions, such as Oregon. But Lord icians led him to recommend that Oregon try for a law Falconer, who chaired the Commission, seemed clearer confined to assistance with suicide. Doctors recoiled on what he did not recommend than on what he did. from the idea of giving an injection, and would be Writing in the Daily Telegraph on January 2 he said more likely to accept a law in which they played a "Commissioners visited the (Dignitas) clinic and spoke remote role – prescribing the lethal overdose but not to the people who ran it. They did not like much of being present – because in that situation the what they saw . . But should the UK adopt the model responsibility lay with the patient.
used in Holland? . . We doubt it . . And would we At an annual meeting of the Oregon Medical want a system that required the ingestion of around 90 Society, Goodwin tried to get the Society's support for capsules of medication in a short period of time, often the proposed law. He did not achieve that objective without the supervision or support of a doctor, as is the but the Society did agree to not oppose the law.
Voters approved the law in 1994 and again in 1997. Since 1998, about 600 citizens have used the Death With Dignity Act. On March 11, surrounded byhis family, the 83-year-old Goodwin used it himself. In 2006 he had been diagnosed with corticobasal tragic suicides (and equally tragic failed attempts) are ganglionic degeneration, a rare disease with no cure made less likely when society no longer has a blanket and very few therapies to relieve symptoms. Thanks in prohibition on providing exit assistance. Able to part to his own efforts two decades earlier, he had the openly seek information and support, people become power to choose the time and the manner of his death, less isolated and desperate. Quite often they gain once his doctors had confirmed that his disease had enough peace of mind to go on living.
progressed to the point where he was likely to die from Other speakers included Philip Nitschke it within six months.
("Real End-of-Life Choice") and Swiss Justice MinisterSimonetta Sommaruga ("What Degree of Self- Determination at Life's End?") For all the presentations just mentioned (and Biennial Conference Held in Zurich
for several others), the full text is available via thewebsite of the World Federation, (Overview by Ruth von Fuchs) In the column that runs along the left side of thehomepage, click "Conferences"; on the page which The 17th conference of the World Federation of then appears, choose "Zurich". A link to the public-day Right to Die Societies ran from June 13 to June 18, speeches is given first, and then come quite a few with Federation business occupying the first day and other links that you may want to fol ow.
the beginning of the second.
Much of the full-text content is in German but Thursday June 14 saw four new societies being Nitschke's speech and Faye Girsh's reports are in inducted into the Federation, bringing the total number English. To find an English version of Minelli's paper, of member societies to 48 (from 26 countries). One of search "referat-wf-kongress" in google.com/ncr and the new groups was the Canadian organization Farewell ignore the warning message you receive, or try Foundation, based in Vancouver (604-521-1110 or ). The other three were Society for Old Age Rational Suicide (Britain), Lifecircle While you are on the site you may very well (Switzerland), and Ultime Liberté (France). Lifecircle want to sign up for monthly news-messages from the will accept people from outside Switzerland, as Dignitas Federation. Back at the homepage, go once again to has done for many years. Ultime Liberté shares with the column that runs along the left side, but now click Farewell Foundation the view that aid in dying can be "News". On the page which then appears, use the provided safely and competently by non-doctors who second block at the right-hand side of the page to give have received the relevant training and acquired the the address you want the messages sent to (you can leave the "Filter" block as it is). Thursday also featured speakers from Japan, The left column of the homepage also helps USA, and the Netherlands, as well as a multi-national you subscribe to the Federation's twice-a-year newsletter (edited by Faye Girsh) and to the almost- Friday June 15 was Public Day. Several of the daily ERGO message list (prepared by Derek Humphry).
speakers were eminent or controversial or both.
Early on Saturday, news of Judge Smith's Lawyer Roger Kusch, of Sterbehilfe Deutschland enlightened decision (see pages 2-3) reached the (Death-Help Germany), described "Cases of Assisted participants in the conference. Much rejoicing and Suicide in Germany".
congratulating ensued! Andreas Brunner, Attorney General of the The happiness continued through the morning, Canton of Zurich, outlined his views on "How the State when Dignitas hosted a tour of its new facility "the Should Handle Assisted Suicide". Brunner and Dignitas blue house" and offered refreshments in the sunny have often had differences of opinion, it could be said.
garden. Tour participants were also taken to the Ludwig Minelli of Dignitas made the case that Dignitas office and met many of the 15 part-time employees who keep Dignitas functioning.
police officer who soon arrived was aghast when told Saturday afternoon was devoted to Nu-Tech, that the man had suicided – he cried "And you didn't the informal "think tank" that connects people in many countries who are working to find new self-deliverance A much more common translation is techniques and improve existing ones. Some "accompanying". Many exiters act while their family information from the session is presented in the members are away at work, or they tell their relatives "PRACTICALITIES" section further on in this issue.
to leave the house for a while and create an alibi by The conference closed with a banquet going to a place where they are known to staff and celebrating the 30th birthday of Exit Deutsche Schweiz, fellow patrons, enabling any investigators to confirm the host group for the conference. As usual, several that the exiter did not have companionship and moral awards were presented. The Tenrei Ohta Award, for support from a loved one.
the person who has had the most influence on the "Facilitating" is a translation popular with global r-t-d movement, was given to Ludwig Minel i of Dignitas. The Canadian honor, the Marilynne Seguin When people are trying to end their life by Award, went to Russel Ogden of Farewell Foundation.
refusing food and fluids, they often have troublegetting a good night's sleep during the week or sobefore they lose consciousness. But when they ask FOOD FOR THOUGHT
their doctor for a sedative (and some useful drugs canbe dissolved under the tongue with just one ice chip) (Column by Ruth von Fuchs) the doctor may think "If I do this I wil be assisting mypatient's suicide by making the process more In Other Words
"Assisting" suicide is the terminology used by Similarly, at least one doctors' association has the Criminal Code of Canada, in the section where it forbidden its members to provide patients with their describes an offence for which the penalty can be as medical records if there is a possibility that the records much as 14 years of prison. The same word is used in are wanted for sending to Dignitas.
the laws of many other jurisdictions.
All these creative translations flourish in the Unfortunately there are many different notions climate of fear created by the current law. People about what constitutes, or does not constitute, anxious to shield themselves let their imaginations run wild, and recoil in every way they can think of.
The most extreme interpretation I have come But it is futile to try making sense of a pro- across involved a man with Parkinson's who cal ed me hibition on assisting with a self-administered death. to learn about ways in which he could exercise some The law itself is nonsense.
control over his dying. One step I suggested was that Ending your life yourself is a legal act, and by he buy and use a living-will book which was then the time you are in a state which makes you consider available – "Let Me Decide", by Dr. William Mol oy. He that act, you may very well need help with it. We are wanted to write down the details but his hand was a social species and helping our fellows is one of our shaking so much that he could not manage. He asked most characteristic activities. Under "Humane" my his son, who was in the room, to write down the dictionary says "Human; having the feelings and information for him. The son refused, out of fear that he dispositions proper to man; kind; benevolent; tender; could be accused of assisting with a suicide.
merciful". Humane support in situations of At a less extreme level, the forbidden action is hopelessness and helplessness should be encouraged translated as "allowing". An Ontario ALS sufferer who by our laws, not discouraged.
chose to end his life before enduring the final stages ofhis disease was fully supported by his family, whonotified the authorities after he had exited. The young (Column by Ruth von Fuchs) book "A Hastened Death by Self-Denial of Food andDrink", which is now out of print. If you make your NuTech at the World Conference
cheque for $45 instead of $35 she wil send you thebook as well as the DVD. Even if you think you would "NuTech" is the nickname adopted by a group not want or need to use this method, it doesn't hurt to of informally linked right-to-die workers (myself among be prepared for surprises such as a non-fatal stroke or them) who are trying to develop "new technology" for a change in the attitudes of relatives.
self-deliverance, and to refine existing technologies. It Neal Nicol, from the USA, showed a device he has become traditional for the group to meet at the has developed for compressing the carotid arteries to same time and place as the World Federation confer- cut off the blood supply to the front part of the brain. ence, though usually there is a printed disclaimer Loss of consciousness occurs quickly and will be making it clear that the NuTech meeting is not actually followed eventually by death if one is not getting part of the conference. At the 2012 meeting there was oxygen, e.g. if one has enclosed one's head in an standing room only, in a space that could seat 50. elasticized bag. Some people have died without using Highlights follow.
a bag but the brain also gets oxygenated blood via A very useful DVD has been produced by Dr.
arteries that come up from the spinal column and Boudewijn Chabot in the Netherlands. The English cannot be compressed because they are protected by version is entitled "Dying at Home with Helium". It shows one method (the "hem" method) for making a Nicol's device is very high-tech and many suitable bag/hood, and it also covers how to prepare people would have trouble getting the necessary and use all the other materials (low-pressure helium parts, which include pediatric sphygmomanometer tank, vinyl tubing, etc.). If you search <dying-at-home- bulbs. It is also very distinctive-looking, which means with-helium> in google.com/ncr you will get to a that after the third time it was used by an website which can be used for ordering the DVD and for institutionalized person an image of it would be reading some valuable extra information about the circulated on message lists used by hospitals and method. (The site also lets you order a Dutch or nursing homes, with the likely result that the luggage German version, if you prefer – click the appropriate bar of incoming patients/residents would be searched and near the top of the screen.) the device would be confiscated if it was found.
Ordering via the website requires using a bank Carotid compression can also be accomplished to transfer the funds (22.50 Euros, which is about via everyday items such as a strong toothbrush and a US$30). An alternative is take advantage of a "bulk length of inch-wide sturdy cloth tape, of the kind purchase" made by Faye Girsh. Canadian-dollar intended for stiffening the tops of curtains. These cheques will be accepted but the amount should be items are not likely to be confiscated if they are found $35 to allow for a fee which her bank will probably during a search conducted in the Admitting charge. The cheque should be made payable to Faye Girsh and mailed to her at Many of the participants in the workshops #108 - 7811 Eads Ave.
given by Chris Docker (in Scotland and England) have made sure that their take-with-me-to-hospital bag contains what they would need in order to end their Write "Helium DVD" in the "Memo" area of the cheque. life by the compression method, if their prospects Print your address somewhere too, if it is not imprinted became very grim and they were unlikely to be able to on your cheques.
go home. (Theoretically the method is not restricted The disc is designed to be played via a to an institutional setting, but practically speaking it is computer, in the CD/DVD drive or via an external disc usual y seen as a last-resort option.) The latest edition of Docker's book Five Last Acts can be purchased via Special offer! Faye also has copies of Chabot's <amazon.com> for about $50 US.
Tijn Hagens, of the Dutch group "de Einder" It is a testament not only to Dick but to the differences (The Horizon), works with people who qualify according in approach to this question of self-determined, to the spirit of the law, or according to the future law, dignified death.
but perhaps not according to the current letter of the I am proud of him for including all these law – e.g. people who feel they have completed their avenues thoroughly and without the negative life, or those whose misery stems from an intractable implications that we sometimes apply to other condition which is considered to be "mental". (Other people's work when it is not our own approach.
Dutch groups, and some groups outside the Nether- It also more than justifies the existence of the World lands, also have expressed concern about such people.) Federation since there is such a vast, internationalThese born-too-soon citizens are informed about exit striving to achieve the same end.
methods they can implement themselves, such as helium or chloroquine.
Chloroquine is an anti-malaria drug which is Price: $29.95 US plus shipping available without prescription in several places outsideNorth America, including some European countries Peaceful Pill Handbook, 2nd Edition
which are close to Holland. (The desirability of beingable to obtain the drug without a prescription stems Philip Nitschke, co-author of this book, uses from the fact that a doctor is unlikely to prescribe the the phrase "peaceful pill" as shorthand for "tolerably necessary quantity to anyone who does not seem reliable and comfortable exit techniques available to healthy enough to be planning a six-month stay in laypeople". Wide-ranging and detailed, like the first Central America or some other place where the malaria edition, this new version covers recent developments.
parasite has not yet become resistant to chloroquine. For a hot-off-the-press level of recency, people But people who are that healthy may not be equipping can subscribe to the digital version or "e-Handbook", themselves for an exit, saying "I'll cross that bridge which will send regular notifications to their e-mail when I come to it.") address, telling them which content has been updated Since chloroquine may cause convulsions since the last notification and allowing them to read before it causes death, people need special sedatives whatever new material is of interest to them.
in addition to it, and of course they also need a strong On people can order the anti-vomiting drug such as metoclopramide. (The book print version or subscribe to the digital version. The Five Last Acts, mentioned above, gives details about print version costs $40 US and the digital version chloroquine use.) costs $85 US for 2 years.
Right to Die Society of Canada NEWSLETTER In Search of Gentle Death
Editor: Ruth von Fuchs (Review by Faye Girsh, June 12) Address: 145 Macdonel Ave.
Toronto, Ontario I am on my way to Zurich and have been travelling around the UK with Richard Côté's astonishing Phone: 866-535-0690 or 416-535-0690 new book on my IPad. I have gotten through almost all 480 pages and am constantly amazed and impressed with the writing, the organization, the research, and the inclusiveness of this work.
Print: 1927-6400 It wil certainly be an encyclopedia for our Online: 1927-6419 movement for a long time, though it reads like a novel.
WARNER-LAMBERT V ACTAVIS – DO WE HAVE AN EFFECTIVE SYSTEM FOR ENFORCING SECOND MEDICAL USE PATENTS IN THE UK? Why is this important? Increasingly, unmet medical needs are being met by "repurposing" of old medicines for new diseases. Before such medicines may be used to treat patients for the new disease, expensive research including clinical trials must usually be performed. One mechanism to incentivise this research is to grant innovator companies exclusivity for the new indications through second medical use patents. Thus, there is a public policy argument for granting second medical use patents, and to ensuring that these patents are enforceable. On the other hand, generic versions of innovative drugs should be allowed on to the