California Governor Jerry Brown signed a bill on October 5, 2015 that makes California the fifth state to allow physician assisted suicide (“PAS”). Governor Brown indicated that he is unsure if he would utilize PAS himself. However, he did not want to deprive others of this option.
Passage of the bill must be credited to Brittany Maynard, who captured national attention and brought support to the end of life movement in 2014. Maynard was diagnosed with terminal brain cancer, and she decided to relocate from California to Oregon to die with dignity on her own terms. Although Maynard died in November 2014, her captivating story and leadership has urged states to consider allowing PAS. Currently, 24 states and the District of Columbia have considered bills that would authorize some version of PAS. It is predicted that the passage of California’s bill may encourage these states to finalize and pass their bills as well.
A nurse named Barbara Mancini was accused of homicide in 2013. Allegedly, she handed her father a bottle of morphine with the intent to assist in his suicide. Her father, Joseph Yourshaw, 93 years old, suffered from end stage renal disease and was in home hospice. However, the case has been dismissed. Judge Jacqueline Russell stated in her decision that the Pennsylvania Attorney General did not prove that Ms. Mancini gave Mr. Yourshaw the morphine with the intent to assist in his suicide, and that Ms. Mancini could have intended solely to alleviate his suffering. Some believe that though assisted suicide is legal in five states only, this decision “is the latest in a series of recent developments signaling the reluctance of courts” and legislatures to criminalize medical treatment that “may hasten death.”
Dr. Virginia Helena Soares de Souza of Brazil recently pleaded not guilty to killing seven ICU patients to “free up hospital beds.” The charges against Dr. Sores de Souza accused her of causing patients to be injected with lethal doses of anesthetics, sedatives and painkillers to kill patients. Dr. Sores de Souza is also accused of manipulating patients’ oxygen levels, ultimately causing death by asphyxiation. CNN reports that other healthcare professionals involved in the case are also facing charges.
George Sanders, 86, was arrested last fall for killing his wife Virginia, 81. Virginia was diagnosed with multiple sclerosis in 1969 and more recently with gangrene on her foot. George was his wife’s sole caregiver, however his own health was deteriorating. When George was arrested for his wife’s murder last fall, he was charged with first-degree murder. He claimed that his wife begged for him to kill her as she was facing hospital admission and then a nursing home for the rest of her life. George subsequently pleaded guilty to manslaughter and faced a sentence of up to 12 years in prison. At sentencing, the prosecution asked the judge not to sentence George to prison, stating “I don’t know where our society is going with cases like this, judge . . . At his point in time, what Mr. Sanders did was a crime.” The prosecution also noted the “very unique, difficult circumstances of [the] case.” Ultimately, the judge sentenced George to probation, a sentence that the judge believes “tempers justice with mercy.”
Representative Krayton Kerns (R), Chairman of Montana’s House Judiciary Committee, has sponsored a bill that would penalize doctors and caregivers who participate in assisted suicide. The bill is intended to reduce potential elder abuse while maintaining “the integrity of the medical profession.” Supporters of the bill believe assisted suicide is unnecessary in light of palliative care, whereas opponents believe the bill will limit the personal autonomy of people struggling with terminal and other devastating illnesses. The issue of assisted suicide in Montana gained much attention after the Montana Supreme Court ruled in 2009 that state law did not prohibit the practice.
Pending legislation in Texas would allow doctors to add a DNR order to a patient’s chart without consent. The legislation does require that the patient’s health care surrogate be notified of the DNR order and allows the surrogate to request a second opinion. However, the notification requirement does not apply if “reasonable medical judgment” indicates that death “is imminent despite attempted resuscitation” or if “resuscitation would be medically ineffective and there is insufficient time to contact the surrogate.” Notably, “medically ineffective” is not defined within the legislation.
The Health & Welfare Committee of the Vermont State Senate recently voted in favor of a physician-assisted suicide measure that, upon the request of a terminally ill patient, allows a physician to prescribe a lethal dose of medication. The Committee also made changes to the bill, such as removing a requirement that terminally ill patients seek palliative care before ending their lives under the law. Instead, physicians will be required to discuss palliative care with patients seeking to utilize the statute. In addition, the Committee removed a requirement that prosecutors must prosecute if a person other than the patient illegally participates in the patient’s death. As revised, such prosecution will be discretionary. Next, the full Senate will vote on the bill and if it passes, it will head to the House of Representatives.
A three judge panel Irish divisional court unanimously upheld the assisted suicide law by rejecting a challenge to the Irish assisted suicide act.
This decision is particularly important for Canada because the Fleming case was based on the Carter case in British Columbia. The Carter case is going to the BC Court of Appeal in March 2013. According to the Irish Independent the Irish court unanimously upheld the assisted suicide law in a 100 page document. The Divisional Court:
rejected Ms Fleming’s claims under the Constitution and the European Convention of Human Rights.
The court said that it was impossible to liberalise the law on assisted suicide and at the same time protect vulnerable persons such as the aged, the disabled, the poor, the unwanted and others including those who were financially compromised who may be vulnerable to assisted suicide.
The Irish Independent stated:
In her landmark action, Ms Fleming claimed that the strict ban on assisted suicide was unconstitutional and in breach of the European.
Convention on Human Rights (ECHR) as, she claimed, it violates her rights to dignity, privacy and autonomy.
According to the Irish Independent, the Crown opposed to the arguments by Fleming based on:
Lawyers for the State opposed the action during a six day hearing.
The State said that although suicide had been decriminalised, there was no constitutional right to commit suicide.
The State said it was entitled, as a matter of social policy, to maintain the ban.
The Irish Times explained the Fleming decision in this way:
While finding her personal autonomy and equality rights were engaged by the ban, the court found no disproportionate interference with those rights.
This case was “entirely different” from one where a competent adult refused medical treatment, even if such refusal led to death, because assisted suicide involved the taking of “active” steps by a third party to bring about the death of another.
If the court could “tailor-make” a solution to suit Ms Fleming’s needs “alone” without any possible implications for third parties or society at large, there might be “a great deal” to be said for her article 40.3.2 case, but the court could not be so satisfied.
The court had heard ample evidence to support the view any relaxation of the ban would be impossible to tailor to individual cases and also inimical to the public interest in protecting the most vulnerable. Evidence from other countries where assisted suicide was legal showed abuse risks were “all too real”.
The decision of the Irish court was very important. The three judge panel heard very similar evidence as the Canadian court in the Carter case and decided to uphold the current law.
The Fleming case will likely be appealed to the Irish Supreme Court.
Civil Beat recently published a Community Voices article by Dr. Charles Miller called “Aid-in-Dying is Not Assisted Suicide.” In his article, Dr. Miller, founder of the Physician Advisory Council for Aid in Dying (PACAID), promotes what he euphemistically calls “aid-in-dying” in lieu of the generally accepted term “assisted suicide.”
Groups like PACAID attempt to obfuscate the moral and legal issues surrounding assisted suicide in Hawaii by using the euphemism “aid-in-dying.” However, the real meaning of this term becomes clear by an understanding of the group’s mission, which is to promote physician involvement in hastening patients’ deaths, such as through issuing a prescription for lethal drugs.