Category Archives: Euthanasia

Safeguards for the mentally ill and the demented are slipping away

By Michael Cook | Jun 20 2017 |

If there is anyone who could be called a patron saint of Dutch euthanasia, it is the psychiatrist Boudewijn Chabot. In 1991 he gave one of his patients, Mrs B, a lethal dose of medication. After accompanying her until she died he reported himself to the police and was subsequently tried. In 1993, the Supreme Court declare that he was guilty of assisting a suicide, but did not punish him and allowed him to keep practicing medicine.

Physically, there was nothing wrong with Mrs B. Nor did she have depression. But her personal life was tragic and Dr Chabot felt that she in a state of existential distress that she should be allowed to die. It was a landmark case in the steady advance towards legalisation in 2002.

That was 25 years ago. Now Dr Chabot looks back and is horrified. Writing in one of the leading Dutch newspapers, NRC Handelsblad, he says that legal safeguards for euthanasia are slowly eroding away and that the law no longer protects people with psychiatric condition and dementia.

The Dutch are complacent about their famous law, he says. But there is no room for complacency.

Under current legislation, euthanasia is only legal if a doctor believes that three conditions have been met: (1) the request must be voluntary and deliberate; (2) there must be unbearable suffering with no hope of improvement; and (3) there must no reasonable alternative to euthanasia.

However, as euthanasia has sunk its roots deeper and deeper into Dutch medicine, the second and third conditions have shrivelled up. Patients define what is unbearable and they define what is a reasonable alternative. Unhappiness can be unbearable and a nursing home may not be a reasonable alternative. So, as one ethicist has observed, requirements (1) and (2) add little to the requirement of a voluntary and thoughtful request. Autonomy has trumped medicine. As a result, the number of euthanasia cases roughly tripled between 2007 and 2016, from 2000 to 6000.

In itself, this does not bother Dr Chabot. After all, he is the Grand Old Man of Dutch euthanasia. He says that he is prepared to accept tens of thousands of euthanasia cases. But he is aghast at the rapid rise in the number of people with psychiatric illness or dementia who have been euthanised:

What does worry me is the increase in the number of times euthanasia was performed on dementia patients, from 12 in 2009 to 141 in 2016, and on chronic psychiatric patients, from 0 to 60. That number is small, one might object. But note the rapid increase of brain diseases such as dementia and chronic psychiatric diseases. More than one hundred thousand patients suffer from these diseases, and their disease can almost never be completely cured.

One sign of the changing times is the rapid expansion of the services of the End of Life Clinic Foundation (Stichting Levenseindekliniek). This organisation offers euthanasia to patients whose own doctors have refused. They never offer to treat the underlying illness, whether it is physical or mental.

By 2015, a quarter of euthanasia cases on demented patients were performed by these doctors; in 2016 it had risen to one third. By 2015, doctors of the End of Life Clinic performed 60 percent of euthanasia cases in chronic psychiatric patients, by 2016 that had increased to 75 percent (46 out of 60 people).

Last year, Dr Chabot points out, doctors from the End of Life Clinic each performed about one euthanasia every month. What happens to doctors for whom a deadly injection becomes a monthly routine? he asks.

Now the End of Life Clinic is recruiting psychiatrists to service the mentally ill and demented. One obvious problem is that there is a shortage of good psychiatric help in the Netherland which tends to take a long time have an effect, in any case because of budget cuts.

Without a therapeutic relationship, by far most psychiatrists cannot reliably determine whether a death wish is a serious, enduring desire. Even within a therapeutic relationship, it remains difficult. But a psychiatrist of the clinic can do so without a therapeutic relationship, with less than ten in-depth conversations? Well

Dr Chabot is deeply sceptical about euthanasia for the demented: we are dealing with a morally problematic act: how do you kill someone who does not understand that he will be killed?.

How? It turns out that sometimes a relative or doctor secretly laces their food or drink with a sedative to make it easier to give them a lethal injection. In one notorious case last year, the sedative didnt work and relatives pinned the terrified woman to the bed while the doctor gave the lethal injection. Dr Chabot was astonished to discover that surreptitious administration of medication has previously occurred, but has never been mentioned in an annual report.

Isnt anyone paying attention to these developments, Dr Chabot asks.

The euthanasia practice is running amok because the legal requirements which doctors can reasonably apply in the context of physically ill people, are being declared equally applicable without limitation in the context of vulnerable patients with incurable brain diseases. In psychiatry, an essential limitation disappeared when the existence of a treatment relationship was no longer required. In the case of dementia, such a restriction disappeared by making the written advance request equivalent to an actual oral request. And lastly, it really went off the tracks when the review committee concealed that incapacitated people were surreptitiously killed.

After surveying the wreckage of the euthanasia law, Dr Chabot concludes bitterly,

I dont see how we can get the genie back in the bottle. It would already mean a lot if wed acknowledge hes out.

_________________________________________

Michael Cook is editor of MercatorNet. Dr Chabots original article in NRC Handelsblad was translated by Professor Trudo Lemmens, of the University of Toronto Faculty of Law. Excerpts have been republished from his blog with permission.

See more at: https://www.mercatornet.com/careful/view/a-dutch-euthanasia-pioneer-surveys-the-wreckage-and-despairs/19992#sthash.ClTxHOn3.dpuf

The rest is here:

A Dutch euthanasia pioneer surveys the wreckage and despairs - Catholic Citizens of Illinois (press release)

OTTAWA Euthanasia opponents find it a great irony the physician who championed Quebecs euthanasia law now has second thoughts.

Only weeks after the secretary of the Quebec College of Physicians, Dr. Yves Robert, wrote his May 10 reflection on the Colleges website on whether the push for euthanasia has gone too far, two individuals have mounted a legal challenge against the Quebec law because they are ineligible to receive so-called medical aid in dying (MAID).

The plaintiffs in the case, filed June 13, are Jean Truchon, 49, who has lost the use of his arms and legs, and Nicole Gladu, 71, who suffers the effects of post-polio syndrome. They are ineligible for euthanasia because they are not terminally ill as is required under Quebec law.

The plaintiffs would rather die with dignity than live with intolerable suffering, their court document said.

Plaintiffs in British Columbia, along with the B.C. Civil Liberties Association, had already mounted a challenge of the federal laws requirement that death be reasonably foreseeable. The euthanasia laws are also under pressure from those who want to widen accessibility to include mature minors under 18, those suffering from mental illness, and incapacitated persons who have signed advanced directives.

Aubert Martin, executive director of Living with Dignity, said Robert is now realizing euthanasia has nothing to do with doctors medical competence, but is asking them to be a rubber stamp of someones request to die.

The Physicians Alliance Against Euthanasia wrote on its website that Roberts reflection is reminiscent of the classic novel Frankenstein, in which an idealistic scientific genius creates a humanoid monster that threatens the human race.

He stated a very clear statement of principle: if the clients will is the only criterion for euthanasia, then the wisdom of medicine, the art of medicine and the science of medicine has no role to play.

In an article written May 10 on the Colleges website, Robert mused about how so-called medical aid in dying is now being seen as a right.

For many, it is about having control over their death and the right to choose the time and the way, he wrote. While medical aid in dying was reserved to those suffering at end-of-life, we see the emergence of speech demanding a form of death la carte, he wrote. But is this really what our society wants?

If the answer is yes, Robert asks why the medical profession needs to be involved.

He suggested this euthanasia on demand could take the form of assisted suicide, managed by a private company that would deal with the person, as in Switzerland. ... But is it really in this direction that Quebec society wants to go? he asked.

Martin pointed out a patient cannot go into a doctors office and insist on getting an operation on his shoulder when the physician says there is no need. But in the case of euthanasia, even if it is against the doctors advice, it is about the patients rights.

What is a doctor now? asked Martin. Hes starting to be a waiter, providing services only.

The Alliance said Robert seems to believe the protection of the common good can co-exist with the pressure of unrestricted individual freedoms and that a stable compromise can be reached between these two perspectives.

But the legal and moral shift we have witnessed when euthanasia has moved from homicide to medical aid in dying is more than an evolution since both are genuinely different, the Alliance said. There is no compromise. We are talking here of a clearly perceptible seismic upheaval that leads us to a radically different medical paradigm, based solely on personal subjective choice.

The Alliance is urging its member physicians and others to telephone or write to Robert to tell him they share his concerns.

Original post:

Doctor who promoted Quebec's euthanasia law having second thoughts - The Catholic Register

Re: Balancing one right with another for access to assisted dying, June 14

Balancing one right with another for access to assisted dying, June 14

Mr. Warren misrepresents what is meant in medicine by a referral. In referring a patient to another physician, I make a pledge of responsibility to that patient that I am acting in their best interest. Whether that other physician proceeds or not with a given intervention is immaterial to my duty to only refer for the good of the patient. If I refer to a surgeon who I know to be careless and unskilled, it doesnt matter whether the surgery goes forward or not the referral itself is immoral. Likewise with euthanasia: if I refer for an assessment for medical killing, the referral itself has a moral weight, regardless of whether the patient receives the needle.

It is offensive to read Mr. Warren accuse conscientious objectors of abandoning or impeding patients in their hour of need. Myself, along with hundreds of other physicians who object to killing patients, want nothing more than to serve our patients in their final illness, providing them with the best possible medical care and showing true compassion. Not wishing to provide or participate in euthanasia as a matter of conscience in no way impedes the broader society (including Mr. Warrens organization) from providing this service. Forcing physicians to refer for euthanasia against their good conscience will only serve to break their personal integrity, the same integrity which they swore to uphold in their life and profession.

Lucas Vivas, MD FRCPC, Toronto

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Not referring patients for euthanasia is a matter of conscience - Toronto Star

Four days after mid-day's report, health department comes forward to bear medical expenses of government doctor ailing from cancer

Sangita, wife of Dr Bharat Maruthi Lote

Four days after mid-day reported on the heart-breaking video in which a 56-year- old doctor pleaded for euthanasia, with no idea how to pay off debts of Rs 30 lakh incurred for pancreatic cancer treatment, the state's conscience has finally woken. The Health Department has offered to cover the medical cost at the earliest, requesting that treatment not be stopped in the meanwhile.

In a letter dated June 17, the Maharashtra Health Department assured it would cover all the medical costs of the cancer treatment of Dr Bharat Maruti Lote, who spent years in service to the state as a government medical officer. But is it too late?

Having given hope of being able to pay for the expenses, Dr Lote stopped co-operating with the treatment and, as a result, his health has deteriorated. He is currently battling for his life in the ICU. His wife, Sangita, said, "When I was following up with them twice a week, they were mum. Now, without any follow-up, they approached me on Saturday, assuring me that they had started the process to provide financial support."

Also read - Pune: Cancer-ridden doctor asks permission to die in a heart-breaking video

She added, "I am thankful to mid-day for waking the health department to our plight. But now it may be too late, as my husband's health has become worse. If they had acted earlier, his condition would not have been critical."

Dr Bharat Maruthi Lote making a plea for euthanasia in the video

State's assurance The state's letter to the hospital treating Dr Lote states: "The amount of treatment has been gone up to Rs 30 lakh and this amount will be paid. Until then, please do not stop the treatment on account of money. The Chief Minister's office has acknowledged this case and has directed that action be taken to address this grievance on an immediate basis."

As mid-day had reported on June 13, Dr Lote was diagnosed with pancreatic cancer in March, after which his family immediately began treatment. As a medical officer posted at the primary health centre at Rampur village in Chiplun taluka, Ratnagiri, and as someone who had served the state health department for 26 years, Lote was entitled to an advance on his salary up to Rs 30 lakh to cover any medical crisis.

Weeks of silence His wife applied for the money on May 15. But with no answer from the authorities, she was forced to scrape together emergency funds Rs 3 lakh from his provident fund, Rs 10 lakh by mortgaging their home and pawning off her jewellery and Rs 12 lakh in loans from friends. Nearly a month later, with still no money in sight, her husband finally expressed his wish to give up on life altogether, requesting euthanasia in a video.

"A week ago, my husband called me and asked me to record a video as he asked for euthanasia, since the medical expenses were still rising and the government had not given us a single penny. Being a doctor, he took a government posting because he wanted to serve the poor. Is this how the government paying him back? He even received two prestigious state-level awards for his serve, and this is how he is being treated now," said Sangita.

Strangers were kinder Not everyone has been as slow to respond to their plight though. After posting the video on Facebook, the couple have received Rs 10,000 in donations from Good Samaritans online. Grateful for their compassion, Sangita said that if the money from the government comes through, these donations will go to help the needy.

Officialspeak Satish Pawar, director of the health department, said,"After the media report, I personally checked the file and found the application was pending at Mantralaya for approval. We are following up on it on an emergency basis, and the Rs 30 lakh will be provided shortly. In the meantime, we have asked that the hospital continue to treat the patient."

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Pune: State government to help cancer-afflicted doctor who sought euthanasia - Mid-Day

Despite asking to adopt the puppy and offering full medical care, Ms Ob was told she couldn't. She got in touch with an animal rescue group, who were also turned down.

She says a vet tried to enter on Sunday morning, but was not allowed in. The centre has now closed for the day.

Hope is suspected to be part-pit bull. Auckland Council's website says it has "a long-standing policy, as did all of the legacy councils before it, not to adopt out dogs that are of this type".

"The Dog Control Act allows councils throughout New Zealand to adopt this policy and many of them do. We strongly believe that this policy is in the best interests of the community as a whole."

But Tracey Moore, Auckland Council's animal management manager, says the dog's breed has not been determined yet.

"It has not been with us for the full seven days yet. Any determination would be premature."

If the dog is found to be a pit bull, it will leave euthanasia perhaps the shelter's only option.

Ms Ob says the shelter workers seemed "truly as heartbroken" as she was.

"I'm not saying that the animal shelter is at fault, but they're holding a puppy so young and she's sick. And she's so sweet, but quiet and withdrawn, because she's so small."

Tracey Moore, Auckland Council's animal management manager says it's sad, yet avoidable.

"[It's a] situation our team sees on a daily basis where yet another dog owner has failed to take responsibility. The council strongly recommends people think very carefully before taking on the responsibility of giving a dog a home, and that dog owners desex their animals."

The dog will be checked by a vet tomorrow, when she passes to legal ownership of the council. A decision will then be made on Hope's fate.

Newshub.

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Sick puppy facing euthanasia because she might be a pit bull - Newshub

There is endless debate about the ethics of euthanasia. Yet even if one sets aside principled objections to the procedure, there are still contextual risks to introducing new medical interventions into a medical market-economy. We can never set aside the risk of a market takeover.

Writing in ABC Religion and Ethics this week, Daniel Fleming from St. Vincents Health Australia explores the risks of market forces undermining attempts to regulate euthanasia once it is introduced in a jurisdiction. Citing sources from Harvard philosopher Michael Sandel to Slovenian intellectual Slavoj Zizek, Fleming argues that once medical procedures are introduced into a particular social context, they face the threat of being governed by the ideology of that social context. And for free market economies, the ideology is capitalism:

Fleming continues:

These are uncomfortable considerations, but as the author observes, its a discussion that legislations considering euthanasia need to have.

MORE ON THESE TOPICS |

Link:

Should we worry about a euthanasia market-takeover? - BioEdge

June 15 is World Elder Abuse Awareness Day. Timed to coincide with this international day, the Australian Law Reform Commission has released its final report into a long-running inquiry on Elder Abuse and the Law.

Running to 432 pages, the report takes a comprehensive look at the legal landscape across Australia and argues for a comprehensive nation-wide approach to tackling Elder Abuse. While looking mainly at the law, it also looks at abuse in Aged Care settings and argues for an overhaul of staffing, staff training, recruitment and mandatory reporting type structures to protect people.

The report also looks at training for lawyers and medical professionals.

What is elder abuse?

The World Health Organisation describes Elder Abuse as: a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person

It is recognized to take various forms, such as physical abuse, psychological or emotional abuse, financial abuse, sexual abuse, and neglect. The World Health Organization has estimated that the prevalence rate of elder abuse in high-or middle-income countries ranges from 2% to 14% of people usually defined as over the age of 60 or 65 years.

The WHO also noted that research in other predominantly high-income countries has found wide variation in rates of abuse in the preceding 12 months among adults aged over 60 years, ranging from 0.8% in Spain and 2.6% in the United Kingdom to upwards of 18% in Israel, 23.8% in Austria and 32% in Belgium.

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Whether there is a connection between the extremely high rate of Elder Abuse in Belgium and the existence of their euthanasia regime can only be guessed at, though intuitively one could easily develop a best guess argument based on culture alone.

The report notes that vulnerability to such abuse is not necessarily related to the age of the person. However, the effects of aging, broadly understood, can make our elders vulnerable to such abuse. There is also a connection to disability as noted in the report:

While older people should not be considered vulnerable merely because of their age, some factors commonly associated with age can make certain older people more vulnerable to abuse. Disability, for example, is more common among older people. More than 80% of people aged 85 years or over have some disability. While fewer than one in 20 Australians under 55 years have severe or profound core activity limitations, almost one-third of people aged 75 years or over have such limitations. The authors go on to add: Vulnerability does not only stem from intrinsic factors such as health, but also from social or structural factors, like isolation and community attitudes such as ageism. All of these factors contribute to elder abuse.

We have discussed ageism before in terms of the dominant meme that elderly people are burdens. Similar observations can be made in respect to ableism and disability.

By way of explanation a simple anecdote:

Dr. Kevin Fitzpatrick OBE and I shared a podium in Ireland a few years ago. Kevin became a paraplegic after an incident 40 years previous. He asked the audience to imagine that he and I separately visit our doctor; both of us displaying suicidal tendencies. Kevin observed that, in my case, I would be offered all sorts of support and interventions under suicide prevention strategies. In his case (as had been his experience) he said that the doctor would say that they understood why he wanted to kill himself because he had such a difficult life.

As Liz Carr recently observed, treating each of us differently based on disability is scary in terms of assisted suicide and euthanasia and is one of the reasons why many people living with disability do not want such laws. They already experience discrimination in medical care and recognise the potential that such discrimination will also be present in discussions on this subject.

LifeNews Note: Based in Australia, Paul Russell is a leading campaigner against euthanasia.

Excerpt from:

Elder Abuse is a Clear Consequence When Euthanasia and Assisted Suicide Are Legalized - LifeNews.com

NARELLE HENSON

Last updated12:00, June 16 2017

123RF

Euthanasia is a contentious issue, the world over.

OPINION: The euthanasia debate is back on and if there is one thing we can't afford to do, it is to sit on the sidelines.

What I mean by that, of course, is wriggling out of the debate by saying "oh, I feel a little uncomfortable with it myself, but if others want do it that's up to them".

I have heard that line probably more than any other in the discussions I've had about euthanasia. Many of us feel a bit icky about the idea, and yet think that we have no right to interfere if others want to be euthanased.

It's their choice, after all, isn't it? And who are we to get in between another human being and what they want?

Aside from the fact that it defeats the point of a democratic society, there is another problem to deal with.

We interfere with individual freedom all the time. And we do it because we believe that individual freedom has to be balanced against a thing called the "social good", which means "what is best for the rest of us".

We do not give individuals the freedom to take anything they see and happen to like. We call that stealing and it is a crime. We do not give individuals the freedom to have sex with whomever they would like, whenever they would like. We call that rape, or incest, or abuse depending on the situation. And they are crimes.

And at present we do not give anyone the right to kill, or help to kill, someone. We call that murder. And it is a crime.

Any change to murder laws, and you and I ought to be on high alert. We ought to be looking very carefully at what is changing, and why.

We ought to be looking at what has happened overseas, we ought to especially be looking at the risks involved, but most of all we ought to be looking at who loses out with such laws. After all, for every social change we make there are people who benefit and people who are harmed.

In this case, harm means murder. And that is very serious because once we are dead, we cannot come back.

So if euthanasia laws do result in some people being harmed, saying that we personally feel a bit unsure but we're happy to let others do what they please is a little like saying we're not sure about slavery laws, but we're happy to let others do as they please.

It is unethical, because our silence may be creating victims.

On the other hand, if your reading makes you certain such laws are what is best for our society, why would you want to stay silent? Surely, we should all speak up for what is good, right and best for all of us.

It is no secret I believe that euthanasia laws absolutely will create victims. That is to say, based on the evidence from overseas, safeguards like consent, age restrictions and illness restrictions will gradually be eroded. And, of course, a law without safeguards is by definition not safe.

That matters to me because I have a vested interest in the future. I have a little boy whom these laws will affect in one way or another. And that is the point. We are all connected, and our actions do impact other people, as much as we like to imagine that they don't.

So we can all keep pretending ethics are personal opinion, but the fact remains that the victims of bad laws are real.

That alone should be enough to convince us that the sidelines are not an option in a debate about death.

-Stuff

Read more here:

Narelle Henson: Step off sidelines in euthanasia debate - Waikato Times

READER REPORT:

ANDREA LANE

Last updated13:03, June 15 2017

123RF

Many of those who would seek assisted suicide are not physically capable of taking their own life.

There are few topics as popular, and yet divisive, aseuthanasia. Both sides raise compelling arguments, and those arguments are numerous.

Clearly the issue requires detailed consideration and that, if nothing else, makes it unfortunate that David Seymours End of Life Choice Bill has been drawn in an election year. Euthanasia campaigner Matt Vickers noted that it would have been better if the issue could have been debated before the election year.

The best-case scenario is that it becomes a major election issue; the worst, it is dismissed quickly and quietly to allow politicians to get on with the important business of campaigning. But we should not be content to let this opportunity slip away.

Suicide itself has not been a crime in New Zealand since 1893, and attempted suicide was struck off the statute books in 1961. There is no legal barrier to a person taking his or her own life. The current prohibition on assisted suicide is also at odds with our otherwise patient-centred health system.

READ MORE: * Euthanasia an election time-bomb * Euthanasia advocate's advice to NZ * Health staff support assisted dying * Euthanasia a 'good death'

End of life care for the terminally ill or those with irremediable illnesses is dictated by law, regardless of what is in the best interests of the patient. This is the one area of medical care in which the patients views cannot be considered and taken into account in determining a course of action.

Rather than law, then, the barrier is one of ability. Many of thosewho would seek assisted suicide are not physically capable of taking their own life. Even where a person is capable of taking action themselves, I would argue it is barbaric to leave them with the choice between a potentially long and undignified exit from this world or violent options to take their own life.

As Lecretia Seales said in her affidavit to the Supreme Court, [as]my death has become more inevitable, I constantly worry that it could be slow, unpleasant, painful and undignified. I worry that I will be forced to experience a death that is in no way consistent with the person that I am and the way that I have lived my life.

And that is the crux of the issue for pro-euthanasia campaigners dignity.

SUPPLIED

Lecretia Seales died from cancer, shortly after hearing that a bid to allow her doctor to help her die had failed.

The most commonly cited argument for rejecting any form of assisted suicide is that it is not possible to balance the right to dignity with the vulnerability of those potentially eligible. There is a fear that the disabled, chronically ill or elderly might feel obligated to relieve their families (and society) of the burden they are perceived to have become.

Alternatively, if patients are unable to make the decision for themselves, their lives could be ended too early under the guise of "best interests". These arguments have been used in high profile courts cases in the UK to rule against assisted suicide.

But such fears have been shown to be unfounded. Six states in the United States and four European countries have some form of assisted suicide and the ceiling has not caved in. Research looking at the state of Oregon, the first place in the world to allow assisted suicide and where it has been lawful since 1997, found no evidence of vulnerable peoplebeing abused as a result of the law.

MONIQUE FORD / FAIRFAX NZ

Only Parliament can deal with the issue of assisted suicide, but we should be as involved as possible.

Concerns specific to David Seymours bill centre around whether it is too vague to provide sufficiently robust protection of those vulnerable people, but I disagree.

In addition to requiring up to three different doctors to assess the person and their request, thebill provides for the appointment of a registrar to monitor compliance with the provisions and co-sign the prescription for the life-ending medication.

Finally, thebill would require the patient themselves to confirm their wish to die immediately prior to the medication being administered. I find it difficult to conceive of a way to make the safeguards any more robust without making the hurdles too high for thebill to be a realistic option for our terminally or irremediably ill.

Further, the comprehensive requirements for reporting compliance with the safeguards and the resulting death mean records would be clear and transparent. The fact that these reports must be reviewed by a committee comprised of two doctors and a medial ethicist would allow for constant monitoring to ensure there is no abuse of the system.

One important way in which thebill could be improved is in its definitions. Although it is not defined, "terminal illness"is sufficiently defined by the likelihood of it causing death within six months. The concept of an "irremediable disease"is more nebulous. Labour MP Carmel Sepuloni went so far as to suggest acne could be considered an irremediable disease for the purposes of thebill.

READ MORE: * Euthanasia in NZ liable to abuse * Why can't I have the option of assisted dying? * Their life, their death, their decision * Fundraising for defence

While common sense would say no doctor is going to certify that acne is sufficient cause for assisted suicide, the general issue of requiring watertight definitions is not unreasonable. Extending the definition section to at least include "irremediable"can only strengthen thebill.

My main concerns relate to the expectations placed on doctors. The mandatory requirements are onerous and time-consuming.

In addition to the expected requirements to explain the patients condition and their options, doctors are required to encourage their patients to discuss the option with their loved ones and/or a counsellor. They mustprovide the opportunity for the patient to do so while simultaneously ensuring the patient understands that they do not need to discuss the situation with anyone if they do not want to.

The burden of ensuring the patients decision is free from influence also falls on the doctor. It is these aspects that I see as the undoing of the Bill.

In a health system that is already stretched to breaking point, most doctors would tell youthatas much as they would like to take the time required to guide a patient through this process, their workloads probably would notallow for it.

That, combined with the responsibility for ensuring the decision has not been made under pressure from others (something that is potentially subjective and difficult to evaluate), may lead many doctors to opt out under the conscientious objection clauses.

If our doctors do not feel that they can give effect to thebill without jeopardising themselves or their career they are far less likely to be comfortable with the process.

The bottom line is that only Parliament can deal with the issue of assisted suicide, but we should be as involved as possible.

The New Zealand Supreme Court, in the Lecretia Seales case, found that any declaration on the topic would have the effect of changing the law, therefore "trespassing on the role of Parliament". This is the perfect example of how important it is for everyday New Zealanders to be involved in our democratic processes.

At the end of the day, it is those we have elected to Parliament who will make these important decisions on our behalf. I sincerely hope the End of Life Choice Bill progresses to select committee stage and strongly encourage everyone to contribute to the discussion and leave Parliament in no doubt as to where the public stands.

-Stuff Nation

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Whose death is it anyway? Why I support the euthanasia debate - Stuff.co.nz

A Potlatch woman told the Latah County Commissioners on Wednesday the county has a feral cat problem, and euthanasia might be the most safe, cost-effective and humane solution.

Khaliela Wright asked that the commissioners spend the $20,000 the county provides annually to the Humane Society of the Palouse more effectively.

In a letter, Wright wrote that the county's $20,000 could spay and release 50 feral cats annually whereas the same $20,000 could euthanize 400 animals.

"To me it would make sense to use the money that you do have as efficiently as possible and that would be taking money out of the hands of the Humane Society and making it available for people who want to get rid of feral cats," she wrote.

She said Wednesday that residents could choose to spay or neuter and return the feral cats to their outdoor homes or euthanize them.

Wright said much of the research she has done proves the Trap-Neuter-Return program is very ineffective and often the most expensive option available.

She said people do not want feral cats returned to their homes after they are spayed or neutered so the program is ineffective.

"It's an ongoing problem, and it needs to be dealt with, and it needs to be looked at," Commissioner Dave McGraw said.

The TNR program also recommends vaccinating the cats but those vaccinations wear off, Wright said. She said residents would have to trap the cats annually, which is not something people want to do.

Feral cats sometimes die painfully from vehicles or other animals rather than being euthanized humanely, she said.

Plus, she said, they continue to reproduce.

Wright said she cared for four feral cats last year that she tried to give to the shelter. Now she has 10, which she said the Humane Society of the Palouse will not take because they are feral, and one of them is pregnant again.

She said it would cost her $1,000 to spay and neuter the 10 feral cats.

"As far as I'm concerned - and a lot of other people, euthanasia really is the compassionate option," Wright said.

She said People for the Ethical Treatment of Animals, the American Veterinary Medical Association and the Humane Society of the United States recommend euthanasia for feral cats.

Feral cats produce health risks. Some of the infections Wright mentioned to the commissioners can be transmitted to humans while others can spread to pets.

McGraw said he and the other commissioners will look into solutions to the feral cat issue and welcomes input from the public.

Commissioner Tom Lamar said they should communicate with all the Latah County towns to better address the problem.

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County hears support for euthanasia of feral cats - Moscow-Pullman Daily News