WORLD FEDERATION MANIFESTO:

The World Federation of Right to Die Societies (an international non-governmental organisation) is aware of the increasing concern of many individuals over their right to die with dignity.   Believing in the rights and freedom of all persons, we affirm this right to die with dignity, meaning in peace and without suffering.

All competent adults - regardless of their nationalities, professions, religious beliefs, and ethical and political views, who are suffering unbearably from an incurable illness, should have the possibility of various choices at the end of their lives.  Death is unavoidable.  We strongly believe that the manner and time of dying should be left to the decision of the individual assuming such demands do not result in harm to society, other than the sadness associated with death.

The voluntarily expressed will of individuals, once they are fully informed of their diagnosis, prognosis and available means of relief, should be respected by all concerned as an expression of intrinsic human rights.

Tokyo 2004/Toronto 2006

                                                                                ______

April 7, 2007

The concept of a good death knows no countries' boundary and accordingly I felt this excellent article out of America is one of the better examples to explain "The Issues".....of course, there is a diversity of thoughts relating to the "Issue" of a peaceful death much closer to home further into this page.

2007-04-05 From: USA Today
Excerpt from 'Final Exit'
http://www.usatoday.com/life/books/excerpts/2007-04-05-final-exit_N.htm?csp=34

By Derek Humphry
EXCERPT

The Most Difficult Decision

This is the scenario: You are terminally ill, all medical treatments acceptable to you have been exhausted, and the suffering in its different forms is unbearable. Because the illness is serious, you recognize that your life is drawing to a close. Euthanasia comes to mind as a way of release.

The dilemma is awesome. But it has to be faced. Should you battle on, take the pain, endure the indignity, and await the inevitable end, which may be days, weeks, or months away? Or should you take control of the situation and resort to some form of euthanasia, which in its modern-language definition has come to mean "help with a good death"?

Today the euthanasia option­or the right to choose to die­comes in four ways:

Passive euthanasia. Popularly known as "pulling the plug," it is the disconnection of medical life-support equipment without which you cannot live. It could be a respirator to aid breathing, a feeding tube to provide liquids and nutrition, or even the sophisticated use of certain drugs to stave off death. There is not likely to be much ethical or legal trouble here provided that you have signed a Living Will and also a Durable Power of Attorney for Health Care­they are also known as Advance Declarations­that express your wishes. (More on these later.)

Self-deliverance. Taking your own life to escape the suffering. This method does not involve any other person directly, although a loved one or friend should ideally be present. It is legal in all respects, and widely accepted ethically.

Assisted suicide. You get lethal drugs from somebody else, usually a physician, and swallow them to cause your death. It is legal for you to do so, but at present it is a felony for the person who supplied the drugs or took any action physically to help you. Despite the present criminality of assistance, this procedure is gaining increasing ethical acceptance. In 1996 two U.S. appeals courts ruled in favor of physician-assisted suicide, making it likely that this is the modified form of assisted death which will be adopted. But the U.S. Supreme Court quickly squashed that and the appeals court were overruled.

Active euthanasia. Death brought about by a physician's injection of lethal drugs. This procedure is illegal and, despite the necessity for it in certain cases, has limited ethical acceptance in the medical profession. It is already available in the Netherlands but is probably more distant in America.

Often, persons who have not properly thought these situations through claim they are not worried about a bad death because they have a Living Will and the plug can be pulled at their behest. Probably so, but roughly half the people who die in Western society are not connected to life-support equipment in their final days, so relief by that way is not an option.

Before we go any farther, let me say this: If you consider the God whom you worship to be the absolute master of your fate, then read no more. Seek the best pain management available and arrange for hospice care.

If you want personal control and choice over your final exit, it will require forethought, planning, documentation, good friends, and decisive, courageous action by you. This book will help in many ways, but in the last analysis, whether you bring your life to a quick end, and how you achieve this, is entirely your responsibility, ethically and legally.

The task of finding the right drugs, getting someone to help or at least be with you, and carrying out your exit in a place and in a manner that is not upsetting to other people is yours. Suicide, even the most rational and justified version, the sort we are talking about in this book, is not something other people are anxious to be involved in. It is best to seek the help of family or the closest of friends.

If you have not already done so, sign a Living Will and have it witnessed, but not by anybody who is going to gain from your other will dealing with your estate. A Living Will, which has nothing to do with property or money, is an advance declaration of your wish not to be connected to life-support equipment if it is judged that you are hopelessly and terminally ill.

Or, if you are already on the equipment because of an attempt to save you that has failed, a Living Will gives permission for its disconnection. By signing, you are agreeing to accept the fatal consequences.

Make sure you get the particular Living Will form that is relevant to your state. They all differ in small details. Strictly speaking, the Living Will of one state or nation does not apply in another place. But carry it when you are away from home, because any sensible physician would recognize it as a valid statement of your wishes. A valid Living Will is likely to survive a court challenge because all American states recognize them and the U.S. Supreme Court has given them its blessing.

But remember this: A Living Will is only a request to a doctor that you not be kept needlessly alive on support equipment. It is not an order. It may not be legally enforceable. But as your signed "release" of his or her responsibility, it can be a valuable factor in the doctor's thinking about how to handle your last hours. The Living Will gives the doctor a measure of protection from lawsuits by relatives after your death. And it gives you a measure of control and choice.

A more powerful document is the Durable Power of Attorney for Health Care, which, in different forms, is available in all American states. Here you assign to someone else the power to make health care decisions if and when you cannot.

For example, if your doctor is unable to make you understand the consequences of what treatment or care is planned, then he or she will turn to the next of kin; you are considered incompetent. Now, if the family member is confused, or has different ethical values than you, that may not work well. You may end up getting medical attention of the sort you did not want when you were rational.

With the medical Power of Attorney given to someone in whom you have already confided your general or specific wishes, someone who has accepted the responsibility, then it is most likely that you will get the kind of treatment­or dignified death­that you desire. A doctor must get the approval of the person (also known as surrogate or attorney-in-fact) that you have named. This is especially important if there is disagreement in the family about what to do. The surrogate person has the absolute right to make the final decision, although only if you are too ill to make it yourself.

The medical Power of Attorney is legally enforceable, whereas the Living Will is not. It may seem like a man using both a belt and braces to keep his trousers up, but experience shows that if you care about a good death you cannot be too careful.

The Durable Power of Attorney for Health Care could be the most significant document you ever sign. As of today, however, it works only for passive euthanasia­the cessation of treatment. It does not empower anybody to assist in your suicide or provide euthanasia. Since 1991 the Patient Self-Determination Act, passed by Congress, requires all federally funded hospitals in the United States to advise patients of their right to make out any Advance Declarations their state has. Some hospitals supply this information efficiently; others do not. So it is absolutely necessary for you to sign these documents when you are healthy and get copies into your medical files, your private files, with your attorney if you have one, and with the person who is to be your surrogate decision-maker. Also, hand copies to some or all of your adult children.

This book is chiefly about self-deliverance, assisted suicide, and euthanasia, which the Advance Declarations do not cover. But undoubtedly the very existence of two properly signed declarations would influence health care workers if a question of hastening a death arose. Membership in a right-to-die organization, and having read this book, are at present the two most powerful demonstrations a person can make of sincere beliefs in assisted dying.

Where do you get the documents? From a good stationery store, your primary-care physician, local hospital, or call the state medical society. Nowadays most attorneys, when drawing up your financial will, will ask if you also would like Advance Declarations. This service is worth a few dollars extra. You could also contact Partnership for Caring, 1620 Eye Street NW, Suite 202, Washington, DC 20006. Phone: 202-296-8071. Fax: 202-296-8352. Hotline: 800-989-9455 (option 3). E-mail: pfc@partnershipforcaring.org

A Warning

Some lawyers and concerned groups advocate signing an Advance Declaration that contains many caveats and conditions under which they may take effect, a whole "laundry list" of your medical provisos so that every possible illness is embraced. This seemed a good idea at first, putting in writing which medical conditions were important to you and under what medical state you wanted to be allowed to die. But experience has shown one serious flaw in the "I want this and I don't want that" type of Advance Declarations. What if you are dying of a condition not mentioned in your document? It is impossible to think of every possible way in which death may come. Disputes have arisen between hospitals and patient-surrogates because a particular illness or injury was not spelled out in the document, whereas many others not relevant to the patient were.

My advice is to use those Advance Declarations that your state has approved which make simple and broad statements to the effect that you do not want "heroic measures" carried out merely to keep you alive in a clearly terminal condition. It is a mistake to think that these Advance Declarations are absolutely foolproof: academic studies have shown that many doctors either are ignorant of them or disregard them. To get them respected it is sometimes necessary to be noisy and threatening. Tell the doctor or hospital executive who is being uncooperative that your lawyer will be in touch with them tomorrow to initiate a lawsuit. That usually wakes them up to their responsibilities.

Once these documents are completed, you are ready to plan and tackle the other aspects of bringing your life to an end if and when the suffering in your view justifies it.

Shopping for the Right Doctor

If you are interested in the option of assisted dying at life's end, good rapport with your doctor is extremely useful. It is important that your doctor know your views on dying and death so that he or she is forewarned. This way there will be one believable witness around who can testify to a rational decision made well before health problems became critical and distracting. This may influence possible inquiries later on by the police and coroner's office.

Therefore, unless you are perfectly satisfied with your present doctor, and both of you are on the same ethical wavelengths regarding issues of death and dying, you should now shop around for another.

Have you directly tested your present doctor's views on right-to-die issues? Don't take any chances. Just because a doctor is a nice person, appearing to be very caring, does not automatically mean that you share religious views and cultural values. Find out. The perfect opening gambit to test views on passive euthanasia (allowing to die) is to arrive at the doctor's office with your completed Living Will and Durable Power of Attorney for Health Care. Present these documents and candidly ask if they will be respected when the time comes for you to die.

One way to ask the next question about assisted suicide would be to say, "Doctor, you've heard they've passed a law in Oregon allowing physician-assisted suicide under certain conditions. If that was law here, would you help me to die?" With the question framed this way, you are not going to embarrass the doctor by asking if he or she would break the law for you.

Make your own careful judgment from the answers you receive as to whether this is the right doctor for you. Do not be influenced by kindly and well-meant remarks such as "Don't worry. I won't let you suffer," or "Leave it to me. I've never let a patient die in pain." This sort of response is too vague and general to be relied upon. It may only mean that you'll be "deluged" with narcotic drugs for the last days of life if they happen to be extremely painful. (That "knockout" procedure, known as "barbiturate or terminal sedation," may be acceptable to you. Fine. But some of us want to be able to say good-bye to the world in a manner of our choosing.)

Pin the doctor down. Would life-support equipment be disconnected once it was realized that there was no hope of recovery? Would such equipment be used regardless of a prognosis of hopeless terminal illness? Having opened up the subject with these basic (and legal) questions, then address the matters where the law unfortunately is less clear. Tell the doctor that you have read this book, that you are a supporter of a particular right-to-die group (if you are), and ask directly if lethal drugs would be supplied to you in certain compassionate, terminal circumstances.

The doctor's reply to this tough line of questioning may be an outright rejection on religious or legal grounds. Or it may be hedged because of the complications of the current laws, or ignorance of them. The doctor does not want to be trapped. Today more and more doctors­particularly the younger ones­have taken the trouble to read and think about euthanasia. Thus, a few will give you an outright assurance of direct help should it be needed eventually. The number of doctors who think progressively on this subject today amounts, surveys show, to at least 50%, so there is hope that your approach will be well received.

You have to judge from the nature of the answers to your questions whether this is the doctor for you. Of course, if the Advance Declarations are scorned, or there is ignorance of them on the part of the doctor, you need to change immediately.

Call your local hospitals and ask for their physician-referral service. If that doesn't work, look up the medical society of your county or state in the telephone book and call them. Get the names and numbers of five or six doctors who are reasonably close to you; also, if you have any particular health problem, ask for their specialties. And don't forget to check with your health insurance company on whether these doctors are on their acceptance list.

_______

January 27, 2007:

A letter to a Scottish Herald Newspaper tells it well:

Public attitudes to euthanasia

YOUR article on public attitudes to euthanasia raises an important point (January 24). The report states that "those who demonstrate a concern for the sanctity of life are those who are most opposed to assisted dying". It may be true that such people claim to be concerned about the sanctity of life. But it can be argued that allowing people to end their lives with dignity shows more respect for the sanctity and value of life than forcing them to die slowly and painfully.

Recent research shows that people who have witnessed the deaths of patients who were denied euthanasia are much more likely to support the practice. This suggests that those who oppose euthanasia are lacking in the moral imagination necessary to put themselves in the position of a dying patient. We should also not forget that a form of euthanasia is already legal: if a patient requests withdrawal of life-supporting treatment, he or she is allowed to die. While doctors might be reluctant to embrace euthanasia, there is no moral difference between killing and letting die. Those who cling to this supposed distinction actually show scant regard for the sanctity of life.

Dr David Shaw, Centre for Ethics, Philosophy and Public Affairs, University of St Andrews
 

December 8, 2006:  

2006-12-08 From: The Globe and Mail, Toronto, ON, CA

Putting a price on life

(regardless of which Country it originated,  this article is relevant!)
http://www.theglobeandmail.com/servlet/story/RTGAM.20061208.wcocancer08/BNStory/specialComment/home

We must balance what's gained by spending more dollars caring for people with end-stage disease, with what we would gain spending the same dollars elsewhere, say health analysts MICHAEL DRUMMOND and DEBORAH MARSHALL

A requirement of many regulatory bodies around the world, including Canada, is the need to demonstrate the value of new drugs through a pharmaco-economic analysis. In the context of limited resources and an ever-expanding need for health-care services, determining the value for money of new treatments is an important consideration for policy makers, who have to make life and death choices within a constrained budget.

The concept of "opportunity cost" is a fundamental part of economics. In health care, it means that since resources are limited, using any of them for the care of a particular group of patients means someone else, somewhere, loses out. Those losing out on funds could be patients with another disease, young children, or the recipients of a public program for disease prevention that is cut because the province has to find money to cover hospital overruns. Policy makers need to balance, therefore, what is gained against what is lost.

In matters of life-ending ailments, policy makers must balance what is gained from spending more dollars in caring for people with end-stage disease with what we would gain if we spent those same dollars elsewhere.

Until the early part of the 20th century, most people died of infectious diseases, and cancer was a disease without hope. Diagnosis was often at a late stage; no treatments were available that significantly altered the course of disease. Patients with cancer now live much longer, and cancer is considered more of a chronic, debilitating disease, from which most patients eventually die. As the population ages, there will be a disproportionate increase in cancer patients. This poses a daunting resource-allocation challenge to policy makers and the public alike.

Clinical effectiveness, costs, and patient preferences must be weighed when assessing value for money in cancer care. The seriousness of the ailment, the availability of alternative therapies and considerations of equity or fairness may also be factors when deciding whether expensive new drugs are funded.

Recommendations to fund cancer drugs probably often reflect a combination of these factors. But at what point is it no longer "worthwhile" to provide funding for drugs and treatment to prolong life, or alleviate suffering for patients in the end stages of disease? And what is the ethical justification for denying treatment? Isn't life priceless?

End-of-life care for cancer patients is inevitably expensive, largely because people are very sick. Based on Medicare data from the United States, it has been estimated that more than two dollars of every eight spent is spent in the last year of life, and one in eight is spent in the last month. One response to this apparent imbalance would be to try to be more efficient in the provision of end-stage cancer care. For example, home management of terminally ill patients could potentially contribute to decreased costs. A retrospective Canadian study compared the cost of managing cancer patients who required narcotic infusions in hospital and at home. Medical costs in 1991 Canadian dollars averaged $370 a day for inpatient care, and $150 a day for outpatients.

Some would argue that reducing expenditures at the end of life is a justifiable way of cutting wasteful spending and making resources available for other needed health-care services. In the context of these alternatives, it could be argued that interventions for patients whose death is imminent are inherently wasteful, since they neither cure nor stop the progression of disease or disability. For example, one might question the use of an intrathecal pump for administering morphine -- the spinal-access pump has an initial cost of about $20,000 -- to achieve better alertness and pain control, compared to oral or subcutaneous morphine.

What amount of benefit should be considered worthwhile? What is it worth to extend life by a few days? What if this extension in life is accompanied by a decrease in quality of life, because of the toxicity associated with treatment? What is the value of interventions that are not associated with improved survival?

One approach is to set a common threshold of cost effectiveness that should be applied to all health-care interventions. In the United Kingdom, where health-care rationing is practised to a fine art, the National Institute for Health and Clinical Excellence (an agency that provides guidance to the National Health Service) tends not to approve treatments that cost more than £30,000 (about $68,000 Canadian) per year of life gained (adjusted for quality of life).

A similar approach has been proposed in Canada in the past. A blunt instrument, no doubt, but it does force explicit consideration of both benefits and costs.

An important question, of course, is that of how we obtain the data for these assessments. Little attention is given to measuring cost or quality of life in clinical trials. The gold standards for outcomes of cancer treatment remain improved survival, and disease progression.

Decisions about whether to fund expensive therapies in end-stage disease will never be easy and will inevitably raise complex social, ethical and legal issues. It does not make sense, however, to dodge the issue and pretend that resources can be consumed without consequences for other patients, or society at large. We need to generate more data on the cost effectiveness of alternative treatments, in cancer and other diseases, and to have a more open debate about how these difficult choices should be made.

Michael Drummond is professor of health economics at the University of York in the United Kingdom; Deborah Marshall is assistant professor of clinical epidemiology and biostatistics at McMaster University in Hamilton, Ont., and vice-president of Global Health Economics and Outcomes Research.

                                                                  _____
 

The following article was part of Chapter 8 of a book, printed in 1983 “Keeping Love Alive” by Candida Peterson. I could not seek copyright permission as the publishers Dove Communications were not in the current phone book. I had to retype most of it so please accept my apologies for any mistakes and bring them to my attention for correction.

The final challenge: death

The sweeping up the heart And putting love away
We shall not want to use again Until eternity
Emily Dickinson’

‘Parting is all we know of heaven,’ wrote the poet Emily Dickinson, ‘and all we need of hell.’ Death, the final challenge in a couple relationship, is probably the most difficult one of all. Furthermore, it is a challenge that gets harder rather than easier as time passes. As couples cross the early hurdles of building a mature style of love and creating harmonious domestic togetherness, and as they progressively learn how to communicate their deepest feelings, to resolve their most divisive conflicts and to share in complex tasks like rearing children and advancing in their careers, their dependence upon one another steadily increases. And so separation entails the loss not only of the partner’s cherished company but of all the varied benefits that participation in a seasoned, growing, intimate relationship can provide.
Separation from a lover is not easy, not even for a limited period. Nor does having made the deliberate decision that parting is necessary insulate divorcing spouses from painful encounters with grief, loneliness or the uphill struggle to resume an unmarried style of life. However, the difficulty with the loss of a beloved partner is undoubtedly intensified, when, as in death, the separation is both permanent and involuntary.
Planning for death
Although their attention is drawn to the possibility of being parted by death as they repeat the marriage vows few young couples do much conscious planning or open discussing of this eventuality during their early years together. Many older spouses avoid the issue too, despite the passage of time having brought a final separation nearer. The fact that contemplation of one’s own or one’s partner’s mortality evokes pain, fear and anxiety makes avoidance of the subject understandable. The problem is not confined to couple relationships. Society as a whole tends to operate by a strategy of death denial. Few adults today gain much practice in dealing with either the emotional or the practical ramifications of death and bereavement opportunity to observe how other adults cope with the loss of their intimate partners. Apart from such cursory preparations as the drawing up of a will, advance planning might almost be said to be nonexistent for most couples.
This reluctance to consider the subjects of death and bereavement nevertheless poses serious problems when a crisis does arise. If a spouse is suddenly fatally injured, or if an illness is diagnosed as terminal, the couple relationship is thrown into intense emotional turmoil. Partners may not discuss their feelings or make the intelligent mutual decisions that could have been possible before such a calamity struck.
Advance preparation has become more necessary for modern day couples than it was in the past as a result of new dilemmas, changes and choices that the process of dying now entails. For one thing, medical technology has become capable of artificially prolonging life for lengthy periods and many people now believe that they and their spouses should have a say about whether and under what conditions they should be kept alive in this way.
When she was in her fifties, the anthropologist Margaret Mead drafted a ‘living will’ to explain to her doctors and loved ones what her own choices in this matter would be. The document specified that if she was unconscious, she wished to be spared all medical, surgical or nursing procedures which might entail a risk of her surviving ‘with any sort of decreased mental efficiency of any kind, brain damage, amnesia, cognitive loss.’ She explained her reasons for legally formalising this decision in terms of the stress which might otherwise be put upon her friends and family. She wrote:
In our present culture I am the only one who can make such a decision and I do not wish to impose on others the burden of carrying out measures which they know I would not have chosen but which they would have no way of choosing against. It is my belief that a decision not to live when one has ceased to be oneself can be taken in full responsibility and with love for those whom one leaves behind.

The choice of whether to be allowed to die at home or in hospital is another decision which couples ideally should reach together well before the period of terminal crisis. Even such relatively straightforward questions as whether a spouse would prefer to be buried or cremated, or what kind of funeral service is desired, may need to be discussed ahead of time nowadays. Family traditions now no longer limit or totally specify an individual’s own options and preferences.
The ability of modem medical technology to describe an illness as terminal and to predict when death will occur creates further dilemmas for the married couple. Sometimes spouses must break the news of impending death to their dying partners; or they may have to face the responsibility for concealing a fatal diagnosis. In still other cases, terminally ill patients have to decide whether or not to tell their loved ones that they are dying. In any of these situations, the adult’s own struggle to come to terms with catastrophic loss is compounded by concern for the partner’s welfare. It is painful to foresee a spouse’s death. The thought of the distress one’s own death will cause a loved one is painful too. But though secrecy may alleviate some of this grief, it carries with it its own set of problems.
Margaret Mead considered this issue stated that

At all times and under all circumstances I wish to be told the full truth about any physical condition without any protective evasions or optimisms whatsoever. If I am to have a limited and definite period before death, I wish to use such a period responsibly and constructively.

Not all adults would agree with Mead that knowing is better than not knowing. Some believe they would die more comfortably and peacefully if spared the agony of such awareness. Furthermore, a person’s opinions are apt to change with time and experience. Nevertheless, in the event of terminal illness partners who have at least discussed their own preferences with one another are in a better position to make a decision than those who have never dared broach the topic.
The question of whether or not to tell terminal illness has been diagnosed creates a whole array of challenges and dilemmas over and above the problem of possibly not knowing the partner’s true wishes. The decision to keep secret the fact that a spouse is fatally ill raises the problems of dishonesty and concealment.
Even when the partner has expressed a wish not to be told, the fact of having to practice deceit in order to carry such deceit can impose severe stress on the relationship. When lovers have been completely open and honest with every thing else, it may seem unbearable to have to tell lies at a time when mutual support seems most necessary. The practicalities of maintaining secrecy are also unusually awkward, particularly for spouses not accustomed to deceiving each other about everything else. The pretense and subterfuge necessary simply to talk about the future with the unknowing victim of impending death may seem an unbearable travesty of an intimate and communicative partnership.
In his novel The death of Ivan Ilych, the Russian writer Leo Tolstoy describes some of the adverse consequences of such deceit:
This deception tortured him — their not wishing to admit what they all knew and what he knew, but wanting to lie to him concerning his terrible condition, and wishing and forcing him to participate m that lie. Those lies — lies enacted over him on the eve of his death and destined to degrade this awful solemn act to the level of their visitings, their curtains, their sturgeon for dinner — were a terrible agony for Ivan Ilych. . He saw that no one felt for him, because no one even wished to grasp his position.

On the other hand, secrecy may be called for when the lover has expressed a preference for not being told, or when a partner’s health or personality seems too weak to bear the truth. Medical personnel may likewise advise a husband or wife to remain silent when the patient’s chances of recovery are seen to hinge upon believing in the possibility of a cure. Though concealment may still prove difficult under these circumstances, spouses may find it of some consolation to know that they are performing final and important services for their partners.

Nor is open communication easy when a terminal condition has been diagnosed. If discussing death is difficult at the best of times, it may seem impossible during the distress and turmoil of impending separation. Even those lovers who have agreed in advance that full knowledge is the alternative which suits them best may find themselves tongue—tied once the threat of terminal illness is actually upon them. Couples, whose habitual practice has been to avoid all confrontation and open discussion of serious difficulties, may likewise lack the skills necessary for talking about such an anxiety-ridden and unfamiliar subject.

Another stumbling block is the danger that the dynamics of the couple relationship may be unbearably altered by one partner’s knowledge that the other is dying. In one instance, a wife who had kept the confirmed diagnosis of her fatal disease secret from her husband for over two years explained that although she had found it extremely difficult not to tell him, she had refrained from doing so because she did not want him to pity her. As she saw it, their marriage rested on a strictly egalitarian foundation and she wanted to keep up her side of the balance for as long as she was physically able to do so. She also feared that if her husband began to look on her as someone who was dying, she would ‘see the distance of our separate eternities reflected in his eyes’.

       sp;  &np;bsp;          _____________________

I have included this article taken from the Exit Newsletter February 2006 as I understand many people are confused by the two organisations which both have a specific way of arriving at their chosen destination, Voluntary Euthanasia.

I support both Voluntary Euthanasia Societies in Law Reform (if ever and if only!), and I welcome the impatience of Exit to want to help people here and now.   And then there is Self Help, which is as close as whatever takes ones fancy.   At the end of the day, I believe self help will lead to the least angst for anyone, if only those who needed it most were able to help themselves! 

Dying, like living, is sometimes very hard.  Just be grateful if you don't have a pace maker inserted which will keep on, keeping on!   I heard recently of a man who didn't want to die at the age of 73.  About to have his legs amputated due to gangrene, he was trying waiting desperately for the Health Authority to develop an artificial heart which could be attached to his chest on the outside of the body.  He died before the amputation could be undertaken.  

Modern medicine has excelled itself into a corner,  

Roll on little white pill, it is sure to be available before the Law Reform will be implemented! 

Exitorial: Why Exit Differs from the VE Societies

Exit goes to some length to differentiate itself from traditional Voluntary Euthanasia Societies both here and overseas. The recent actions of the New Zealand Medical Council have served to make this distinction even clearer. — -. As described in Killing Me Softly: VE and the Road to the Peaceful Pill, I believe the medico- legal (also known as the law reform) approach to Voluntary Euthanasia does little to promote the interests and dignity of sick or elderly people.
Rather, by its very nature, a law on VE will do little more than create a small exclusive sub-group within society, a group able to get lawful help to die. To join this group you will need to be extremely sick (almost dead in fact) and will need to present yourself to those who will judge your eligibility (always doctors). This legislative model promoted by VE societies is based on illness - a discourse which places the medical profession to the very heart of the action.

Despite Marshall Perron maintaining that he never wanted the sick to be subjected to some macabre test in order to qualify, to die, that is exactly what VE laws do. The onus is on the person to prove they are eligible: terminally ill, of sound mind etc etc. There is no “right to die”. Rather, one only has the right to ask permission to die, permission that may or may not be granted. None of my four patients, the first people in the world to use voluntary euthanasia legislation, would have made use of this law if they had access to a Peaceful Pill.

Historically, it is only recently that doctors have become involved in the dying process. This is a point to remember. Dying is not necessarily a medical experience, but rather is a social, cultural and very natural act.
For an organisation to focus, therefore, upon law reform is to condone the paternal role of medicine in everyone’s death. It is to support the authority of doctors - as it is vested in them by law - to make one of the most fundamental decisions that anyone of us will ever need to consider.

This is why Exit cannot and will not support the medico-legal approach to VE. If law reform is to be considered at all, it must be based upon a universe model of access to information and methods. To date the Drion Model is the only end-of-life theory that provides for this.

The late President o the Dutch Supreme Court, Huib Drion, advocated that everyone over a certain age should have access to lethal drugs. No ifs, no but There should be no test no hurdles. Drion assume - correctly - that age teaches us well. In Exit workshops we now focus almost exclusively upon Drion’s Universal Model. This is why the actions of the NZ Medical Council are so misplaced.

Our workshops are not some quasi-medics consultations. Nor do they draw particularly on the knowledge that comes from my medical training. Workshops were pioneered by Exit, and at them we present practical information and practical solution Information that comes from our ambitious Exit Research and Development program.

If my medical education taught me anything it was to recognise the privilege of the medical profession for what it is. Often interfering, often paternal and frequently scared out of its wits about its own irrelevance as death is faced.

Exit maintains that ALL elderly people, not just the terminally ill, have the right to a peaceful death if an when they wish. Drion’s Universal model is enshrined in the Peaceful Pill project and it is the pursuit of this goal that clearly differentiates Exit International. If only we had more judges like Huib Drion.
Signed Philip Nitschke


Contact Us
Exit International
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This article was received, December 4th, 2005 from a contributor of my website, who was responding to get another Government Initiative:  One person's personal story of hardship.

Following this weeks 7:30 Report and AM story on "Claims of Public Hospitals Crisis, I have used the net for further information on The Hospital Reform Group, and Citizens Juries. 

Thank all of you who stood up for change by bringing these issues forward.  

I have read with interest your posting " Let the people Decide! Citizens Juries in Health" from New Matilda. Thank you for stating that (informed) people need to have some input into the debate about their health issues and outcomes in relation to the dwindling money available.

 Informed people now have usually done some research on their health (or family members) issues and long term outcomes. A very different attitude from my childhood days, when the only information was from the treating medical people. I am old enough to remember when a visit to a local doctor depended on money in your pocket or payment by instalments "off" the bill.

Medicare ushered in relief for the working class ( many, like my parents had some health cover) and the underprivileged. But this benefit is being eroded by a new generation who expect it as a right not a privilege. The expectations of the uninformed of doctors, hospitals, and technology certainly needs to be changed, while having the privilege of living in this country.

In 1970 I was admitted to a Public Hospital as a car accident victim. The skill and care within the system enabled me to eventually regain reasonable good health. As a single working mother with two sons I also had health cover. The public hospitals were where the skills were, and were being taught. But the care and interaction from all personnel including the cleaners, tea lady, and porters who lifted me many times each day whilst I was in traction contributed to my recovery. I also had the advantage of skilled alternative medicine practitioners, for long term maintenance.  

Today alternative modalities are very much part of our health care. Not funded by the government, but used when tax paid by practitioners fills the coffers, while allowing ridicule by the medical cathedrals establishments. Undermining their expertise instead of embracing differing skills only widens the economic crisis and creates fear for the community. Even some health care workers use these services albeit with secrecy.

 Now at the closing part of life, once again informed people are agitating for reform when faced with medical futility, which also includes old age. Thousands of words written in Universities, in books and now on films, and documentaries. The body can not live forever, even though that miracle cure is around the corner. Each patient has been part of the discovery and it will always be so.

  Informed  people have been speaking out in a form of Citizens Jury for over 70 years, asking for a legal choice when life has become long term suffering. Participants in this process or realising they are facing it are making plans for the manner in which they would prefer to die, and they want input into that process by having Advance Directives acknowledged, and legal in all states. Queensland has led the way, and Western Australia seems to be making up their mind. Victoria is humming & haaring, because politicians are afraid of loosing votes because dying is not popular with certain sections of the community. Northern Territory are also fearful of opening Pandora's box after the events of 10 years ago when their bill was overturned.  

Be assured the issue will not go away, even though the Government passed a bill to prevent people using the phone or internet to look for information. An excellent Australian web site www.yourchoiceindying.com keeps people up to date. This is all part of the "health $" keeping people alive who would prefer not to be 30, 15, 10, or 8 years in a nursing home, as has been the case with 4 of my immediate circle of family or friends family. Dying is part of the cycle of having lived, but there seems to be a myth that by hiding people away it will go away. Bring on an informed Citizens Jury on the right to choose this option. How often are other health & social  issues part of families coping with these issues. 

As a member of VESV since 1983 after watching the way my parents suffered, as they died, I am still working for change in the expectations of what medicine and technology can achieve, when faced with this last challenge in life. Once again, nurses, doctors, funeral and palliative care personnel, albeit secretly are of the same opinion.  So too are many patients who dare not voice their wishes because of some sacred cow which has to be maintained in order to keep the world spinning in the right direction.

 Last year, two weeks after visiting my local doctor with a list of troubling symptoms that were just handled with a prescription in a 15 minute consultation, of checking blood pressure etc. and reviewing my blood tests, I took a taxi to the public hospital in my area. Red alert, I was suffering heart failure, and among other tests, all the items I had presented to my doctor were found to be contributing factors. I still had the list in my handbag. But they did discover a very major factor relating back to the outcomes of the original car accident, and an attack in the street by some people 14 years later, requiring the need for a replacement hip in 1988. Once again I had health cover for this procedure at a private hospital.  

At 72 years of age I was admitted to the special section for aged people, my care was excellent, but worrying as to some of the questions I was asked regarding my mental health. I fully understood why the need to assess aged people's cognitive awareness etc are carried out, but I felt some 30 something's workers attitude was overbearing in their university trained  knowledge. I have six medical conditions, each contributing in some way towards the body wearing out. I can accept it, why can't the powers that rule this game acknowledge I perhaps want a choice not to be used as a further tool in the plan.   

While waiting for surgery for the condition they had found regarding the replacement hip being wobbly, I observed and interacted with the patients around me which was similar to what I had felt when I had been in rehabilitation after a knee reconstruction. Bewilderment that they were in this situation, and the question of " What is to become of me? How will I manage " was often spoken. Most knew (unspoken) that they were at the end of living and their expectations of care were now being questioned.

 Informed people are voting out of the idea of nursing homes, even though the buildings may be luxurious, with paintings and plastic flower arrangements, if you have some assets to pay for them. How much are developers adding to the fantasy as they place advertisements in the seniors magazines. Many people are choosing to stay within their own home with care provided by local councils if possible. But even this care is straining under funding costs.  

I did not have surgery (i.e. a new hip) as it was considered the risks of the operation out weighed the benefits. I am grateful for the honesty, and also for the understanding I observed of staff and patients while there. The staff throwing up their hands in bewilderment at the amount of money spent, the work load and beds being taken away from younger people waiting years for treatment.  I am not advocating people be neglected, but that there could be some realistic understanding of outcomes by the general public, instead of hysteria. Maybe future policy makers should have been required to have had some work experience within the real world. Perhaps you could do a costing on my 28 day stay for my educational experience, I was well looked after and the food had improved since my knee replacement 2years earlier. And I did not mind sharing a room with men patients, we even joked that this would not have been acceptable when we were in our teens. 

I was sent home with a special "Healthy at Home" pilot program, ( funded by DHS as part of the innovative projects strategy) which must be part of the changes in health care as put forward by Kate Carnell. CEO Australian Division of General Practice on the Press Club Luncheon program recently. 

Yes it is innovative, but in my case useless except that one day when I was ill they did arrange for a person to call at the house to take my blood test…..I had to ring the case manager first, then she rang the diagnostic centre, I was not to ring them!! They have shown me all sorts of gismos I could buy, hire, etc, and have made an application ( on the waiting list) for government money to provide me with the appliances I am at present hiring. 

But !! on one occasion when I was having a bad day when the leg locked, the case manager who by profession is a nurse was due to visit me, assessed the situation, brought me a glass of water and some Panamax from my bedroom, I continued to stand upright leaning on my gutter frame, while she entered notes into her laptop. I asked her could she carry my commode bucket (containing urine) into the bathroom so I could empty it, I was told, she was not allowed to do that. Is this also part of the Health $ employing people to drive around in cars earning a living, entering how many people on their list they have visited in a day. Granted there are some very sick people who may have to have dressings etc, and this does take pressure from Public Hospitals and GP's.   

I hope I am being a voice for the hundreds of people who are members of VE organisations who want also to see change when medical futility has been reached. They are not advocating killing, as is so often used by opponents, nor do they insist that others be denied their right to suffer if they want or need to, just for compassion as well as economic reasons.

 Why are people, who can afford it travelling to Switzerland for death with dignity, while others are contemplating some effective other way of making a final exit that will not affect others. 

I have a word for your last question on your posting. Why does it not happen?

Mumpsimus.

"A human tendency to follow tradition and blindly refuse to correct error" it is an old fashioned word, but we could do well to resurrect it and use it often.  

I would also like to read that other story.  

A reasonably informed citizen concerned for the future health system. 

Ps Thank heavens I have my computer and the internet.   JR

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 Under a document issued May 2002 the Stanford Encyclopedia of Philosophy tells us that the debate on the legality of Euthanasia is a second half of the twentieth century activity. That the Greek and Romans did not consider life needed to be preserved at any cost, and were as a result, tolerate of suicide in cases where no relief could be offered to the dying, or in the case of the Stoics and Epicureans, where a person no longer cared for his life. Thomas More envisaged a community that would facilitate the death of those whose lives had become burdensome as a result of “torturing and lingering pain”.

It is only in the last 100 years that there have been concerted efforts to make legal provision for voluntary euthanasia. It brings me back to the feeling that the Lawmakers and the Legal Profession weren’t making any business or money out of the issues so they had to ensure they were included in the Loop of Society’s decision making, even within families, even in something as personal and profound as Death. Is a politician, a policeman or a lawyer really “needed” when one wants to end their life of intolerable pain? Is there a place in that enormous time of decision making, for the bureaucrats? I mean to say it is very obvious when a person is suffering excruciating pain, not your bright eyed, cheerful face suddenly dying without reason. I am talking about the obviously ill, wasting, and dulled eyed and perhaps moaning and groaning. Isn’t a medical opinion, or three even, the only ones that really count? Of course, the doctor too doesn’t want to be losing cu stom unnecessarily so one could hope that they would have a vested interest in a consensus!!

Can we bring about “Choice” for those of us who believe I raise a valid point of view?

The Issue surely is that if it is lawful, to encroach on nature to the extent we now make babies in a test tube, we send soldiers to kill in countries that are no threat to ours (eg murder! according to my dictionary) that the medical profession provides technology for second life, replacement hearts and lungs (the very essence of life itself), A small part of society wants to tell us that it is illegal or immoral to end a suffering life.

Lets get our priorities right.

What is obscene to me is those in society (religious and lawmakers included) who rape small children either mentally or physically. That is the true obscenity and crime of our society. I too have been their “victim”!

I’ve talked elsewhere about making a Living Will or a Medical Enduring Power of Attorney (you don’t need a lawyer for this one). The details you require are on the website, www.VESV.org.au but currently in New South Wales and Victoria, they are not legally enforceable, although something is better than nothing. Refer also to the Medical Treatment Act 1988, which offers some protection to an ill person, unfortunately Medical Staff who choose to ignore it are yet to be held accountable.

Doing Nothing, ensures Nothing will happen!!

You and I can promote change, but we need the Politicians to understand that we do have a voice and want to be heard.

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2006-01-21 From: Telegraph.co.UK
Fury as euthanasia group puts dignity in new name
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/01/21/ndig21.xml&sSheet=/news/2006/01/21/ixhome.html


By Sarah Womack,
Social Affairs Correspondent
(Filed: 21/01/2006)

Plans by the Voluntary Euthanasia Society to rename itself Dignity in Dying came under bitter attack last night.

Critics said the phrase was used by terminally ill people seeking a better quality of life - not asking for euthanasia or assisted suicide.

The name change comes 71 years after the society was set up and follows research showing doctors are involved in as many as eight deaths a day from voluntary or "non-voluntary" euthanasia.

Representatives of the disabled, and experts in medical ethics and palliative care, strongly objected to the society using Dignity in Dying. In a letter to Alan Johnson, the Trade Secretary, they said the phrase was "used by patients worried about the care they will receive.

"These patients are not asking for euthanasia or assisted suicide; they are asking for good care."

The signatories said at least five charities caring for the disabled and terminally ill had dignity in their names.

"If the change takes place, whenever a lecture is given in future about improved care for the dying it will broadcast an inadvertent advertisement for the VES."

The letter was signed by John Wiles, the chairman of the Association of Palliative Medicine, Jane Campbell of Not Dead Yet UK, Tony Cole, the chairman of the Medical Ethics Alliance, Jared O'Mara of the British Council of Disabled People, and Rob George, a senior lecturer in bioethics and the philosophy of medicine.

The society, which was planning to announce its new name on Monday, said it had been received well by MPs and members of the Lords.

Deborah Annetts, the chief executive, said members had sent in about 200 suggestions for a name change, which a group of staff and members reduced to two: Choice in Dying and Dignity in Dying.

About 65 per cent of the public preferred Dignity in Dying, she said.

The VES dismissed the letter to Mr Johnson saying it was from a tiny cluster of people with pro-Roman Catholic views.

Mary's Comment:  I too disagree with the name change planned for the Victorian Branch of Australia,  Voluntary Euthanasia Society of Victoria,  for entirely different reasons.   I am proud to be associated with the words Voluntary Euthanasia as they are entirely without ambiguity and I may not necessarily want to be dignified when I die, just dead,  quickly.  "Dignified" reminds me of not requiring your bum to be wiped by another person, or not making "a scene by screaming" when one is in pain, either psychologically or physically, as you near death.   

Choice in dying, I feel would have been more appropriate to the Victorian Charter, if a change of name was really an issue to the majority of members.     Unlike the Christian religions who have not moved out of the Dark Ages in their opinion about Life and Death issues, the Voluntary Euthanasia Societies are moving with the times and bending over backwards to become more acceptable to main stream society. 

Unfortunately it is not mainstream society that has the need for voluntary euthanasia.  It is the terminal and hopelessly ill members our society that needs clear and straightforward help to die if that should be their choice.  The Church haven't moved enough and we've moved too far!......(I must always remember the Minister of Religion who sidled up to me at a meeting and told me he agreed and respected what I was trying to achieve.  It is always easy to forget that formalised bureaucracy does not always represent its members.  I also remember this when the Catholic Women's League Australia Inc, Bioethics Working Party claimed to represent 8000 women in a submission to the Public Senate Hearing into the Suicide Related Materials Bill.  Because she was voted into the position as the Convenor she automatically put her personal views as representative of the majority.)

The words, "Voluntary Euthanasia" has a ring of confidence about it.   A belief and pride in what it really does mean.    A Good Death! and it's Voluntary!