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Issue No. 27
4th Quarter 1995

From the Presidency
News From Around The World

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(Dr. Aycke O.A. Smook of Bergen aan Zee, The Netherlands, was elected President of the World Federation of Right-to-Die Societies at the organization's biennial meeting in Bath, England in September. Dr. Smook practices oncology and surgery.)

In the year since the Bath conference our movement is in a state of flux. Some of our achievements were productive in several Countries or States; nevertheless, our opponents turned out to be still more powerful and were able to obstruct implementation of laws. For example, in Oregon the enacting of the law passed by voters in the election was challenged in the courts and remains in the courts at this writing; apparently the law enacted by the Northern Territories of Australia is also on hold. In South Australia the introduced bill has been rejected. In The Netherlands, the decisions about legalizing euthanasia have been postponed.

Notwithstanding these negatives, there has been some progress. Our movement is very much in evidence in many countries. It seems apparent that most people in most places believe in a basic human right to choice in regard to end-of-life decisions. Thus it could be said that we are on the way to a mature society.

In many cases, however, fear of dying obstructs adult discussion on the subject. "Because I am not prepared to admit to my own mortality, I contest your right to consider your own appears" to be the code by which many of our opponents live.

Next year will see our 11th biennial meeting in Melbourne in October, 1996. VES, Victoria is in charge. I do hope that each member Society will be able to send at least one representative to our meeting so that we can count on many participants in order to be able to exchange views on this subject that is so very dear to all of us.

We need to show the world that our objective is honest. The media will pay more attention if there is extensive participation and world-wide representation. There is abundant evidence that Euthanasia is a hot issue not only in Australia and The Netherlands but that it is supported by many individuals and organizations all over the world.

We not only have to convince our legislators, but also- and perhaps just- the medical establishment. It is the physician who has the key to the medicine che so. If you can help change the attitude of the medical association in your country, you will have helped our movement take a tremendous step forward.

Aid in dying has taken place through the centuries. In most cases, individual doctors have proven willing to discuss the subject with their patients. Medical treatment is becoming, more and more, a mutual responsibility of both patients and doctors. The physician's duty is to inform the patient about the ins and outs, the prognosis for the disease and its possible treatments. In the end, it is only the patient who must decide what has to be done.

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Around the World


A New Organization is Established in Africa

Final Exit-Zimbabwe is the name chosen for a new right-to-die society in Harare, the capital city of Zimbabwe. The founder is Jeanette Lamb, a university lecturer who has been getting help and encouragement in her quest from various WF member organizations. She visited England in the early summer and received counsel from John Oliver, Executive Secretary of VES and she has also been in correspondence with Derek Humphry, President of ERGO! and others in the movement. It is expected that John Oliver will visit Harare in the winter to work with Jeanette Lamb in getting the organization going. The address is: Final Exit-Zimbabwe, POB a 269, Avondale, Harare, Zimbabwe. The new organization is in need of contributions and counseling. Any member organization that can be helpful is invited to contact Jeanette Lamb.



Exitus/Margareta Hohenthal

The summer season has been quiet- only one person has applied for membership. That makes our current financial situation look bad. There is one organization though that might help us. The profits from the slot machines in Finland are used for promoting public health. If we can convince the slot machine organization that voluntary euthanasia and the spreading of information about the living will is consistent with promoting public health, then they might provide us with the money necessary for our activities.

They already support out planned poll about euthanasia and have almost promised to pay the cost of conducting it. A special Commitee from our society has been working on the poll questions. Members of the Commitee have contacted the authorities and have been told that we have to provide them with official facts about public attitudes before discussions about laws on euthanasia can begin. In smaller street polls, 70-80% of those interviewed have supported Self-Determination. If the poll proves favorable to our purposes, we shall have taken a large step. Nevertheless, we should be overly optimistic. As Oregon has proven, one person or group of persons can marshal the power to obstruct a law voted for by a majority of citizens.

Meanwhile, we have visited some other towns and cities arranging general meetings with philosophers, doctors, nurses, theologians and others. Our members live all over Finland, although most of them are from the capital. When our poll is published in Spring, 1996, there will be media coverage and debates which might be beneficial to increasing membership in our organization. Of course, we already write letters to newspapers and the Oregon and Australia laws dealing with end-of-life gave us an opportunity for public exposure. Nevertheless, the media in Finland has reported these events sparingly.



The Israeli Society for Dying with Dignity

Israel has kindly sent an English translation of key articles which appeared in the Society's publication. All are too long to reprint here, but, according to the Society, this has been sent to other WF members worldwide.

On another front, we have received the following intelligence on the Internet from Dani Rubin at Emek-Hayarden Regional College. He said that on October 23, Israeli newspapers reported that under certain restrictions. doctors can elect not to extend the life of a terminally ill patient.

Judge Rivlin noted that hospitals in Israel are required to utilize a panel of three doctors to decide whether a patient can be disconnected from life-support systems. He said that in spite of this position, there is still a legal problem. The law says that persons who participate in the death of a person shall be guilty of manslaughter. However, the judge's verdict is interpreted as meaning that in the future, there will be need of court decisions on this issue and that it will not longer view doctors who accede to demands of patients to die as having participated in a criminal act.

Ed. Note: The Directors of the World Federation wish to express to their Israeli colleagues their sincere regret and dismay at the assassination of Prime Minister Yitzhak Rabin.


United States

* ERGO! (Euthanasia Research & Guidance Organization)/Derek Humphry, President-

We are one of the smallest groups in the World Federation but our informational outreach to the general public worldwide is perhaps the largest. About 10,000 people every day use their computers and the Internet to look at its two web pages which are packed with information and news about the entire right to die subject.

More than twice as many people in October,1995, looked at DeathNET http://www.rights.org/~death than in the previous month -- an indication of the explosive growth of this form of communication. DeathNet is a joint effort of ERGO! and the Society for the Right to Die in Canada run by John Hofsess.

Every known right to die organization is listed in ERGO's other web page, the Euthanasia World Directory http://www.efn.org/ergo. It also contains vital links to sources of information about euthanasia and assisted suicide.

Most of the 30 million people in the world now on the Internet are young and the requests from students for help are enormous. But gradually more mature people are joining cyberspace. This is a wonderful means of communication for an international movement such as ours.

* New Hampshire Hemlock/ Luis A. Gallop, Chairman

For the first time in United States legislative history, a Death with Dignity bill will be considered by a full legislative session. HB 339, sponsored by state Rep. Robert Guest, was reported favorably by the Judiciary and Family Law Commitee on October 25 by a 12-7 majority. It will go before the full house in early 1996. A modification of the Oregon law passed by Oregon voters as Measure 16 in November, 1994, HB 339 has two important differences from the Oregon statute:(1) The wording refers to "terminally ill patients in a condition of severe, unrelenting suffering"(2). An amendment was proposed at the October 25 meeting which defined suffering as "a state of severe distress, sense of personal loss, lack of hope, loss of control and impaired quality of life."

* New World Federation Member

Compassion In Dying of Seattle, Washington, USA, has become the newest member of the World Federation of Right to Die Societies. Compassion was formed in April, 1993, as a nonprofit charitable organization providing information, counseling and emotional support to mentally competent, terminally ill adults who are deciding how life should come to an end. Compassion believes that terminally ill patients who seek to end their lives should not have to die alone because others fear prosecution if they are present. In the greater Seattle area, they are willing to be with the patient and family at the time of death, if this is requested.

Compassion is also involved in a major effort to overturn the laws on assisted suicide through their National Litigation Project. The lawsuits, Compassion in Dying et. al. v. Washiington State and Quill et. al. v. New York State are both in the appeals process. Oral arguments for the Washington State case were presented before a rare en banc review on October 26, an eleven judge panel of the 9th Circuit Court of Appeals in San Francisco. This was the largest judicial panel to date to hear a right-to-die case. A decision is expected soon on the New York case which was heard in the Second Circuit Court on September 1. One or both of these cases at some time may be reviewed by the United States Supreme Court. Compassion hopes that the decisions will uphold the right to choose a humane, hastened death as protected under the United States Constitution.




Voluntary Euthanasia Society (VES)/John Oliver/Executive Director

"Coat-hanger euthanasia is taking place under the most cruel and appalling conditions" said Russell Ogden, a Canadian social researcher who spoke at a seminar following the Annual General Meeting of VES on October 21. "Sometimes these assisted deaths are far worse than the disease they were intended to defeat", Ogden continued.

Ogden uncovered the "grim reality" of assisted death within the AIDS population in British Columbia. Canadian Lawyer Magazine said that these findings sent "shock waves through Canada's medical and legal communities.

Ogden's ground-breaking research showed that horrific circumstances and botched acts are common. He concluded that there is need for legal, regulated euthanasia not because coat-hangar euthanasia is taking place but because it shows what happens in a climate of prohibition.

Also on the seminar panel were Cleone Gardner, who witnessed a friend's suicide and Annie Lindsell, who has Motor Neurone Disease. Chief of the symposium was Rt. Rev. Alastair Haggart, former Bishop of Edinburgh and currently convenor of the Scottish Voluntary Euthanasia Society (VESS). Other speakers included Dr. Colin Brewer and a hospice doctor, Dr. David Oliver.



Dying with Dignity-Toronto/Marilynne Seguin, Director

First and foremost, Congratulations to Australia's Northern Territories' passage of the Right of the Terminally Ill Bill.

Here in Canada, momentous events have been occurring. A referendum on October 30 saw Quebec vote to remain with Canada. This is of particular importance to us as polls indicate the right to choose to die movement of Quebec has consistently demonstrated the highest acceptance for legalization of euthanasia in our country.

DWD has worked with Gallup Canada, Inc. to develop a new poll. The main question that has been asked for the previous 26 years was modified to read as follows: "When a person has an incurable disease that is immediately life-threatening and causes that person to experience great suffering, do you or do you not think that competent doctors should be allowed by law to end the patient's life through mercy-killing, if the patient has made a formal request in writing?".The national results of the poll completed in July and reported on August 7, 1995 were: Yes-75% No-17&, 8% undecided. The response in Quebec was Yes-86%, No-8% and 6% undecided.DWD also requested a second question be added to this same poll. The purpose was to attempt to determine the public's ability to empathize with those not necessarily terminally ill but suffering irremediable illness. It read as follows: "When a person has an incurable disease that is not immediately life- threatening but causes that person to experience great suffering, do you, or do you not think that competent doctors should be allowed to end the patient's life through mercy-killing, if the patient has made a formal request in writing?" The national response demonstrated significantly different results with only 57% in support, 32% voting no and 11% undecided.

We are convinced that a great deal of education is required to demonstrate to the public that compassion for those suffering form long term irreversible illness is deserving of equal consideration as the terminally ill. We are dissatisfied with the use of terms such as "mercy killing" in both polls. We shall continue to work with the Gallup organization to rectify this and other problems.

Of dramatic importance in Canada was the report of the Special Senate Commitee on Euthanasia and Assisted Suicide. The vote lost narrowly, 4-3 but we have been advised by reliable sources that the vote was intentionally close to ensure that parliament will be forced to answer positively to their promise of a free vote in the House. This will take place before the next national election in about two years time.

DWD has initiated as "Adopt-an-MP" program and the Social Action Commitee is working hard to provide educational and support material to every MP on a regular basis. As we are not allowed to lobby, our members write as individual citizens.

Also, Choice in Dying, Ottawa, DWD and a number of other similarly focused groups in Canada are combining their energy to coordinate efforts toward legal change.

Upon invitation of the Canadian Bar Association, Marilynne Seguin addressed the legal community at their annual General Meeting. I stressed the urgency of much needed change in our laws and the depth and breadth of the underground movement in assisted suicides.

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Deciding How We Die: The Use Limits of Advance Directives -- Roanoke, Virginia, September 15th, 1995 -- Report by Chris Docker, VESS

The Right to Die movement has, since its inception, been chiefly occupied with two issues: voluntary euthanasia and advance directives. These issues couldn't be more dissimilar: One is largely illegal, the other is seen as a way to protect one's legal rights for refusal of treatment. If the first is made possible, there is small doubt about the outcome: the patient will be able to apply for and receive euthanasia. But what of the second? Advance directives are seen as a means to an end - refusal of unwanted treatment and, from that refusal, hopefully a desired, peaceful death. But are advance directives effective in achieving the aim intended?

The keynote lecture of this conference provided fairly weighty evidence to indicate that advance directives alone fall far short of their objective. 9000 patients were studied over a period of ten years. In very few cases did the advance directive have any influence over decisions to withdraw or withhold life-prolonging treatment. The passage of the Patient Self-Determination Act half way through the study changed their effectiveness by barely one percent.

The study also found that the most important decisions to terminally ill patients rights were not necessarily medical ones. Patients were particularly concerned, for instance, to make decisions with which surviving near-ones would be able to live. Another important factor is that people do not want to "look stupid" at the end of life: they will follow patterns, therefore, that seem "acceptable". This becomes even more poignant in the light of another startling statistic: one in two patients die in severe pain in the last three days of life. So what of hospice care? Certainly, hospices can relieve more pain, but less than 10-20% of patients receive any sort of hospice care at the end of life. Hospices tend to benefit those in middle-class suburban settings and focus on particular diseases.

The current position of living wills might be compared to Don Quixote tilting at windmills. Without strenuous interventions to improve the situation, the right-to-die movement may have expended vast effort to establish something that basically doesn't work. Patients mention them in passing to their doctors who promptly forget about them. When-patients become ill they cease to "insist". So what interventions would make a difference? The study team attempted to bring patient, neafrones, doctor and health care staff up to the same level of awareness in specific case studies. The most effective of these attempts was when the nurse initiated interviews with all parties and corrected misunderstandings and poor communication. This, itself was many times more effective than any law.

The study was headed by Dr. Joanne Lynn and will be published next year in theJournal of the American Medical Association.

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(Mary D. Clement is a New York attorney who specializes In end of life policy and decision making. She is also the legal advisor for ERGO! and has recently established Gentle Closure, Inc. and end-of-life consulting service in New York City.)

I attended a conference this past summer in Boston entitled "Care Near the End of Life." and sponsored by the Harvard Medical School, Division of Medical Ethics. Dr. Ruth L. Fischbach, Assistant Professor of Social Medicine at the Harvard Medical School reported that 66% of all physicians interviewed in a particular study felt there was nothing wrong with overriding a patient's advance directive, even If the directive unambiguously stated the conditions for the withdrawal and withholding of medical treatment. I later read the results of another study which examined the views and experiences of physicians at a major Canadian teaching hospital regarding the use of advance directives in clinical care.

Here, 40% of the physicians questioned chose a level of care different from that requested in advance by patients who subsequently became incompetent. These physicians interviewed indicated that they would only follow a patient's advance directive if it was consistent with their own clinical judgment. They indicated that they wanted to reserve the right to make clinical judgments about treatment regardless of a patient's request.

Not only did these statistics command my attention- they also made me focus on the tension, dissension and disagreement that exists between physicians and their patients, between physicians and between the American Medical Association and individual state medical associations. While I was genuinely impressed with how the physician participants at the conference were wrestling with the issues surrounding end of life medical care, I also became aware of the divisions within the medical community. This polarization of professionals produces barriers to the full implementation of legally approved advanced directives. The divided response to the more controversial and illegal physician assisted suicide and euthanasia presently makes resolution appear insurmountable.

To refresh recollections, an advance directive is a general term that refers to any instruction or statement regarding future medical care. The advance directive is a relatively new device that facilitates an active role for the patient in future decisions about life-sustaining treatments. The goal of such directives is to specify in advance the types of medical procedures people would or would not want to undergo if they become mentally incompetent or otherwise unable to communicate their wishes. The two basic types of advance directives are:

1. Living Will: A legal document which allows a competent adult to state the kind of health care he or she wants and under what circumstances, in the event of incapacity; and

2. Durable Power of Attorney or Health Care Proxy: A legal document which allows a competent adult to appoint someone he or she trusts to decide about medical treatment, Including life-sustaining measures, in the event of decision-making incapacity.

Approximately 90% of the American public want advance directives. Both the young and the healthy express at least as much interest in planning as those older than 65 and those in fair to poor health. The population clearly seeks more control over both their future medical care and also the method, timing and place of their death. Yet these incredibly high figures of 66% and 40% show that physicians often do not allow patient control. How disheartening for a patient to fear that his or her doctor cannot be trusted in a matter of such importance. It appears that many doctors have no respect for patients' wishes. Ironically, maintaining trust in the medical profession is one of the four traditional reasons, cited in any number of court decisions, for restraining patient control over ending their life.

Tension exists in medical ethics between the principle of beneficence and that of patient autonomy. Although these days fewer physicians rule by fiat without much consideration for the patient's wishes, it is unmistakably apparent that medical paternalism still exists. Adult patients, however, are not children and a growing number do not want to be treated as such. A lingering paternalistic attitude on the part of many physicians is fostering distrust. If the treatment preferences of patients are to be honored, doctors may face the difficult prospect of relinquishing, at least in part, this central element of their professional role.

The issue of control over patient decision making was close to the surface in conference discussions both formal and informal. There was some talk about the need for physicians to be more compassionate and for them to not withdraw from the patient as death approaches. Dr. Edward M. Hundert, Associate Dean for Human Affairs and Associate Professor of Psychiatry at the Medical School, demonstrating his understanding of his co-workers, softly and with a smile on his face, quoted from A Separate Peace by John Knowles, "The part of the heart that wants to help is right next to the part of the heart that wants to control." During one of our small discussion groups, a New York physician curtly announced his annoyance with "runaway patient autonomy."

In attempting to explain how nurses are often caught between doctor and patient, a nurse and hospital ethicist from the Harvard Medical School, Christine Mitchell, R.N., told a horrifying tale. A diabetic woman whom a nurse had, with all good intentions, cajoled into the hospital with the promise that the doctor would not amputate her leg without her consent. The physician thought the amputation was the only way to save her life. The woman refused. The surgeon wanted no part of patient autonomy. Amputation was the "best" treatment. The woman was completely competent. Realizing that he was unable to change her mind, the surgeon brought in a psychiatrist to talk with the ill woman. The surgeon put enormous pressure on the psychiatrist to declare the woman incompetent, freeing the way for the doctor to assume the role of decision maker and to amputate her leg. As she was being wheeled oft to the operating room, perfectly competent and aware of her dilemma, she began crying hysterically, shouting at the nurse, "You tricked me. You lied." This distressing story is an extreme example of the discord that must be overcome in the physician/patient relationship, not to mention the physician/nurse relationship, which has deteriorated over the last forty to fifty years.

Health care has been transformed from a domestic, almost spiritual concern into an often impersonal secular undertaking, and the erosion of trust in our health care providers has been an inevitable result.

Moreover, health care professionals are often ill prepared to inform patients about advance directives, even though the public clearly wants to be educated. At a Veterans Affairs Medical Center in California 215 physicians, nurses, and social workers were surveyed about the California advance directive, the Durable Power of Attorney for Health Care. All of the social workers had heard of the directive, but 36% of physicians and nurses had never heard of it and an additional 20% had had no experience with one! Considering that 90% of the population wants a directive to better control their future health care, one can readily see that publics demand for information and expertise is not being met. Moreover, of those physicians who had heard of the directive, only 19% of them brought up the issue of a durable power of attorney with their patients before a crisis occurred. Only 16% of older patients in the hospital had been asked by their physician if they had filled out a directive. The most commonly cited reasons for failure to discuss directives with patients are lack of proper forms and pamphlets and a lack of knowledge about where to refer a patient. One can only wonder why the profession is not more knowledgeable, better educated and/or more enlightened.

If advance directives are to become an integral part of health care and if the public is to feel that its needs are being met, more than legislation and regulations will be needed. Professional education must include training to familiarize caregivers with the intent and potential benefits of advance directives, as well as instruction in the skills and procedures needed to discuss these forms with patients. The barriers to planning, as perceived by patients, could be substantially overcome by physicians.

Contrary to a common clinical perception that patients may not want to discuss their deaths, one of the obstacles to patient execution of directives most frequently cited by patients was their expectation that their physician should be the one initiating the discussion. Physicians are obviously not initiating the discussion, leaving more patients feeling uncared for. Surprisingly, the patient's own discomfort with the topic of death was mentioned very Infrequently as a reason for failing to sign a directive.

Finally, with regard to the often unsatisfactory alliance between physician and suicide should be legal, only 40% would actually assist a patient in dying. Contrast these numbers with a 1993 Harris Poll which showed that 70% of the U.S. population favors physician assisted suicide for terminal patients.

Researchers found that hematologists and cancer specialists were the strongest opponents of euthanasia and assisted suicide, while psychiatrists were the strongest proponents of the two practices. Moreover, female doctors were significantly more likely to support assisted suicide than male doctors, while both sexes had similar attitudes toward euthanasia.

The researchers concluded that "the polarized attitudes of physicians will make it difficult to formulate and implement laws and policies concerning assisted suicide and euthanasia."

Among the building blocks of disagreement between physician and patient and physician and physician, there lies growing conflict between state medical associations and the national medical association over the issue of hastening death. In an April 1994 editorial in its official newspaper, the American Medical Association reiterated its firm opposition to physician assisted suicide. In the editorial headed "No To Physician Assisted Suicide," the American Medical Association reaffirmed its 1993 declaration that assistance in a suicide is "fundamentally inconsistent with the physician's professional role." The editorial says it is "illogical" to argue that the practice is "a natural extension" of a physician's task. "Assisted suicide is not about healing. Nor is intentionally causing death an ethical approach to helping a patient in pain." The editorial urges doctors to improve pain control and other ways in which "medicine helps patients live as best they can until the end."

In American Medical News (February 14,1994), the newspaper of the American Medical Association, AMA board Chair Lonnie R Bristow, M.D., said, "The House of Medicine has spoken very clearly on the matter and has stated that to prescribe a medicine and to knowingly inform a patient of the lethal dosage so that a patient can in effect plan their own suicide is unethical behavior. And even if a state passes a law making it legal, it won't make it ethical." Needless to say, it was no surprise when the American Medical Association came out strongly against Measure 16, the 1994 Oregon initiative that, if approved by a majority of the voters (which itwas), would allow a physician to prescribe a lethal dose of medication to a terminally ill patient, which the patient would then self administer.

It would be too strong to say that state medical associations are required to accept the position of the national AMA, but it is generally expected that " the company line is going to be similar between the national and state organizations," said an Oregon surgeon. There was to be no united party line on Measure 16, however, as two state medical associations disagreed with the powerful American Medical Association. The slippage from the strong hand of the AMA goes back to April, 1994, when the Oregon Medical Association's House of Delegates did not reaffirm the AMA's opposition to physician participation in the ending of a patient's life. The House of Delegates Is the policy making body of the AMA. Resolutions were brought forward for debate In anticipation of Measure 16.

After a long debate the doctors could not reach a consensus on the issue. Therefore, the organization's formal conclusion was to adopt a neutral stance and to allow the people of Oregon to decide on Measure 16. The Oregon Medical Association's action, or more precisely lack of action, raises the question of whether the AMA continues to reign on ethical issues.

Shortly thereafter, the Michigan State Medical Society debated the issue, propelled largely by Dr. Kevorkian's placing the state in the limelight of this controversy. Despite the AMA's efforts to get the MSMS to take a firm position against physician assisted death, the Society voted, for the second year in a row, to maintain its neutral stance. Before taking this independent position, the group had opposed all forms of euthanasia, in line with AMA policy. The national organization had lost its grip on a second state.

In a statement that would include the Michigan State Medical Society as well, the current AMA president remarked, "It doesn't make either the AMA or the MSMA comfortable to be disagreeing with each other It's sort of unprecedented."

In the realm of end of life medical care and decisions, conflicting viewpoints are rampant. Emotions are running high. Several studies show that physicians are rarely "undecided" in their opinions about hastening death. As medical technology advances and patient longevity increases, patients express a greater desire to exert more control over decisions concerning how, when and where they will die. Stronger and more decisive positions are being taken as more information becomes available and as people have more time the think about the issues. Add the impact of religion along with personal values and life experience, and it is no surprise that unanimity is not a part of the increasingly complex picture.

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Ethics in Medicine -- Jean Davies at the 6th International Congress in New York- October 24, 1995

(Jean Davies is a founder and former President of the World Federation. She is the newly-elected President of the European Federation of Right to Die Societies and a Director of VES. She lives in Oxford, England.)

Held at The New York Academy of Medicine, this conference followed by two days the VES Conference at the Royal Society of Medicine, Wimpole Street, London and there was an interesting overlap of theme.

Loss of control of one's life and infringement of one's personal dignity are two of the things that matter most to people- part of the opening lecture given by Jonathan Mann, Professor of Health and Human Rights at Harvard. His talk focused on the poor, the unemployed and AIDS sufferers (he is also Director of the International AIDS center), those the French call "les exclus". In discussion from the floor following his address I suggested that fear of an undignified death, in circumstances outside our control, was what had led to the growth of the voluntary euthanasia movement, He accepted the implication that towards the end we all run the risk of joining the ranks of les exclus.

In New York there were two and a half days of lectures followed by discussion periods. The topics included the ethics of clinical trials, problems relating to genetics and the difficulties of distributing health resources equitably. The final half-day was concerned with death and dying, one session on "Assisted Suicide" and the other called "Patient Autonomy, Medical Futility and the Ethics of Medicine".

These Conferences are for doctors though increasing numbers of nurses attend them. When I first started attending them, identifying myself as speaking on behalf of the World Federation, I half expected to be shunned at coffee and lunch breaks. Yet some of the most eminent attendees express their complete agreement with our basic ideas. Many speak of having helped patients to die, and of knowing that the vast majority of their doctor friends have also done this. One, who happened to be arguing strongly against legalizing voluntary euthanasia, said that she and her husband - also a doctor- and their closest doctor friends- had agreed to help each other if the occasion arose! The thought that this was extremely selfish seemed not to have occurred to her.

In the final session my contribution to discussion was to ask the speakers - mainly doctors, some lawyers and some religious spokesmen - to try to see the problem from the point of view of the dying patient because one day they too would die. This plea earned applause from the audience. There is no doubt that we are making progress in getting the medical profession better informed about and less hostile to our movement.

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