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Issue No. 28
ISSN 0742-535X
June 1996

From the Presidency
Voluntary Euthanasia: Securing the Choice
News From Around The World
Assisted Suicide Ruled Legal
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 last biennial meeting in September, 1994. Dr. Smook practices oncology and surgery.)

In this newsletter you will find information about our 11th biennial conference to be held in Melbourne, Australia in October. I hope that you will attend and that we will have representation from as many member societies as possible. This year's host -- The Voluntary Euthanasia Society of Victoria -- is extending itself to provide a compelling program.

Since our last meetings, nearly two years ago at Bath, England, our movement as come a long way. The Oregon initiative, the Northern Territories act permitting euthanasia, the American court decisions and the acquittals of Dr. Kevorkian in his Michigan trials, the recognition of living wills in Geneva and elsewhere, and the acquittals of doctors in Japan and Israel- all demonstrate that the world is coming to understand that terminal patients do have rights- human rights- to make their own decisions about this most personal right: to decide what they will about their own lives, their own bodies.

The American research, published recently, demonstrating that 75% of the populace believe a terminal patient has the right to make a decision to die, is mirrored in research in many other parts of the world. As a physician and scientist I believe that this shows that the desire not to suffer at the end of life is a human problem- not a Dutch one, or a Spanish one. Suffering knows no nationality.

I have been proud to head up this international group during the past two years. I look forward to meeting you in Melbourne. We will meet together in strength to advance our cause.

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Voluntary Euthanasia: Securing the Choice

11th Biennial Conference of the World Federation of Right-to-Die Societies


Basic Structure of the Conference:

Tuesday, October 15

2-5 PM Meeting of 1994-96 Board. Delegates Registration. Informal Dinner.

Wednesday, October 16

First delegates (business) meetings, followed by choice of workshops. Topics include counseling once assisted dying is made legal, psychiatric perspective on depression and voluntary euthanasia, and law reform (legislative, referendum or the courts) Evening: Dinner and a guest speaker.

Thursday, October 17

All day public forum with national and international speakers, including:

* Mr. Marshall Perron

Retired Chief Minister of the Australian Northern Territory (1988-95) who was responsible for the first legislation in the world to permit active voluntary euthanasia.

* Professor Peter Baume, AO

Professor of Community Medicine at the University of New South Wales, Chancellor of the Australian National University, a Commissioner of the Australian Law Reform Commission and Patron of the Voluntary Euthanasia Society of New South Wales. He was a Cabinet Minister between 1982 and 1983.

* Professor Dr. Meinrad Schar

President of the Swiss Association for Human Dying (EXIT), a WF member organization. He was Professor of Social and Preventative Medicine at the University of Zurich for more than 20 years and Vice-Director of the Swiss Office of Public Health.

* Dr. Michael Irwin

Chairman of VES, London, Dr. Irwin was medical director of the UN (1982-91) and UNICEF's representative in Bangladesh.

* Professor Dorothy Angell

Professor of Nursing and head of the Caroline Chisholm School of Nursing, Monash University, Melbourne.

* Dr. Roger Magnusson & Dr. Harry Ballis

Dr. Magnusson is a postdoctoral research fellow in the Faculty of Law at the University of Melbourne. Dr. Ballis is a lecturer in sociology at Monash University, Gippsland. They are currently undertaking research into AIDS sufferers and assisted dying.

* Dr. Faye Girsh

A clinical and forensic psychologist and founder/president of the Hemlock Society of San Diego, Dr. Girsh is a member of the American Psychological Association and has published articles in medical, legal and psychological journals on the right to die. She was recently appointed Executive-Director of Hemlock, USA in Denver.

* Mr. A.N.A. Josephus Jitta

Head of the Public Prosecution Office at one of the district courts in the Netherlands and a public prosecutor for over 25 years, Mr. Jitta is also a Board member of NVVE, the Dutch V.E. Society. He is also co-author o a recent bill to legalize voluntary euthanasia.

Friday, October 18

Second delegates (business) meeting, followed by a meeting of the new 1996/98 Board. At about 5 PM there will be drinks and a closing talk.


The Commitee has booked the Downtowner, a motel close to the center of the City. The rates vary according to the type of accommodation preferred. Illustrations of room layouts will be sent with registration materials.


Estimated full cost for a delegate sharing a room will be AU$400 plus accommodations and all meals except breakfast.

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News from Around the World

The Beijing Social Investigations Institute recently interviewed 3,105 people between the ages of 20 and 45 in Shanghai, Wuhan and Beijing, and found that 78 percent believe doctors should be allowed to help people to die if they want to. The investigation in April showed that 73 percent of those surveyed think that people should have the right to choose whether to live or die. Suicide is not considered a sin according to traditional Chinese or Taoist beliefs, but many Chinese, particularly those living in rural areas, believe that helping a person to die is taboo. Several legislators have suggested revising laws to allow terminally ill patients the right to die.

SOURCE: 'China Daily' reported in American Medical News, May 6, l996.


From our Member Societies

The Net and the Spanish Society

Our world is changing. I believe Alvin Toffler's claim that we are at the beginning of a third wave. The first wave started ten thousand years ago, with agriculture. The second wave was the industrial revolution, which began three hundred years ago. The third wave, the current one, is the age of information, and in particular, the age of the computer. But computers have become far more than just fast calculators. Now they are also tools of communication, and the age of the computer has become the age of the net. There is a whole universe out there, the cyber universe.

Little by little more and more people are becoming cyber citizens. They communicate with each other through e-mail, share discussions in newsgroups, and visit web sites throughout the world. Newspapers, radio stations and TV stations transmit information in one direction, from a few sources owned by a few people to the rest of the population. But in the cyberworld communication flows in all directions, from everybody to everybody, in a radically democratic way.

Those of us who work to conquer a new human right need to look at the future, and take advantage of what it offers us. Internet is a new and powerful forum for which we need to be prepared. We are used to taking our arguments and reasons to the media, conferences and debates, and now we also need to learn how to educate people through the cyberworld.

I am proud of having been present at the creation of one of the right to die societies of the world, the Spanish society D.M.D. (Derecho a Morir con Dignidad, Right to Die with Dignity). I was its president from 1984 through 1989, when I was forced to leave by other business in my life - since then I remain a normal member, and received the title of "Honorary President" which I appreciate. The D.M.D., now with its headquarters in Barcelona (the city that organized the Olympic Games of 1992), has made progressions that seemed almost utopian at its beginning. One of its most recent successes, a change in the Spanish Penal Code that considerably reduces the penalty for aiding a suicide of a terminally ill person. In spite of its low membership figures, the D.M.D. has performed an important "catalytic" action in the evolution of public opinion and legislation in Spain.

Now the D.M.D. faces the new challenge of reaching the cyberworld. It already has an e-mail address, admd@redestb.es, and is preparing itself to make a www page in a Spanish site. In the meantime some information is being displayed in its provisional www page: http://www.ma.utexas.edu/~mlerma/dmd/


In it there is information about its goals, its Living Will, some news, and a list of links to other right to die societies.

The right to die is part of one of the basic components of human freedom: the right of Self- Determination. Another basic right is freedom of speech, the right to communicate and receive information. The world wide computer network called Internet has given this freedom a new and wider meaning. We can use it as a tool in order to conquer other rights, and in particular this last right, the right to decide our destiny at the end of our lives.

Miguel A. Lerma (D.M.D.-Spain)

VES Auckland (NZ)

A recent news release states that approximately 75% of the population in NZ support appropriate changes in the law. This figure compares favorable with recent polls in the United States, Spain and other countries.

EXIT-(Geneva, Switzerland)

A letter from Jeanne Marchig, President of EXIT, advises that effective 28 March, 1996 the High Council of the Canton of Geneva (the parliamentary body) adopted a new legal article which recognizes living wills (called "anticipated directives") in that it enjoins health professionals to respect patients' wishes. EXIT launched petitions three years ago which resulted in this rule which is of benefit to terminal patients. Congratulations, colleagues of the Suisse Romande!


Margareta Hohenthal has submitted the following report: At the beginning of this year, we were still rather optimistic concerning our activities. The Slot Machine Organization, which distributes its profits to charities, institutions, etc. promoting public health had provisionally promised to give us financial support. This organization is accountable to the Ministry of Welfare and Health.

In March we heard from the Minister of Welfare and Health advising us that our case in not urgent. He cited organizations supporting the disabled, deaf, cancer, etc.

We have celebrated our third anniversary and we are proud of our achievements. Euthanasia is now being debated widely and a growing number of students are contacting us for information for their projects and dissertations. The legality of the living will has been discussed among doctors and they agree it is binding because we have a patient's rights law. They also think there appears to be no need for legalization of the living will.

A bill is scheduled for presentation to Parliament that would prevent nursing staff from being prosecuted if involved in the discontinued treatment of a terminally ill patient.

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Assisted Suicide Ruled Legal

By Mary D. Clement, Esq -- 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 operates Gentle Closure, Inc. an end-of-life consulting service in New York City.

Two United States Federal appeals courts ruled, within a month's time, that a mentally competent, terminally ill adult has a constitutional right to seek a doctor's assistance in hastening death. Stepping boldly into "a controversy that may touch more people more profoundly than any other issue the courts will face in the foreseeable future," the U.S. Ninth Circuit Court of Appeals in San Francisco on March 6th held that the Washington law that made physician assisted suicide a felony, is a denial of due process of law under the Fourteenth Amendment to the Federal Constitution. Then, less than a month later, the U.S. Second Circuit Court of Appeals in New York struck down a long-standing state ban on assisted suicide, holding that it violated the Equal Protection Clause of the U.S. Constitution, again found in the Fourteenth Amendment.

Elsewhere in the world the barrier had been broken but for Americans these decisions are a giant step towards humanity, compassion and death with dignity. Lawmakers in Australia's Northern Territory agreed last year to allow doctors to give lethal injections to terminally ill patients. The legislation will go into effect on July 1,1996. Until the Australian law passed, the Netherlands had the most liberal policy in the world on physician assisted suicide and euthanasia, even though both are still officially illegal. Doctors in that nation are guaranteed immunity from prosecution if they follow procedures and report cases to the authorities. In the United States, Oregon passed a law in 1994 allowing a physician to prescribe lethal medication for a mentally competent, terminally ill adult who wishes to hasten inevitable death but implementation has been halted by court challenges.

Similar decisions in the US were reached on different constitutional grounds. In the Ninth Circuit's decision, the majority, in essence, decided the issue on the grounds of removing the government from an intensely personal sphere. I will try to briefly explain this complex area of Law. The 14th Amendment to the United States Constitution says that no one may "be deprived of life, liberty or property without due process of law." The Supreme Court has found, over the years, that there are certain "protected liberty interests" on which the State may not infringe. A woman has a right to legalized abortion, as established in Roe v Wade and upheld in Planned Parenthood v. Casey. She has a "protected liberty interest" in her right to choose, a decision involving "the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy." In other word, it's none of the government's business and it is unconstitutional for the government to be involved in something as personal as whether to abort a fetus. The state cannot tell you how to live your life regarding this matter Also, the Supreme Court in Cruzan, found that "a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment," the right to refuse unwanted medical treatment being another "protected liberty interest."

Following the liberty interest line of reasoning, the Ninth Circuit Court found persuasive evidence that the Constitution encompasses a due process liberty interest in controlling the time and manner of one's death. After finding this "protected liberty interest" in the "right to die," the Court balanced this right against various state interests, such as the state's general interest in preserving life and the state's interest in protecting the integrity of the medical profession. In conclusion, the Ninth Circuit takes the decisions about assisted suicide out of the hands of the government, both state and federal, and puts them "where they rightly belong, in the hands of the people." In other words, the statute that prohibited assisted suicide is unconstitutional The state cannot forbid a terminally ill patient, under certain circumstances, to hasten death. "It is your choice", said the Court. "It is not a matter for the State to decide."

By contrast, the 19th Century New York statute forbidding assisted suicide violates the Equal Protection Clause of the 14th Amendment. According to the 14th Amendment, equal protection of the laws cannot be denied by any state to any person within its jurisdiction This constitutional guarantee simply requires that states treat in a similar manner all individuals who are similarly situated. The concept that a competent person may order the removal of life-support systems found Supreme Court approval in Cruzan. Therefore, the Court held, the current state statute violates the 14th Amendment by allowing some terminally ill, mentally competent patients to hasten their deaths by directing the removal of life-support systems, while prohibiting other terminally ill adults from seeking and taking lethal doses of drugs prescribed by a doctor. In view of the foregoing, said the Court, New York does not treat similarly situated individuals alike and the Constitution does not allow this. Finding, then, that the statute banning assisted suicide is not rationally related to any legitimate state interest (another constitutional analysis), the Second Circuit Court of Appeals found the statute unconstitutional. Similarly situated people must be treated similarly.

Though they differ in their reasoning, both Courts allow, in the states of their jurisdiction, a doctor to legally prescribe medication for a mentally competent, terminally ill adult who voluntarily wishes to hasten an inevitable death. The patient would then self-administer the lethal drugs, the result being a dignified and humane death. The terminally ill can now determine the time and manner of their death. They may now die in their own beds, at home, surrounded by their loved ones, an orderly and dignified death These rulings apply only to the terminally ill competent adult; that is, individuals who are at least 18 years of age, understand their conditions, diagnosis and prognosis and who, in all likelihood, will not live longer than 6 months.

To allay the fears of those who are unclear or anxious about the Courts' decisions, let me stress that this method of dying is completely voluntary. People need not fear that someone else will make a judgment about their pain and suffering or their quality of life. Those who are morally or religiously against this kind of death need not be touched by the decisions. They do not create an environment that will make anyone do anything. It is a matter of choice on the part of the physician and the patient. It opens up alternatives for those who want them. If one chooses to prolong the dying process, tethered to all that medical technology has to offer, that is also a choice. As the Ninth Circuit articulates, "Those who believe strongly that death must come without physician assistance are free to follow that creed, be they doctors or patients. They are not free, however, to force their views, their religious convictions, or their philosophies on all the other members of a democratic society, and to compel those whose values differ from theirs to die painful, protracted, and agonizing deaths."

These two decisions should make physician assisted suicide available to the people of almost one quarter of the States. The United States has 13 Federal Circuit Courts, which are a step below the Supreme Court. Each circuit court hears appeals from specified states. The Ninth Circuit's opinion is applicable in 9 western states, including California, Washington, Oregon, Arizona, Montana, Idaho, Nevada, Alaska, Hawaii- and the Territory of Guam. The Second Circuit's ruling applies to the people of New York, Connecticut and Vermont. This means that these other states' bans on assisted suicide are, by implication, unconstitutional. Unfortunately, at the beginning of June, 1996 assisted suicide is not operative in any of these twelve states. Although the Ninth Circuit Court took the unusual step of reviewing its own decision- which it let stand- Associate Justice Sandra Day O'Connor of the US Supreme Court put the decision on hold until the Supreme Court decides whether or not to review it. The Second Circuit three judge panel also granted a "stay" to allow time for New York to appeal to the U.S. Supreme Court. It will continue in effect until the Supreme Court decides whether to hear the case, and after that if it decides to do so. At this writing, the previous laws which made assisted suicide a criminal offense are in effect.

The New York Court has correctly invited states to make laws that will regulate the process of prescribing lethal medication for the terminally ill. The Court wrote that, "The State of New York may establish rules and procedures to assure that all choices are free of such pressures (psychological pressures)." Again, the Court said, "New York may define that stage of illness ("terminal illness") with greater particularity, require the opinion of more than one physician or impose any other obligation upon patients and physicians who collaborate on hastening death," The legislature would be wise to insist on many of the guidelines set in place by the Oregon Death With Dignity Act. These safeguards would include a waiting period between the request for drugs and the actual prescribing of said drugs, consultation with a second physician to determine that the patient is, in fact, terminally ill, and a mandatory psychiatric evaluation if depression is suspected.

Until now, the right-to-die debate has been primarily centered on two states: Oregon, where a right-to-die law has been blocked by a federal court judge, and Michigan, where state prosecutors failed for the third time to get a murder conviction against Dr. Jack Kevorkian. The decisions have had their effect on both Oregon and Dr. Kevorkian. Due to the legal changes in the western states, lawyers in Oregon recently moved to reinstate the Oregon law passed as Measure 16 in 1994. Proponents of the Oregon statute, including the state attorney general's office, are seeking to lift the earlier Federal District Court injunction issued by Chief Judge Michael Hogan, barring the implementation of Oregon's far-reaching law. In denying physician assisted suicide to the people of Oregon, the Ninth Circuit wrote, "Judge Hogan clearly erred."

Moreover, there is potential good news for Kevorkian. The doctor's medical license was suspended in California in 1994 amid the storm of controversy over his right-to-die crusade. Since the Ninth Circuit's decision is applicable to California, allowing for a physician to prescribe medication to the terminally ill, Geoffrey Feiger, Kevorkian's defense attorney, has vowed to renew his court fight in California to get Kevorkian's medical license reinstated.

Such reversal of West Coast or partial East Coast law will have little, If any, effect on future suits against Kevorkian. Michigan is not within the jurisdiction of either the Second or the Ninth Circuit Court of Appeals. Therefore, there is no binding precedent on Michigan law Consequently, the Michigan Supreme Court's ruling in 1994 that physician -assisted suicide violates fundamental law, still stands. The Michigan Supreme Court found that assisting in a suicide was always a "common law" crime. There is no indication that they have changed their mind.

Whether the U.S. Supreme Court decides to hear either of these cases remains an enigma. They are under no moral obligation to do so since there was agreement between the two Circuit Courts. Had there been split Circuit decisions, the Supreme Court would have been obligated to resolve the federal issue. It is likely that there will be review in the future. I suspect that agreeing to hear either case right now means it might be overturned. Otherwise, there would be no reason to review it. That is, they would probably replace the ban on assisted suicide. So, no news may be very good news.

Far from putting the right-to-die controversy to rest, these decisions have opened the door to controversial times ahead. Ninth Circuit acknowledged that religious and ethical convictions sharply divide Americans about assisted suicide on both moral and constitutional grounds. The reasoning of the Ninth Circuit invites further division. The majority found precedent in U.S. Supreme Court decisions upholding a woman's right to choose an abortion. The Constitution protects the right of an individual to choose to die, the Ninth Circuit reasoned, in the same way the Constitution allows an individual to choose to terminate her pregnancy. Because the abortion rulings are themselves as controversial as any of the 20th century, this connection will no doubt add heat to the debates over both abortion and the right to die.

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Book Reviews


By Derek Humphry

Lethal Dose -- A novel by Steven Snodgrass.

Published by Icam $22.95 US / $29.95 Can.

lSBN 0962463-1-7

Although this is fiction, 'Lethal Dose' is a chilling foretelling of what might happen when voluntary euthanasia is legalized and operating justifiably in a medical setting.

Religious zealots attack the medical staff of a hospital which is authorized and set up to help suffering patients to die after careful consultations and evaluations. Not content with murdering a couple of doctors and blowing up one's car, the extremist wing of the right to-life movement then bombs the hospital, killing an innocent person.

One of the zealots realizes that killing people is the very negation of their cause and rebels. Inside information then enables the harassed doctors to exact revenge in a primitive -- but perhaps understandable- manner.

The similarity to recent abortion clinic bombings and murders in America is strikingly obvious. Despite this, the author -- a young surgeon in Kentucky -- has come up with a fast-moving medical thriller set in a background of social and ethical problems. An unusual book. I enjoyed its 'feet to the fire' flavor and gutsy realism (albeit fictional) - We hope such events will not happen in real life, but they might.


Drug Use in Assisted Suicide and Euthanasia

Editors: Margaret P.Battin, PhD and Arthur G.Lipman, PharmD

Pharmaceutical Products Press, Binghamton, New York

Hardcover $29.95 US. ISBN 1-56024-814-9

Softcover $17.95 US ISBN 1-56O24-843-2

The publication of such a book by an academic publisher is a measure of how far the campaign for the right to choose to die has reached by 1996. It could be described as the health profession's own version of 'Final Exit' which of course was aimed at the patient.

Edited jointly by professors of philosophy and pharmacology, the 16 chapters by different experts range from surveys of the arguments for and against hastened death, through physician and nurses concerns, to the law, pain control and drug dosages --- all important information for those doctors and nurses coming fairly new to this complex subject.

For those already well briefed on the issue and its history, there are at least four important chapters which point to the future application of assisted suicide and euthanasia which I found useful. For instance, the role of pharmacists has been little explored, and the chapter by Kristine Marcus hints that they feel somewhat left out. The drafters of the Oregon Death With Dignity Act, she writes, "appear to have thought that pharmacists simply act as agents of physicians". She points out that her profession has deep concerns about which drugs should be prescribed, their efficiency, and whether the pharmacist might be legally liable if the assisted suicide fails.

In the chapter by two leaders of Compassion in Dying, of Seattle, they detail how the group helped nearly 50 dying people with their suicides at home. They describe the counseling, the comfort, care, and drug methods used in the final act.

The authors of this chapter point out that only about eight percent of patients who made serious inquiries about rational suicide actually met Compassion's criteria and were helped. Nevertheless, they say, others received reassurance and comfort knowing that the option existed.

Any physician considering actively helping a patient to die needs to read Dr.Gerrit K.Kimsma's lengthy chapter on how it is carried out in the Netherlands. He summarizes the failures and successes of different drug methods over many years and reports precisely on what toxic agents are used today.

As America moves toward legalizing physician-assisted suicide but banning euthanasia, Dr.Kimsma has one important warning in the book: "Experience has taught us (in the Netherlands) that there are many cases of assisted suicide in which the suicide fails. Physicians need to be aware of the necessity to intervene before the patients awaken."

Dutch doctors give a lethal injection if the drugs which have been taken orally do not work after 4-5 hours, but for American doctors that would be illegal. It is interesting to note that the Northern Territories state has- wisely in my view-legalized both assisted suicide and euthanasia.



Information Needed for Next WF Newsletter

The next WF newsletter will be issued in November-December, 1996, as soon as possible after the Melbourne Conference has ended.

Member Societies are asked to send their news and information by disk, if possible Disk format should be Microsoft Word or Wordperfect, Windows. Material can also be sent by e-mail to GallopL@earthlink.net.

A reminder card will be sent to member Societies in October.


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