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Issue No. 30
ISSN 0742-535X

August 1997

Medical examiner says hotel death a homicide
Assisted Suicide Guidelines
Measure's Language Heads For High Court
Put My Cancer Son's Hired Killers in Jail
"Death" Doctor Arrested
South Australia's Vol. Euthanasia Bill
Testing Committees Encounter Practical and Principle Problems
Doctor Acquitted
Colombian Congress to Rule on Euthanasia

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Medical examiner says hotel death a homicide

August 15, 1997

Karen Shoffstall died from a poisonous injection likely administered by somebody else, a medical examiner said Thursday, one day after Dr. Jack Kevorkian's lawyer said his client helped the multiple sclerosis patient commit suicide at a Farmington Hills hotel.

Oakland County Medical Examiner Dr. Ljubisa Dragovic said Shoffstall, 34, of Long Beach, N.Y., suffered from a neurological condition that was "likely multiple sclerosis." But Dragovic said further tests were needed to confirm the diagnosis and the substance used to end her life. He ruled the death a homicide. Meanwhile, New York relatives of Shoffstall were to meet Wednesday with Farmington Hills police, Cmdr. Chuck Nebus said.

Lawyer Geoffrey Fieger told detectives Wednesday that Kevorkian and Janet Good were present when Shoffstall died at the Holiday Inn on 10 Mile.

Nebus said investigators will likely decide in the next few days whether to ask prosecutors for an arrest warrant. But that probably won't happen if relatives refuse to cooperate with police, he said.

Kevorkian, 69, has acknowledged his presence at the deaths of 56 people since 1990, although Fieger has said Kevorkian has helped hundreds commit suicide.

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Assisted Suicide Guidelines

The guidelines issued by a doctors' group in Salem, Oregon, for the practice of physician-assisted suicide as and when it becomes law in that state are as follows:


1. Review the checklist to be sure all the entries are completed and that consents and consultations are within the appropriate time limits.

2. The prescription should not be written until the day the patient plans to take it. Once written, the prescription should be promptly filled. Two specific statements should be written on the prescription. Firstly, writing "If not filled on this date, this prescription is invalid" reduces the chance that the drugs could be taken without a physician present. Secondly, writing "This is a Chapter 3, Oregon Laws of 1995 prescription," alerts the pharmacist to the purpose of the prescription so she may decline to fill the prescription and/or will not ask a lot of unnecessary questions about the prescription.

3. Ideally, the prescription should be dispensed to the attending oranother physician.

4. Before handing the drugs to the patient, the physician should check one final time to be sure that the patient still is competent and wants to proceed. The doctor or nurse may assist in preparing the drugs, and may assist in bringing the drugs to the patient's mouth, but the act of ingestion by the patient must be voluntary.

5. If the patient develops distressing symptoms during or after taking the drugs, the physician may, and should, use good medical judgment to relieve those symptoms. This might include administration of antiemetics, antianxiety agents, oxygen and/or antiseizure medications. These drugs may be given by injection as appropriate. The dose and method of administration must be consistent with an attempt to control symptoms rather than an attempt to hasten death. Intravenous medications such as narcotics that have been used for control of symptoms may be continued and even increased during the suicide process, but the doses must be consistent with an attempt to control symptoms rather than to hasten death.

6. During the early years of assisted suicide, physicians must be present to observe the effects of our treatments if we hope to improve them. For several reasons, the physician should remain near the patient at least until unconsciousness occurs. Once the patient is unconscious, the physician should leave only if another physician or an RN remains. The physician and nurse should be prepared to provide interventions to relieve uncomfortable symptoms.

7. If at any time in the suicide process the patient changes his mind, every reasonable effort should be made to recover him, but any existing DNR (do not resuscitate) request should be honored.

8. Should the attempt at suicide fail, the patient should be allowed to recover naturally from the effects of the drugs. If once the patient regains consciousness he still requests assisted suicide, another attempt can be made if he consents and consultations remain timely.

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Measure's Language Heads For High Court

The Oregon Supreme Court will be asked to decide the wording of a ballot measure to overturn the state's l994 assisted suicide law, opposing sides of the issue said.

The announcement came after state Attorney General Hardy Myers issued a proposed ballot title for Measure 51, which will appear on this November's ballot.

Supporters and opponents of physician-assisted suicide called Myers' title inadequate, and said they would ask the state's highest court to draft the language that will appear on this fall's ballot.

The wording of the ballot title is important to both sides, since studies have shown that some voters make up their minds based on the ballot titles alone.

The fight over the details of the ballot title also reflects what both sides see as a divided public on the question of allowing doctors to prescribe life-ending drugs to terminally ill patients who request it.

The l994 assisted suicide law, known as Measure 16, passed with 51 percent of the vote. The law has been blocked from going into effect by various legal challenges since then. The Oregon Legislature has sent it back to the voters for a second opinion.

SOURCE: Associated Press report in the Eugene Register-Guard, August 12, l997, page 2c

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Put My Cancer Son's Hired Killers in Jail

The mother of a cancer victim who arranged his own murder yesterday called for his killers to be brought to justice.

Jeremy Debonnaire, 45, could not bear the pain any longer but feared that if he committed suicide his family would not receive money from his insurance policies.

Instead he paid hit- men |2,000 to shoot him in the head and make it look like a bungled burglary. At first detectives believed he had been randomly killed but within days discovered that Mr Debonnaire had hired his own executioners.

Two men, aged 35 and 26, were arrested and charged with his murder but the case was dropped by the Crown Prosecution Service because of lack of evidence.

Yesterday, however, detectives told The Express they were continuing to treat Mr Debonnaire's death as murder.

They were backed by his widowed mother, Muriel, 74, who said: "Jeremy was terminally ill and would ring me at night howling with pain but that does not make his life any more worthless." Mr Debonnaire had discharged himself from hospital to return to his |60,00 pound bungalow in Maidstone, Kent, shortly before his death last October. He lived on his own. The former glazier had suffered from asbestosis, developed after working as a brake fitter. Eventually he contracted lung cancer.

An Inquest last week recorded a verdict of unlawful killing after hearing evidence that Mr. Debonnaire had left |2,000pound in cash with a close friend.

He had been instructed to pay the killers after the death.

Detective Chief Inspector Alan Gimes of Kent Police said: "Our investigation will continue. Whatever the circumstances, if a man's life has been taken by someone else then it is murder."

Mrs. Debonnaire, of Poole, Dorset, said: "No one should have helped My son to kill himself in that gruesome way. I want to see someone pay."

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"Death" Doctor Arrested

A DOCTOR who claimed to have assisted dozens of ailing patients to die was arrested by police investigating the death of an elderly cancer victim.

David Moor, a GP in Newcastle upon Tyne, was arrested after arriving at the district police station yesterday morning as arranged. He was questioned over the death of George Liddell, 85, a former ambulance driver who died on July 19.

He was interviewed for about seven hours before being released on police bail.

Mr Liddell was to have been cremated last Thursday, but the funeral was halted by Leonard Coyle, the Newcastle Coroner, after he discovered that Dr Moor, 50, had treated the man. A second post-mortem examination will be carried out.

After the funeral was postponed Dr Moor insisted that he had administered only pain relief to Mr Liddell.

- The Times (London), July 31 1997

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South Australia's Vol. Euthanasia Bill

Anne Levy introduced the Voluntary Euthanasia Bill into the Legislative Council (SA's Upper House) on 8 November 1996. A vote on the future of the Bill was taken on 9 July 97. It was decided by 13 votes to 8 to continue considering the Bill and by 18 to 3 to refer the Bill to a Select Committee. In addition, it was proposed that the Bill should be amended to require a referendum to be held before becoming law in the event that it is eventually passed by both Upper and Lower Houses.

Submissions to the Select Committee from the public will be invited early in August. The Select Committee process may well take around 6 months and a State Election is likely to be called within this period. It thus seems certain that the Bill will lapse before it is again put to the vote. It will then be up to the new Parliament to decide what further action, if any, will be taken.

The essential features of the Bill are:

1. Persons requesting euthanasia must be hopelessly ill, i.e. they must have an injury or illness that either results in permanent deprivation of consciousness or irreversibly impairs their quality of life so that it becomes intolerable to them.

2. The request must be made by a person of sound mind. It can be either a Current Request, which takes effect without further deterioration in the person's condition or an Advance Request, which takes effect in the event that the person becomes hopelessly ill. A Current Request over-rides an Advance Request.

3. The person has the option of appointing a Trustee(s) to ensure as far as practicable that the stated wishes are carried out.

4. Only a doctor can administer euthanasia and a second and independent doctor must confirm the condition.

5. Both doctors must be satisfied that the patient is not suffering from a treatable clinical depression. (A psychiatric assessment is not otherwise required.)

6. 48 hours must elapse between the request and the administration of euthanasia.

7. Any doctor, health care worker, hospital, hospice, nursing home or the like can decline to take part in the practice of euthanasia.

8. Life insurance policies will not be affected.

9. The Coroner and Parliament must be informed of each death.

Issued 1 August 1997

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Testing Committees Encounter Practical and Principle Problems

By Hans van Dam

Before long, (the Dutch) parliament will have to make a decision whether or not the cabinet proposal to have the reporting of euthanasia evaluated by regional testing committees, consisting of a physician, a lawyer and an ethicist, will be passed.

It all revolves around one question: does this regulation really contribute to the practice of euthanasia?

A person who asks for euthanasia asks for something which is illegal, and the doctor who performs it does something which is illegal.

Testing committees will not change that. In practice, two thirds of all requests are not reported, primarily out of fear of prosecution. 60 percent of all granted requests are not reported, mainly because doctors refuse to earmark euthanasia as illegal.

Patients for whom life has become an irreversible disaster dare not ask for euthanasia for fear the doctor will get into legal problems.

This means that these patients have to continue living in, for them, unacceptable circumstances or have to try to commit suicide.

The issue of euthanasia remains unclear. This is unacceptable for at least three reasons: the population broadly supports euthanasia; there are no indications that the euthanasia practices are ethically below standard; and the desired monitoring of decision-making and execution of euthanasia is impossible.

Drawback of testing committees

The first drawback is both physical and pscyhological. Five regional committees must examine all 3,200 cases of euthanasia, or 640 reported cases per committee per year. How can a committee of three cope with this physically as well a psychologically?

Secondly, there is the administrative drawback. The testing committees are the link between the doctor and the justice department. This means an increase in bureaucratic paperwork.

Thirdly, there are formal and procedural problems. As long as euthanasia remains illegal, only the public prosecutor can release the body for burial or cremation. An autopsy, should that be necessary, must be performed without hours after death, so the prosecutor must be notified of the unnatural death, before the committee can be informed. In short, the committees only have an advisory voice. This means that the expectation that the committees will create a distance between the doctor and the justice department becomes moot.

The fact that euthanasia remains illegal has created a legal monstrum: the legislator regulates how the law can be broken by following the criteria for carefulness. Another inconsistency is that the culprit, the doctor, has to incriminate himself by reporting his illegal deed.


Installing testing committees has practical and fundamental drawbacks. The government obstructs the increase in openness and carefulness. These will be in reach if euthanasia is recognized as a normal way of dying and not as an unnatural death. The person who asks for help in dying asks for something out of the ordinary but not for something abnormal or criminal.

The broad societal acceptance and the quality of medical care with respect to euthanasia are reasons not to delay appropriate legislation.

It all evolves around the question whether or not wanting to die is a criminal offence or not. If it is not-and I believe that there is a right but the not the compulsion to live- then giving assistance to a person who wants to die is not either.

FROM "Relevant" Vol. 23, nr.3, July, l997, issued by Nederlandse Vereniging voor Vrijwillige Euthanasie, Amsterdam. Translation supplied by NVVE.

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Doctor Acquitted

SEBRING, Fla. (Reuters) - A Florida jury acquitted a Colombian-born doctor Pinzon who had been accused of killing a terminally ill patient with an overdose of pain medicine.

After five hours of deliberation, the jury found Ernesto Pinzon not guilty of first-degree murder. The family and friends of Pinzon erupted in joy when the verdict was announced.

It was the first time in Florida a physician had been charged with first-degree murder in the care of a patient.

Pinzon could have faced imprisonment for life if convicted of first-degree murder. The jury also considered lesser charges of second-degree murder and manslaughter.

In his closing argument, prosecutor John Aguero told jurors: "Nobody but God can figure out when you're going to die. Nobody but God has a right to take you."

Gurrieri died surrounded by grieving relatives who had asked Pinzon to ease his suffering by injecting enough pain-killers to put him in a coma.

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Colombian Congress to Rule on Euthanasia

Colombia's Congress will be asked to set the terms under which euthanasia, legalized by the Constitutional Court in a landmark ruling last week, can be carried out, a court member said. "At this time it has become more necessary than ever ... to legislate with respect to the problem of dignified death," said court magistrate Carlos Gaviria, a leading proponent of euthanasia. He said lawmakers -- and not the court -- should decide exactly how doctors proceed in cases involving terminally-ill patients who ask to die.

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