4th Quarter 1998 ISSN 0742-535
Zurich Declaration on Assisted Dying
18
societies at "positive" world conference
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We are medical professionals attending the 12th International Conference of the World Federation of Right to Die Societies being held in Zurich from 12 to 15 October 1998.
We believe that we have a major responsibility for ensuring that it becomes legally possible for all competent adults, suffering severe and enduring distress, to receive medical help to die, if this is their persistent, voluntary and rational request. We note that such medical assistance is already permitted in The Netherlands, Switzerland and Oregon, USA.
We are familiar with the different scenarios which occur at the end of life. We know that if we should find ourselves in such situations, many of us have the knowledge to achieve self-deliverance,and we wish to extend this privilege to our patients. At this most critical time we must never abandon our patients. Excellent palliative care should not exclude the right to choose assisted dying.
In the past decade, an increasing number of doctors and nurses in different countries have stated, publicly and courageously, that they have actively helped their suffering patients to die, even when it was illegal.
Now, we, as medical professionals, must state our support for assisted dying and our committment to such humane medical care. Therefore, we support the right of competent, adult patients, who are suffering severely, to seek our assistance, if this should be their enduring request.
We know that many medical professionals around the world share our views and we ask them to make similar declarations.
Signed by physicians and nurses attending the conference:
Anne Clees, M.D., Luxemburg
Henri Clees, M.D., Luxemburg
Jan Hoogendam, M.D., Netherlands
Richard MacDonald, M.D., USA
Wilhelmina Hoogendam-Lanting, M.D., Netherlands
Meinrad Schdr, M.D., Switzerland
Martine Cornelissen, psychologist, Netherlands
Eve Howett, R.N., U.K. Aycke Smook, M.D., Netherlands
Rosemary Dewick, R.N., Australia
Michael Irwin, M.D., U.K N.C. Webb, M.D., USA
Janny Feiertag-Veldman, R.N., Netherlands
Osamu Ishikawa, M.D., Japan
Peter Wright, M.B., U.K.
Alberto Gottlieb, M.D., Italy
Philip Nitschke, M.D., Australia
Corien Zwietnik, R.N., Netherlands
14 October 1998
I was honored to take over the position of President of the WF at the conference held in Zurich on 12th-15th October. I will endeavor to continue the fine work of those who have led the World Federation before me.
They have set the organization on a solid foundation on which your new Board and I must now build and prepare us to move forward into the third millenium. Into a world in which there has been a paradigm shift in attitudes towards the legalization of Living Wills, Assisted Suicide, and Voluntary Euthanasia (i.e. a lethal injection). Our goal is now in sight if we have the courage as a World Federation to support new, creative initiatives.
I returned from the conference full of certainty that the tide has turned in our favor worldwide. There are positive moves afoot everywhere even though it is a frustrating matter of two steps forward and one step back. I console myself with the knowledge that votes for women took eighty years at least and in the South Australian Parliament it took seven Bills before we became the first in the world to allow women to stand for Parliament and third to give the vote. The first VE Society was formed in UK in 1935 so our time has come.
It was interesting to be able to hear such encouraging reports from so many member societies. There were 18 societies represented from our membership of 25. Some delegates were fortunate to have a grant from their own society or through the great generosity of the Swiss Society which also hosted the conference However, such is the dedication of those who believe in our cause with a passion that many were paying their own way. Our new secretary, Libby Drake, who will now be working hard on our behalf, was one such person, The world movement must be grateful for such sacrifice and commitment.
There was an atmosphere of warmth and excitement at the conference, and the air was electric at times. How could we not feel assured when we are so bonded by our belief in the need to change the present cruel law worldwide? In the 5th Century, St Augustine said, "An unjust law is not a law." This century Archbishop Desmond Tutu said: "To disobey an unjust law is a moral imperative. Not to break an unjust law is to collaborate in that law."
His words so often haunt me and disturb my conscience when I hear the awful dying processes which our callers tell us they or their loved ones are enduring. Unfortunately we are not all given the courage of heroes, as the UK doctor David Moor and the Green Bottlers are now showing, as well as that shown by the deceased, brave Ramon San Pedro, Sue Rodriquez, Austin Bastable, and so many others. We must have to do the best we can and be proud of our efforts, great or small. Margaret Mead said, "Never doubt that change is brought about by a small group of people. Thus it has ever been."
So attending such-a conference does reaffirm that we are doing work which will eventually make civil disobedience unnecessary and take away the fear of a suffering end to our-lives, What peace of mind that will provide for humanity. We must none of us give up because nothing seems to be happening.
The change in the four years since the Bath conference is marvelous. As I listened to the positive excitement in Anne-Marie Dourlen-Rollier's voice, I rejoiced with our French society. I recalled so vividly Anne's support at Bath and the utter despair in her voice when she said, "We will never move forward because of the power of the church." And there she was, reporting on the very moves and changed attitudes, which she had so despaired of seeing.
The French experience of positive change is occurring in other places, and I hope your delegate will report on them. How I wish that all the societies would make a written report as requested because it is simply impossible to remember what the previous reports were as you list to your 18th! Some did as asked and we can all now enjoy rereading them at our leisure.
The thing which truly delighted and overwhelmed me was to receive an offer from NVVE to provide, at no cost to the WF, an equipped office and support staff for our hoped-for Development Officer. In addition to this generosity, NVVE is also making a substantial pledge of money towards the salary and expenses, which such a position will entail.
What this means for the WF is that our goal is actually in sight provided those societies, which have not made a pledge, will reconsider and do so. You will have received a letter from me giving more details of this appointment, and I do beg you all to see the need now to continues the moves internationally.
Each domino down makes it easier for the others to follow, so it is imperative to have a global vision as well as a local one. Please be part of, and share, our vision. I cannot imagine what other changes will have occurred by the year 2000 when we meet at the next conference, in the USA, but I am looking forward to it confident that they will be just as important. I hope I will see you there.
It became clear at the World Federation conference in Zurich that member societies would like more information about activities and progress in the other societies.
In response, I'll be gathering information from member societies and publishing it in future newsletters. We can all benefit from the lessons learnt by other societies and hopefully gain some ideas for our own situations.
The aim is to provide summary information so that you are informed of what other societies are doing. If you would like further information or to discuss issues and experiences further, then you can contact that society direct.
In a few months I'll send a brief questionnaire to all societies asking for updates on key activities. The types of information requested will include progress in law reform, political activities The aim is to provide summary information so that you are informed of what other societies are doing. If you would like further information or to discuss issues and experiences further, then you can contact that society direct.
If there is anything you would like to hear about from other societies, please let me know and I will try to include this in the questionnaire. I can be contacted by email at mikelib@bigpond.com, by Fax on 61 2 98025340 or by mail at 96 Lovell Rd, Eastwood, NSW, 2122, Australia.
For those already involved in the movement to have legalized physician aid in dying, or physician-assisted suicide, this is an excellent reference source, providing great detail of the history that has transpired over the past decades. For new students researching the issues in this ongoing debate the book will be invaluable.
The chronology of all the significant events shaping the progress of the "Right to Die" movement is laid out in interesting and readable fashion, dovetailing the emergence of legal acceptance of patient autonomy with the increasing voice of bioethicists discussing the philosophical issues attendant to that autonomy. The authors point out the necessity for education about end of life situations and medical care - for medical professionals, patients and the general public. Although I have been involved, since 1993, in educating both medical and lay persons about the issues swirling around the highly emotional subject of death with dignity, I learned here new historical and informative details.
Those who oppose PAS often decry and debase the Netherlands for thererational approach to dying that has evolved over a span of 25 years. Allaccounts emanating from that country, as well as many polls, have revealedever-increasing approval by Dutch citizens. Humphry and Clement havechronicled a factual record of that "experiment". This should be requiredreading for all who are involved in the continuing bioethical debate, but especially for those who denigrate the Netherlands approach and intentionally misinterpret and repeatedly distort the facts in order to advance their particular anti-euthanasia stance.
Similarly, the chapter dealing with the various approaches to assisteddeath and suicide in other countries will be enlightening to many,particularly those who may be unaware of the World Federation of Right to Die Societies. An insightful comparison between the Netherlands andAustralia is included, revealing that a higher percentage of decisions resulting in ending life occurred in Australia. This confirms that"secret" voluntary euthanasia is known to occur in the United States aswell as worldwide, but it is not openly discussed as it is in theNetherlands.
It may also surprise some readers that countries such as Japan and Switzerland have huge memberships in there "right-to-die" societies, much larger than in the United States groups. Both countrieshave legally decriminalized euthanasia, although assisted suicide is rarely overt in Japan.
\Religious attitudes are explored, revealing diverse opinions among the many different religions in the United States. Humphry and Clement give clear examples of what is, and what is not acceptable to religious leaders. They make a strong case supporting their contention that hypocrisy is readily discernible and that the political activity opposing PAS violates theconstitutional separation of church and state. Also clearly defined isthat religious, medical and political leaders all share the same arguments in opposing legalization of PAS.
The American Medical Association parrots the Catholic Church in this regard and elected representatives in state legislatures appear fearful of the well-financed and vocal religious right. As a result the right-to-die movement is forced to pursue ballot initiatives, since conservatives in ruling positions prevent any legislative proposals from leaving committees.
Three chapters are devoted to the initiative process and Oregon's Death with Dignity Law, giving great insight into the successful campaign for Measure 16. Emphasis is made about the involvement and leadership of young, accomplished and politically savvy professionals who assumed control after the measure was placed on the ballot. The book makes a case that grass roots movements in other states are unlikely to be successful unless they learn from the one state with legalized aid-in-dying.
A short chapter discusses the concern that many feel is important - costs of futile health care when there is no longer any chance of recovery. The implications to third party payers as well as to younger taxpayers as ouraged population continues to increase are explored. As the authorsconclude in the last sentence of this excellent historical review - "This is a social issue that is here to stay".
Richard MacDonald, M.D.
NOTE: This book can be purchased internationally from www.Amazon.com at a 30 percent discount with use of a Visa or MasterCard.