WORLD RIGHT-TO-DIE NEWSLETTER

Assisted suicide campaign ends in defeat
Health-Care Professionals Attending The Biennial Conference On Assisted Dying In Boston Approved The Following Declaration
Energetic Boston Conference a landmark event
'Right-to-Die' News
Look to the courts for PAS progress
The euthanasia movement needs broader appeal
A long struggle ahead
Dutch Euthanasia 'Not Exportable'

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Assisted suicide campaign ends in defeat

The loss can hardly be blamed on lack of money. The No campaign spent $957,474 and the Yes side $1.6 million, according to official data. Both sides poured most of their funds into television advertising.

Four US states have turned down physician-assisted laws in the last ten years - Washington, California, Michigan, and now Maine. Oregon remains the only state where a citizens' initiative vote was successful; the law there has been in operation for three years.

In the Netherlands, voluntary euthanasia and physician-assisted suicide are permitted - and soon to be legalized - while in Switzerland assisted suicide for altruistic reasons is within the law and often practiced. All places with legal assisted dying enforce a 'residents only' rule.

Stephen Jamison has been appointed the first executive director of the World Federation of Right to Die Societies. He lives in California and has a PhD in psychology.

We are health-care professionals attending the Biennial Conference of the World Federation of Right to Die Societies being held in Boston from 1 - 3 September 2000. We support the right of competent adults who are suffering severe and enduring distress from terminal illnesses to seek medical assistance to hasten dying if this is their voluntary, rational and persistent request, after other relevant options offered by palliative medicine have been fully explored. On this occasion, we wish to draw public attention to the practice of "terminal sedation" or "slow euthanasia" which is performed extensively today throughout the world in hospitals, nursing homes, hospices and in private homes. This is carried out under the doctrine known as "double effect", by which a physician may lawfully administer increasing dosages of regular analgesic and sedative drugs that can hasten someone's death as long as the declared intention is to ease pain and suffering. Of course, the key word is 'intention'. Compassionate physicians, without publicly declaring the true intention of their actions, often speed up the dying process in this way.

Many thousands of terminally ill patients are so helped globally every year. We feel that the only real difference between 'terminal sedation' and a rapidly effective lethal dose is one of time - a slow death, over a few days, with life-shortening palliative drugs, versus a more dignified and peaceful death, because it is not prolonged, and is determined by the patient. We urge other medical professionals worldwide to be more open about this form of physician-assisted dying.

By Richard MacDonald MD, President

When Mary Gallnor, as President of the World Federation of Right to Die Societies, greeted those in attendance at the first session of the World Conference on Assisted dying in Boston, Massachusetts, the audience heard a message that indicated caring about those with difficult end of life situations and a passion about the goals of the organizations seeking more choice when facing the dying process.

This was a large gathering, with more than 500 registered for the three-day meeting that included many with long experience in the issues. It was evident from the start that there was an energy in the atmosphere so that the presence of protestors outside the Boston Plaza Hotel could in no way deter those wishing to hear from an incredible array of speakers from many parts of the world. Indeed, if any complaints were heard, it was mostly that not enough time was available to attend the many presentations, the films, the delegate and board meetings and still have the opportunity to converse in small groups with friends and acquaintances from the many societies represented at this world class conference.

The hosts, The Hemlock Society USA, led by Chairman Arthur Metcalfe and President Faye Girsh, extended themselves to organize a complete package that presented the status of the right to die movement around the globe. As usual there were many of the host society present, but an excellent number from other World Federation Societies attended as evidenced at the delegates meetings, where reports of the past two years activities were received and officers of the organization presented information regarding the status of the World Federation and plans for the future.

One highlight of the conference was the presentation of the George Saba Award to Derek Humphry, a past president of the World Federation and Founder of the Hemlock Society. Derek continues to devote his life to this issue that we all find so important and his research organization, ERGO, has significantly developed, with others, means to have a peaceful dying process when there is no legalized option available. He also continues to serve the World Federation as Newsletter Editor. For those interested in hearing and or seeing much of what was presented in Boston, video and voice tapes are available from Hemlock's office in Denver. As to our Federation business meetings, I will touch on the matters that were discussed. Most significant between our biennial meetings was the progress made in raising funds to establish the first paid position in this organization.

The "dream" that Mary Gallnor had talked about at the Zurich conference came to reality, with many hours invested in seeking suitable applicants and interviewing and finally choosing Stephen Jamison to become the first Development Officer. The expertise of the Board Secretary, Libby Drake, was crucial to helping Mary accomplish this task, and all the Board members contributed opinions and support throughout the process. Now it will take continued support of all World Federation member societies to fund this important post. The excellent work displayed by Stephen is already evident on the new World Federation web site, which he has designed and initiated. www.worldrtd.org

In light of the manner in which we wish Stephen to work, with contacts to other global organizations and applications for grants from foundations who will support our goals, the Board has decided that this position requires a title more in keeping with other not for profit groups. Therefore we have named Stephen to be our first Executive Director.

Another major accomplishment in the past year has been incorporating the World Federation as was first agreed at the Zurich conference. With the expert assistance of a prior President, attorney Sidney Rosoff, we are now registered in the State of New York which will facilitate us in seeking financial support from foundations and other sources to help us in our efforts to educate others about the need to offer more options to those with hopeless or terminal illness. The current Board hopes to build on the advances initiated during Mary's tenure and to develop more contact with other organizations on a global basis, such as the International Humanist and Ethical Union, whose Executive Director, Babu Gogineni, spoke in Boston to the Delegates meeting.

Your Board had already decided to initiate efforts to make the World Federation a more visible entity, by being represented at the International Conference on Ethics Education in Medical Schools in Israel in February, 2000, when Olli Pentilla, our Treasurer and I, as Vice-President then, attended. I was accorded the privilege of making a presentation about the Ethics of including assisted dying as an option for those near the end of life.

With the advent of the e-mail age, it has been incumbent on the Board to have the vast majority of communications via that medium, which has the effect of making for far more contact than in the past years, thus placing more requirements on the Board members and it has also reduced the costs of communication, compared with mail or fax expenses, once the equipment is available to all Board members, with most of us owning our own computers.

As a final note I would like to recall what Jacques Pohier stated as the conference opened in Boston when he asked us to pay our respects to those who have died, many who made significant impact on the progress towards the goals that we all seek. Those of us who are working intimately with members of our societies who are planning hastened dying events learn so much from them, not just about how to die, but about the meaning of a good life.

Often, the rhetoric that so frequently occurs in the debates regarding our right to a peaceful, dignified death obscures the difficult issues facing those approaching the end of life. Let us emphasize that the joy of life is important to those of us in the right to die movement. The decision to choose the time and manner of dying confirms the value that we place on life. We have the right to pursue a good life - what we demand is the right to choose a good death.

WF President Richard MacDonald with his wife Paddy at the Boston conference in September.

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Dr. Jack Kevorkian remains in prison in Michigan, USA, serving a sentence of 10-25 years for second degree murder of a terminally ill man who requested death. His defense fund is adequate and a top lawyer has been retained to fight his appeal, which should be reached in the next few months. Kevorkian's hope is to take his case up to the US Supreme Court and get a positive decision to allow physician-assisted death.

The Catalan Parliament on 26 October approved a Bill allowing advance directives on the right to die. This is the first such legislation in Spain. It had the consensus of all the parliamentary groups. Derecho a Morir Dignamente, in Barcelona, had been lobbying hard for this law for several years. Jean-Marie Lorand, Belgium's best known euthanasia advocate, was helped to die on 9 July by a physician in his own home. Lorand, 51, had spent his life in a wheelchair suffering from the incurable Charcot-Marie-Tooth disease which had recently attacked his heart and lungs. Lorand told of his suffering in his book 'Help Me To Die.

Audio and video tapes of the world euthanasia conference in Boston on 1-3 September can be obtained from the Hemlock Society, PO Box 101810, Denver, CO 80250. Or visit their web site: www.hemlock.org Three new groups joined the World Federation of Right To Die Societies when it met in Boston in September - Exit-Italy, the Voluntary Euthanasia Society of Tasmania, and the Hemlock Society of Florida.

The World Federation of Right to Die Societies now has its own web site, run by newly appointed executive director Steve Jamison, at www.worldrtd.org Jamison can be reached at aidindyingcom@aol.com Another international site is www.finalexit.org.

The Not-Dead-Yet group protesters picketed the world conference in Boston every day. Among their many placards was this odd one linking Dr. Jack Kevorkian and Derek Humphry, both advocates of voluntary euthanasia, together with serial murderers Ted Bundy and John Wayne Gacey, both executed.

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Look to the courts for PAS progress

Participants: Charles Baron JD, Professor of Law, Boston College, USA; Adelbert Josephus Jitta, Judge and Board Member NVVE (Netherlands); Kathryn Tucker JD, Legal Director, Compassion in Dying, USA; Alan Meisel JD, Professor of Law and Bioethics, University of Pittsburgh, USA.

By Mary D Clement

Alan Meisel described an encouraging situation as a consequence of the US Supreme Court rule in 1997 that there is no constitutional right to physician-assisted suicide for the terminally ill. The Court, in Washington v. Glucksberg and Quill v. Vacco, wrote that states might continue to ban the practice of physician-assisted suicide. But Meisel cautioned us not to look at the pair of 9-0 decisions as the glass being empty, and rather to see the rulings as filling a glass fuller than we might expect.

First, the Justices give a constitutional right to palliative care, the kind of care that comforts patients even though it can no longer cure. Moreover, in rejecting the right to an assisted death, the Justices endorsed the right to "terminal sedation" and the "double effect".

Both terminal sedation and the double effect are currently used to hasten deaths, yet their legality has never been tested. The double effect, approved by virtually all groups involves the administering of pain medication with the intent to ease suffering, even if the medication shortens the patient's life. Another religiously and medically acceptable way of letting go is the procedure known as terminal sedation. In this procedure the physician, with the help of barbiturates, puts the suffering patient into a coma. The doctor then removes the artificial nutrition and hydration sustaining the patient, and after roughly ten days or so, the patient dies of starvation and dehydration.

Even more optimistic, Meisel then told how the Supreme Court further left the door open by quoting Justice Sandra Day O'Connor in a concurring opinion with Justices Stephen Breyer and Ruth Bader Ginzburg. All three Justices agreed that if there are legal barriers to pain relief then there may indeed be a constitutional right to physician-assisted suicide.

There are legal barriers to pain relief that might lead to decriminalizing statutes against assisted suicide such as:

1. Federal and state criminal statutes governing controlled substances make physicians afraid to prescribe the necessary medications. These statutes are a result of our America's war on drugs;
2. State prescribing statutes on dosages that must be reported in triplicate, where a doctor's license can be suspended or removed;
3. Private consequences for the physician that erect barriers to good palliative care in loss of privileges to practice in a hospital and even bad publicity.
4. The last barrier to good pain relief is the fear the patients will become addicted or sell drugs on the street.

While Justices O'Connor, Breyer and Ginzburg opened the door to reversing their decision if there is a barrier to pain relief, the remaining six Justices stated that their minds could also be changed by specific challenges to the law on an individual basis. Thus, said Meisel, all is not as gloomy as two 9 - 0 decision might imply. We need not be discouraged. The Supreme Court has indeed left the door open to future challenges.

Kathryn Tucker agreed with Professor Meisel in that 1) the Supreme Court had left itself open to future challenges to the law criminalizing assisted suicide and 2) the Court bestowed a right to palliative care in general and terminal sedation more specifically.

Since the defeat in the two federal cases, "We have looked to possible state forums to change the law, most especially to states that are protective of individual liberties." Alaska is such a state and thus a right-to-die case, Sampson v. Alaska, is currently pending before the state Supreme Court. Identical to Gluckberg and Quill, it would allow the mentally competent terminally ill citizen the right to choose a humane hastened death by obtaining medication from their physician that could be self-administered. Notably, Sampson is also the first case where a court can look at the data available from Oregon which shows that speculative fears in that state have not come to pass. Tucker explained why Alaska was chosen as a state in which to bring the first case since the two United States Supreme Court cases:

1. There is an explicit privacy clause in the Alaska Constitution;
2. Alaska law allows restrictions on fundamental rights only when there is a compelling state interest and no less restrictive alternative. This two prong test is a stringent test and difficult to meet, allowing us a better chance for victory than with other state standards; and
3. A recent Alaska case has stated that end of life decisions are protected as are reproductive decisions.

In a relaxed moment in the splendor of the lobby of the Boston Park Plaza Hotel, Philip Nitschke (left), Sally Troy, and Arthur Metcalfe. Photo: Marilyn Hurwitt.

The euthanasia movement needs broader appeal

By Karla Hankes

Ways in which the right-to-die movement might proceed strategically into the next decade were discussed at the Boston conference by Dr. Joe Bandy, professor of sociology at Bowdoin College in Maine, and attorney/author Mary Clement.

Dr. Bandy, a specialist in environmental and labor issues, encouraged the audience to comparatively examine the successes as well as the failures that have plagued other significant movements in the 20th century and which mirror challenges faced by the right-to-die movement. As one example, Bandy pointed out the narrowness that has occurred in the environmental movement due to the focus on legal campaigns.

"During the 1970's and 1980's the environmental movement became extremely professionalized and technically oriented to the exclusion of many issues and members," he said.

"This is also evident in labor reform movements, where over the last 30 years there has been an intense growth and leadership amongst a very professional group of lawyers, scientists, lobbyists, and career politicians. This can have the result of making a movement more technocratic and less representative of its least advantaged members. In addition direct actions against medical institutions or attention to media campaigns which may promote significant change within the healthcare system and the culture at large, might be pushed aside in favor of legal reform." Bandy explained that many movements in the 1980's and 90's began to focus more on actively changing popular culture and belief whether through music, television, film, radio-programming, or merely the publicity surrounding a non-traditional lifestyle. "Popular culture is often very powerful in generating changes in the beliefs of a population, allowing social change in legal or other institutions to occur more rapidly."

Related to this is the fact that although public opinion is on our side, public activism is far more limited. "One major reason may be that, unlike other movements which struggle to eliminate suffering, the right-to-die movement seeks to do so by promoting suicide as a choice, an issue that is taboo in our culture and frightening for many to even consider. The difficulty of mobilizing activists, especially those who do not immediately face end-of-life decisions or terminally ill conditions is difficult, and this difficulty is compounded by the death shroud that public figures like Dr. Kevorkian have placed on the movement by promoting assisted suicide in a less than tactful way." Dr. Bandy challenged the conference by saying, "The right-to-die movement must endeavor to create a popular culture that helps a fearful public overcome its fears about death by presenting models that are more dignified and even more joyous. Rather than a fade into oblivion, death must be presented as the way to punctuate and give completion to a vibrant life."

Dr. Bandy advised that to promote end of life education, the services of the medical profession and the church must be involved stating, "In order for the movement to expand, it is essential that alliances and coalitions be cultivated." Suggested candidates for coalition included medical reform movements, nurses unions, health organizations and organizations of senior citizens such as the American Association of Retired Persons and the Gray Panthers. Bandy argued that it was especially important for the right-to-die movement to consider alliance with progressive Christian organizations. He stated, "For the right-to-die movement to not seek out church organizations as allies in this search for meaning and this alleviation of suffering, would result in the downfall of the movement." Prof. Bandy heartened the Boston audience by saying, "There is a massive attempt on the part of many right-to-die organizations and many committed and courageous people in the United States and other countries, to work diligently at achieving legal reforms which will end unnecessary suffering at the end of life. To end suffering is one of the primary motivations of any great movement." Bandy added, "The prospects for the right-to-die movement are immense and quite encouraging."

Mary Clement told the conference: "A social movement does not appear and grow in a vacuum. It grows out of cultural and economic changes, unmet needs and shifting priorities that percolate below the surface and then gradually emerge into mainstream debate and public policy." Clement went on to say that the right-to-die movement has been pushed along by the values of individualism, participation, self-determination and autonomy. She discussed the forces of activism and forces of restraints that have pushed, pulled and shaped public policy since the 1930's, emphasizing that "It is impossible for the restraining forces to ever stop the right-to-die movement."

Clement cited the climate of the rights' culture of the 1960's where the credo of the Students for a Democratic Society was "Take an active participation in decisions that affect your well being. Take control of your own life and reject the oppression of society."

Other forces that currently spur the right-to-die movement include the decline of the doctor/patient relationship, which is influenced to a great degree by reliance upon technology.

Faye Girsh, president of the Hemlock Society, gives a big hug at the Boston conference to Ann Ogden, of Vermont, at 90 one of Hemlock's oldest members. She has been a member for 20 years.

A long struggle ahead

DEREK HUMPHRY speaking in Boston on 2 Sept 00

Before we took at the future, first let's examine exactly briefly where are we now. We have the Netherlands: unquestionably the world's euthanasia laboratory. And we owe the people of that country a lot. For more than 20 years they've made the pioneering moves, politically, ethically, legally, and we've all learned a great deal from the Dutch.

For me the most valuable lesson from that country is that, particularly in this enormously sensitive field of artificially-induced death by request, that the Dutch have been quick to learn by their experience and swiftly and sensibly adjust the rules and the practice. And, through research such as the Remmelink Reports, they have shared their experiences, good and bad, with the rest of the world. Later this year, I understand that the Dutch Parliament is likely to pass new legislation which will bring the practice of euthanasia under the rule of law, instead of the 'force majeur' - or 'greater good' - type of acceptance in the past.

I think we owe a great deal to the Dutch people for their trailblazing. We all stand in their debt. Then there are the Swiss. Until recently, it was not widely known that assisted suicide had been permissible in that nation since l937. Permitted provided the reasons for the help were altruistic, well-meaning, and justified.

Again, the Swiss have been helpful in providing the rest of the world with background information and particularly forthcoming about the best methods.

The Northern Territory of Australia had voluntary euthanasia and assisted suicide for just nine months in l996-97 before the religious right found a legal quirk in the constitution and sufficient votes in the Federal Parliament to scrap the law. Only four people were able to take advantage of it. In Canada, the plea of Sue Rodrigez to have assisted suicide went to that nation's Supreme Court and was rejected by a 5 to 4 vote. A narrow defeat, but a defeat all the same, making it harder to get a similar case before that court again. The Canadian Parliament has shown no great interest in tackling the subject.

In Britain - supposedly the 'mother of democracies' - at least 80 percent of the public wants law reform, but on seven occasions over 60 years Parliament has refused to listen. There is some consolation in the fact that in the last vote in l997, 89 Members of Parliament did vote FOR change, with 234 against. The struggle against those in 'the corridors of power' in London continues. Belgium came out of the cold this year when its Parliament debated a voluntary euthanasia law, and the resolution of that is expected before long.

And, of course, there's the delicate, teetering Oregon law, which you've heard plenty about in this conference, and a very significant vote in the state of Maine.

VISION

That's where we are now - not very far along, in my view; so where are we going? And how? I question whether the step-by-step approach to law reform - physician-assisted suicide first, voluntary euthanasia later on - is truly useful. Those who oppose us will always oppose everything we do - whether it is a wishy-washy, limited law or full-blown euthanasia legislation. The opposition will fight everything we do, and in my view it is a waste of time conceding any watering down of the laws which we want.

Secondly, let's be honest, we need assisted suicide and voluntary euthanasia if we are to carry our help to all who are dying and ask for a hastened end, not those few who can jump through the hoops of limited physician-assisted suicide.

The argument is often made that health care is not universally available and until it is there should be no options like euthanasia. Well, I would like to see everybody with health care; it's a laudable and important goal. But must we wait for a perfect society - will there ever be a perfect society? Our main goal must be to get more of the medical profession on our side, as the Dutch have been lucky enough to do right from the start. But until doctors see that public opinion has insisted that law reform is instituted, there will be a lot of wavering. Doctors are a cautious lot; we've got to bring them around.

When I started the Hemlock Society in l980 people asked me then how long it would take to get hastened death to be a normal medical procedure when justified. I used to reply that it would take 20 years.

Well, I was wrong. It is going to take another 20 years - at least in the USA and Canada, and maybe Britain and Australia. Our legislative branches must be soundly backed so that there is constant pressure on politicians to recognize the need for change. It's going to take money and consistent effort.

Most of the general public is on our side - the blockade comes from the churches, the political institutions, and the fear of electoral boycotts by those whom we elect to run our affairs. The true goal of the right-to-die movement must be to make us respected by the general public. We can only do this through education and 'being there' for people who are suffering. It will take time. By far the most significant development in our movement in the last decade has been that a section of our colleagues have moved from the theoretical to the practical, and the presence, both the real and the moral support.

MERO - KEVORKIAN

The person who launched this in America was Ralph Mero whose forming of 'Compassion in Dying' in Seattle in l993 showed that there was a way. From that brave little start has gradually developed a new wave, a new surge, of gutsy people willing to help people with what one might euphemistically call 'a negotiated death'.

Dr. Kevorkian's services are not available as he languishes in prison but he only touched the tip of the iceberg. His poor judgment in SOME of his cases - most were justifiable - has hurt this movement. But the new 'helping hand' movement across North America and Australia is far more careful in its selection of those needing help. It is cautious, unpublicized, and just within the law. Therefore Kevorkian is not missed. I hope he is released from prison before too long and goes into retirement. There are people in this audience who are far more deserving of the Saba Medal award than I am, and only the passage of time will allow their sterling services to humanity to be openly recognized. Thus we must proceed with two strings to our bow:

1. The fight for law reform at every possible site to get choice in dying for those who desire it;
2. Extend a hand to all who justifiably call for help so that our mission is seen as caring, careful and compassionate.

Derek Humphry and his wife, Gretchen, at the world conference dinner at the Boston Park Plaza on 2 September 2000 after Derek received the George Saba Medal for long services to the world right-to-die movement. Derek has held numerous office in the world organization since its beginnings in l980. Previous recipients of the medal have been Marshall Perron and Sidney D Rosoff. Photo: Marilyn Hurwitt.

DUTCH EUTHANASIA 'NOT EXPORTABLE'

Panellists: Aycke Smook, MD, Rob Jonquiere, MD, Pieter Admiraal, MD at the Boston world euthanasia conference

By Stephen Jamison, WF executive director

Dr. Smook defined "euthanasia," as "the deliberate termination of life at the explicit request of a person by another." It is a voluntary act. Euthanasia is not refusal of treatment by the patient before or during treatment. Neither is it abstaining from medically meaningless treatment. Nor is it pain-killing treatment with double effect.

Dr. Smook explained how, in his medical practice, the diagnoses of cancer is laden with fear about the future and is often associated with fear of pain and loss of dignity in the end. Knowing his affinity with the subject of euthanasia, his patients ask him to help them in the end, and give him their living wills. As a result, he described how his patients are more at ease and have room to fight the disease.

He said how amazing it is to see the power of patients in the final stage. "In most cases they support the future surviving relatives instead of the other way around, and mourning starts beforehand. He described the impressive case of a woman of 76 years. She had a word for each of her 10 children, children in-law, and grandchildren. She even supported her husband in his grief. "In our department of surgical ecology, a nurse can coordinate palliative care. This woman thanked the nurse and me for our willingness to give her the last medication. After asking her husband's permission to pass away, she passed away with a smile."

Dr. Smook argued that the Dutch system is unique in several ways. In the Dutch health-care system, general practitioners, family doctors, and specialists know their patients and each other for a long time. As a result, a discussion of euthanasia is possible over a considerable period of time. Further, the health care system is accessible to everyone, both financially and otherwise, and guarantees unrestricted and palliative care, not only in hospitals but also at home and in nursing homes.

However, this does not mean that Dutch medicine is always progressive. Physicians also have to look after patients who become victims of runaway medicine that cannot and will not be stopped. "Modern medicine can prevent people from dying in a natural way and create new forms of useless suffering." The physician can provide euthanasia only after having followed strict guidelines. As long as there have been patients and compassionate physicians a kind of aid-in-dying has been given. As Jacques Pohier said in his presentation, "Euthanasia is not a choice between life and death but between two different ways of dying." Dr. Smook concluded by saying that "We have never tried to export our view of euthanasia. The Dutch system should not be taken as a model. Euthanasia is not an export product."

Dr. Jonquiere, the managing director of NVVE then described how NVVE receives letters and emails from all over the world from individuals interested in euthanasia. They ask NVVE questions about the possibility of coming to the Netherlands to obtain euthanasia, or assisted suicide, or lethal medicine or prescriptions. He explained how it sounds many times as if, for the cause of euthanasia, "the Netherlands is heaven." It also seems that the same goes for the media abroad. They all want to know about the ideal situation in the Netherlands and this ideal situation is always called "the Dutch experience." Nevertheless, it is not possible to come to the Netherlands to obtain euthanasia. Dr. Jonquiere explained that the primary difference between the Netherlands and other countries is that in the Netherlands, "not only to we practice euthanasia, but we also talk about it." Politicians, magistrate's, doctors, public officials, everybody talks about it, and "We are convinced that this is one of the reasons that we are at this moment debating legalization of euthanasia in the Parliament." Even opponents strongly opposing euthanasia talk about the issue, and "We can talk about it with our opponents.

Dr. Admiraal then went on to discuss the success rates of prescribed means to end life. He stated emphatically that 9 grams of barbiturates, in his opinion, is the best even though this could take some time to be effective. "In the 25 years that we have been doing this in the Netherlands, there has been no report that anyone has survived this lethal amount of medication. Nevertheless, it can be very long lasting before the patient dies."

Dr. Admiraal provided the most recent figures for "time to death" for the last 60 cases of patients taking this amount of barbiturates in the Netherlands. Of these 60 cases, some 46 died spontaneously, meaning without the need for further intervention. Of these 46 patients, some 21 died within 15 minutes, 11 within 30 minutes, 13 within an hour, and in only 1 case did a patient last 2 hours. This accounts for 46 cases of the 60. Of the other 14 cases, doctors did not wait for the patient to die spontaneously, but gave muscle relaxant intramuscular to aid in the death. This practice, though illegal in Oregon, is performed in the Netherlands. It occurred some five times an hour after the patient had taken the medication, two times after two hours, once after two and a half hours, two times after three hours, once six hours and once after seven hours.

He then described how in another publication it has been reported that it can even take up to 24 hours for a lethal oral dose to work. That is why they advise drinking alcohol, to accentuate the effect of the medications. It is also why they advise doctors to make an agreement beforehand about how long we should wait until we give the patient an extra gift of a muscle relaxant drug.

After their presentations, the panelists were then asked questions about the situation in the Netherlands. There was discussion of under-reporting of the practice of euthanasia by Dutch doctors. In response it was argued that under-reporting may well be because some certain doctors in the Netherlands believe that euthanasia is an act of compassion and not something that should be first seen legally as a possible criminal act and subject to investigation. Importantly, the estimated amount of non-reporting is diminishing each year while the number of doctors who answer all the questions completely is increasing.

Discussion followed on the some 1,000 patients who are reported to receive euthanasia, but who lacked the capacity to consent. This figure is used by opponents in support of their slippery slope argument. In response, it was pointed out that these cases were patients with end stage cancer where both the doctor and the family believed that the patient would have asked for help if he or she had been given the chance. There is no reason to think that Dutch doctors are performing euthanasia against the will of the patient.

Often the family comes to the physician and says, "He would have asked for help if he had foreseen that he would come to this kind of suffering. In the case of patients with loss of consciousness, the request is usually made to put an end to the final struggle.

As Dr. Smook pointed out, "If you have a patient with lung cancer he can live on two or three days with a terrible struggling for air, which you can hear. If you have to witness this as a close relation family member for up to three days and nights, it is clear they come to us and ask if there is anything we can do. In these cases we sometimes discuss the possibility of euthanasia without a direct previous request from the patient if the family tells us that this man or this wife never wanted this and discussed this years ago. Of these 900 cases they are practically all in their last phase of cancer.

"To perform euthanasia without request does not mean that we are doing it against the will of the patient. This is a false implication." The panelists then discussed the slippery slope, which opponents argue will eventually be used to kill patients against their will. This will include the elderly, the handicapped, the demented, and all the others. It was pointed out that the Dutch are now 25 years into the practice, and there is no proof at all of any slippery slope. There has been no euthanasia on demented patients only because he or she is demented. And there is no question of euthanasia being used for a disabled patient.

Michio Arakawa is the new Japanese board member on the World Federation of Right to Die Societies.