Recent cuts in proven cancer drugs will steer people toward assisted suicide if Marris Bill passes

The news broke last week that more than 5,000 cancer patients will be denied life-extending drugs under plans which charities say are a ‘dreadful’ step backwards for the NHS.

If, in addition, assisted suicide is legalised in Britain - and Rob Marris’s Assisted Dying (No 2) Bill is to be debated this coming Friday – then it would also leave vulnerable cancer patients being steered toward suicide as a cheaper ‘treatment option’.

The Cancer Drugs Fund was launched in 2011, following a manifesto pledge by David Cameron, who said patients should no longer be denied drugs on cost grounds.

Since its launch four years ago it has benefitted more than 50,000 patients, who received treatment which NHS rationing bodies had refused to pay for.

But now the fund’s budget is massively overspent.

Health officials have just announced sweeping restrictions on treatment, which will mean patients with breast, bowel, skin and pancreatic cancer will no longer be able to receive drugs funded by the NHS.

In total, 17 cancer drugs for 25 different indications will no longer be paid for in future.

The decision means that in total, two thirds of all treatments which were paid for by the scheme will no longer be paid for by the NHS.

Drugs which will no longer be funded include Kadcyla for advanced breast cancer, Avastin for many bowel and breast cancer patients, Revlimid and Imnovid for multiple myeloma, and Abraxane, the first treatment for pancreatic cancer in 17 years.

Note that these are drugs with proven therapeutic effectiveness.

Mark Flannagan, Chief Executive of the charity Beating Bowel Cancer, said: ’Nothing has changed in terms of the clinical effectiveness of these treatments. They remain as clinically effective now as they were when they were added to the list of funded drugs.’

There is also a much darker side to this move as we learn from the experience of the US state of Oregon, where assisted suicide was legalised in 1997.

Barbara Wagner (pictured) had recurrent lung cancer and Randy Stroup had prostate cancer. Both were on Medicaid, the state’s health insurance plan for the poor that, like some NHS services, is rationed.

The state denied both treatment, but told them it would pay for their assisted suicide, although they had not even considered the latter and did not ask for it.

‘It dropped my chin to the floor,’ Stroup told the media. ‘[How could they] not pay for medication that would help my life, and yet offer to pay to end my life? ’(Wagner eventually received free medication from the drug manufacturer. She has since died. The denial of chemotherapy to Stroup was reversed on appeal after his story hit the media.)

Despite Wagner and Stroup’s cases, advocates continue to insist that Oregon proves assisted suicide can be legalised with no abuses. But the more one learns about the actual experience, the shakier such assurances become.

If AS were to be legalised in the UK end-of-life care would be likely to worsen under financial pressures because it costs on average £3,000 to £4,000 a week to provide in-patient hospice care, but just pounds to pay for the drugs which would help a person commit suicide.

Cancer treatments like chemotherapy, radiotherapy or surgery cost much more. Do we really wish to place that temptation before families, NHS managers and Health Secretaries in cash-strapped Britain?

Because if we pass this law this is exactly what will happen. Assisted suicide will be costed just like any other ‘treatment’ and will be assessed alongside other ‘options’ for ‘cost-effectiveness’. And vulnerable cancer patients will be steered toward suicide. 

Doctors will then be left in the terrible position of having to present assisted suicide as an affordable ‘treatment option’. 

‘I’m afraid you have breast cancer. There is a drug called Kadcyla, which we used to prescribe to around 800 women a year. It has been shown to extend life by an average of six months, with fewer side effectives than any alternatives. But this drug is sadly no longer funded. We can however pay for your assisted suicide as it is so much cheaper.’

This is just one of the consequences of legalising assisted suicide.

You will find much more information on why we should not change the law in a new paper published this week by Care Not Killing: ‘Don’t Make Oregon’s mistake: Ten reasons why England and Wales should not follow suit and legalise assisted suicide’.

Don’t make Oregon’s mistake and legalise assisted suicide – ten reasons why the UK should not follow suit

Lord Falconer’s Assisted Dying Bill, due for a second reading in the House of Lords on 18 July, is purportedly based on the US state of Oregon’s Death with Dignity Act (DWDA).

Dignity in Dying, the former Voluntary Euthanasia Society, who are backing Falconer, claim that everything is wonderful in Oregon. But is that really true?

In fact, far from being reassuring, the Oregon experience sounds a loud warning to the UK not to follow suit.

On 27 October 1997, Oregon enacted the DWDA which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal drugs, expressly prescribed by a physician for that purpose.

The Oregon DWDA also requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report.

These annual reports are all available on the Oregon government website and there is plenty of other relevant information in the public domain to draw on.

In order to qualify under the Oregon Act, a patient must be an Oregon resident, 18 years of age or older, capable of making and communicating health care decisions for him/herself and have been diagnosed with a terminal illness that will lead to death within six months.

It is up to the attending physician to determine whether these criteria have been met.

A similar law came into effect in the neighbouring state of Washington in 2009. Annual reports can be accessed here.

So what can we learn about the Oregon/Washington model? Here are ten disturbing facts:

1. There has been a steady increase in annual numbers of people undergoing assisted suicide in Oregon

In 1998 there were 24 prescriptions written and 16 assisted suicide deaths. By 2012 these numbers had risen to 116 and 85 respectively. This is a 380% increase in prescriptions and a 430% increase in assisted suicide deaths in 15 years. The number of assisted suicide deaths in Washington State, increased by at least 43% in 2013.

How would this translate to the UK? There were 56.6 million people in England and Wales in 2012 but only 3.9 million in Oregon. So 85 assisted suicide deaths in a year in Oregon would equate to 1,232 in England and Wales (14 times that of Oregon).

2. The Oregon health department is funding assisted suicide but not treatment for some cancer patients

Barbara Wagner had recurrent lung cancer and Randy Stroup had prostate cancer. Both were on Medicaid, the state’s health insurance plan for the poor that, like some NHS services, is rationed. The state denied both treatment, but told them it would pay for their assisted suicide! ‘It dropped my chin to the floor,’ Stroup told the media. ‘[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?’ (Wagner eventually received free medication from the drug manufacturer. She has since died. The denial of chemotherapy to Stroup was reversed on appeal after his story hit the media.)

Despite Wagner and Stroup's cases, advocates continue to insist that Oregon proves assisted suicide can be legalised with no abuses. But the more one learns about the actual experience, the shakier such assurances become.

If AS were to be legalised in the UK end-of-life care would be likely to worsen under financial pressures because it costs on average £3000 to £4000 a week to provide in-patient hospice care, but just a one-off cost of £5 to pay for the drugs which would help them commit suicide. Cancer treatments like chemotherapy, radiotherapy or surgery cost much more. Do we really wish to place that temptation before families, NHS managers and Health Secretaries in cash-strapped Britain?

3. Patients are living for many years after having been prescribed lethal drugs for ‘terminal illness’ showing that the eligibility criteria are being stretched

The Oregon and Washington laws, like Falconer’s proposed law, have ‘six months to live’ criteria. But doctors’ estimates of lifespans can be wildly out. Consider Oregon resident, Jeanette Hall, who was diagnosed with cancer and decided to ‘do’ Oregon's law. Her doctor, Kenneth Stevens, didn't believe in assisted suicide and encouraged her to be treated instead. It is now 14 years later and she is ‘thrilled’ to be alive. This is Dr Steven's affidavit filed by the Canadian government in Leblanc v. Canada, now dismissed, discussing Jeanette. This is Jeanette's affidavit, also filed by the Canadian government in the same case.

The Oregon statistics record patients killing themselves up to 1,009 days after the first request for lethal drugs – almost three years – showing just how hard doctors are pushing the boundaries - and/or how bad they are at guessing lifespans.

4. The vast majority of those choosing to kill themselves are doing so for existential reasons rather than on the basis of real medical symptoms 

The main argument advanced for assisted suicide is unremitting pain. But the Oregon data show that those people citing ‘inadequate pain control or (even) concern about it’ constitute just 23.7% of cases overall. So what are the main reasons given for taking one’s life? In 2013 93% cited ‘loss of autonomy’, 89% said they were ‘less able to engage in activities making life enjoyable’ and 73% listed ‘loss of dignity’. These are not physical but existential symptoms.  But should lethal drugs be prescribed to people who feel their lives no longer have meaning and purpose?

The fact that almost a quarter of patients dying under the Act report inadequate pain control or concerns about pain also shows that palliative care provision in Oregon is unsatisfactory. But surely this is an argument for better care rather than AS.

5. Many people in Washington and Oregon give ‘fear of being a burden on others’ as a reason for ending their lives

I have frequently argued that any change in the law to allow assisted suicide or euthanasia would place pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others. This would especially affect people who are disabled, elderly, sick or depressed and would be most acutely felt at a time of economic recession when many families are struggling to make ends meet.

This fear is again borne out by the American data. In Washington in 2013, 61% of people opting for assisted suicide give the fear of being a burden to family, relatives and caregivers as a key reason. 13% cited ‘financial implications of treatment’. In the same year in Oregon the equivalent figures were 49% and 6%.

6. Fewer than three per cent of patients are being referred for formal psychiatric or psychological evaluation

In an article for The Telegraph, former president of the Royal College of Psychiatrists Baroness Sheila Hollins has voiced concern that proposals to license doctors to supply lethal drugs to mentally competent, terminally ill patients fail to take account of the complex process involved in assessing a patient's mental capacity. According to Baroness Hollins, assessing mental capacity ‘isn't like checking the oil or water level in a car’ or ‘the sort of thing that can be done in a single consultation, especially if the decision in question - as it is in this case - is one with life-or-death consequences.’

Commenting on the US State of Oregon, where less than 3% of cases were referred for a formal psychiatric assessment in 2013 she writes: ‘Researchers have found that some patients who have ended their lives under the terms of Oregon's assisted suicide law had been suffering from clinical depression. Depression impairs decision-making capacity, it is common in elderly people and it is treatable. But in some cases in Oregon it has not been diagnosed by the doctor who assessed the patient's capacity and prescribed lethal drugs. Oregon's law requires referral for psychiatric examination in cases of doubt but in some cases that has not happened.’

7. A substantial number of patients dying under the Oregon Act do not have terminal illnesses

In Oregon in 2013 16.9% of those killing themselves under the Act did not have cancer, heart disease, chronic lung disease or motor neurone disease but were classified as having ‘other illnesses’. What were these? A footnote in the annual report tells us that this ‘includes deaths due to benign and uncertain neoplasms, other respiratory diseases, diseases of the nervous system (including multiple sclerosis, Parkinson's disease and Huntington's disease), musculoskeletal and connective tissue diseases, viral hepatitis, diabetes mellitus, cerebrovascular disease, and alcoholic liver disease.’

Many of these conditions might be considered life-shortening but it beggars belief that all these cases were terminal (with less than six months to live). These are in the main chronic conditions, again falling outside the bounds of the Act.  And yet the doctors went ahead and signed the forms anyway – further evidence of how medical practitioners cannot be trusted to keep to the legal boundaries.

8. It is virtually certain that there is underreporting of assisted suicide cases in Oregon

The Lancet recently published a long awaited meta-analysis study which indicated that in 2010 in the Netherlands, 23% of all euthanasia deaths were not reported.  Could similar under-reporting be happening in Oregon? It is a virtual certainty.

Oregon officials in charge of formulating annual reports have conceded ‘there’s no way to know if additional deaths went unreported’ because Oregon DHS ‘has no regulatory authority or resources to ensure compliance with the law’.

The DHS has to rely on the word of doctors who prescribe the lethal drugs. Referring to physicians’ reports, the reporting division admitted: ‘For that matter the entire account [received from a prescribing doctor] could have been a cock-and bull story.  We assume, however, that physicians were their usual careful and accurate selves.’

So with an Oregon-type law like Falconer’s we can expect to see steadily increasing numbers of assisted suicide cases year on year in England and Wales, along with an unknown level of under-reporting.

9. Some doctors know the patient for less than a week before prescribing the lethal drugs

In order to assess whether a patient is being coerced or not, it surely must be necessary for the prescribing doctor to know them personally and understand their family situation. But in Oregon there were patients who knew their doctor for less than a week before he/she prescribed them the lethal drugs – further evidence of doctor shopping.

10. The presence of no independent witnesses in over 80% of cases is a recipe for elder abuse

In Oregon in 2013 there was no doctor or other healthcare professional present at the time of ingestion of the lethal drugs in 81% of cases. Also the duration of time that elapsed between the request for the drugs and the actual death ranged from 15 to 692 days with a median of 52 days.

During this time the drugs were kept at the patient’s home. But without an independent witness how can we be sure that the drugs were taken voluntarily and not administered forcefully or secretly by a relative with an interest financial or otherwise, in the patient’s death? If they struggled who would know? And any investigation into possible foul play would have to traverse the substantial hurdle of the key witness (the patient) being dead.

We know that in Britain, according to ‘Action on Elder Abuse’, there are half a million cases of elder abuse annually, many of which involve financial abuse by family members or close relatives. The Oregon law, and by implication Falconer’s proposed law, is a recipe for elder abuse of the very worst kind – killing for money.

Conclusions

The lessons from Oregon are clear. We should not go there. Keep Britain safe for vulnerable people.

Those helped to kill themselves under Lord Falconer’s Assisted Dying Bill may have years to live

Anyone listening to Lord Falconer talking about his ‘Assisted Dying Bill’ on Channel Four last Saturday night would have been led to believe (by Falconer itself) that it applied only to patients with hours or days to live. They were being misled.

The bill actually licenses doctors to dispense lethal drugs to mentally competent adults who have less than six months to live and a ‘settled wish’ to die.

But according to Margaret Dore (pictured), a Lawyer in Seattle Washington, who has experience of a similar law, says that even six months may be a gross underestimate.  

She argues that ‘eligible’ patients may have years, even decades, to live. 

Here’s her account – the references are on her website.

Lord Falconer’s Bill, which is based on the Oregon and Washington assisted suicide laws, would legalize assisted suicide for persons with a ‘terminal illness’, defined in terms of a prediction of less than six months to live. [1] The Oregon and Washington laws have a similar six months to live criteria. [2]

Under all three laws, ‘eligible’ patients may have years, even decades, to live. This is true for the following the following reasons:

1. Predictions of life expectancy can be wrong 

Patients may have years or even decades to live because predicting life expectancy is not an exact science. Consider John Norton who was diagnosed with ALS. He was told that he would get progressively worse (be paralyzed) and die in three to five years. Instead, the disease progression stopped on its own. In a 2012 affidavit, at age 74, he states:

‘If assisted suicide or euthanasia had been available to me in the 1950's, I would have missed the bulk of my life and my life yet to come.’ (Link) [3]

2. The six months to live is determined without treatment 

Consider Oregon resident, Jeanette Hall, who was diagnosed with cancer and decided to ‘do’ Oregon's law. Her doctor, Kenneth Stevens, didn't believe in assisted suicide and encouraged her to be treated instead. It is now 14 years later and she is ‘thrilled’ to be alive. This is Dr Steven's affidavit filed by the Canadian government in Leblanc v. Canada, now dismissed, discussing Jeanette. This is Jeanette's affidavit, also filed by the Canadian government in the same case.

3. In Oregon, the six months to live criteria is now being interpreted to include chronic conditions such as diabetes. 

Oregon doctor, William Toffler, explains: 

‘Our law applies to “terminal” patients who are predicted to have less than six months to live. In practice, this idea of terminal has recently become stretched to include people with chronic conditions such as chronic lower respiratory disease and diabetes. Persons with these conditions are considered terminal if they are dependent on their medications, such as insulin, to live. They are unlikely to die in less than six months unless they don’t receive their medications. Such persons, with treatment, could otherwise have years or even decades to live. ‘[4]

Margaret Dore is a lawyer in Seattle Washington the President of Choice is an Illusion.

Oregon – steady annual increase in assisted suicide cases sounds warning to UK

Lord Falconer wants to legalise assisted suicide for adults who are mentally competent and have less than six months to live based on the ‘Oregon model’.

Since assisted suicide was legalised in Oregon there has been a steady annual increase in the number of prescriptions written for lethal drugs and in numbers of people killing themselves.

In 1998 there were 24 prescriptions written and 16 assisted suicide deaths. By 2012 these numbers had risen to 116 and 85 respectively. This is a 380% increase in prescriptions and a 430% increase in assisted suicide deaths in 15 years.

In 2013 there were 71 deaths – an apparent fall. But this was number that had been reported by 22 January 2014 and there were still 31 patients for whom ‘ingestion status’ was unknown.

For 2012 it was initially reported in January 2013 that there were 77 deaths – but also 25 whose ‘ingestion status’ was unknown - this increased to 85 once all figures were in so we can expect the 2013 figures to go up by at least a similar level.     

How would this translate to the UK?

There were 56.6 million people in England and Wales in 2012 but only 3.9 million in Oregon. So 85 assisted suicide deaths in a year in Oregon would equate to 1,232 in England and Wales (14 times that of Oregon).

Overall since the Oregon Death with Dignity Act (DWDA) was passed in 1997, a total of 1,173 people have had DWDA prescriptions written and 752 patients have died from ingesting medications. 

So over a similar time period, all other things being equal, we would expect 10,528 assisted suicide deaths in England and Wales.

This pattern of steady annual increase in number is also evident in other jurisdictions which have legalised either assisted suicide or euthanasia.

The number of assisted suicide deaths in neighbouring Washington State, increased by at least 43% in 2013.

There were 119 known assisted suicide deaths in 2013, up from 83 in 2012, 70 in 2011, and 51 in 2010. Assisted suicide was legalized in March 2009, after a ballot measure.

According to Dutch media reports, euthanasia deaths in the Netherlands in 2012 increased by 13% to 4188.

In fact from 2006 to 2012 there has been a steady increase in numbers each year with successive annual deaths at 1923, 2120, 2331, 2636, 3136, 3695 and 4188 – an overall increase of 118% in just six years. 2013 figures are still awaited but expected to show similar trends.

The number of reported euthanasia deaths in Belgium increased by 26.8% in 2013 to 1816 reported deaths. Figures for 2012, 2011 and 2010 were 1432, 1133 and 954 respectively and the increase since the first full year in 2003 is over 600%.

There is also widespread evidence of under-reporting. The Lancet recently published a long awaited meta-analysis study which indicated that in 2010, 23% of all euthanasia deaths were not reported meaning that the total number of deaths last year may not have been 4,188 but rather 5,151. 

Could similar under-reporting be happening in Oregon? It is a virtual certainty.

Oregon officials in charge of formulating annual reports have conceded ‘there’s no way to know if additional deaths went unreported’ because Oregon DHS ‘has no regulatory authority or resources to ensure compliance with the law’.

The DHS has to rely on the word of doctors who prescribe the lethal drugs. Referring to physicians’ reports, the reporting division admitted: ‘For that matter the entire account [received from a prescribing doctor] could have been a cock-and bull story.  We assume, however, that physicians were their usual careful and accurate selves.’

So with an Oregon law we can expect to see steadily increasing numbers of assisted suicide cases year on year in England and Wales, along with an unknown level of underreporting.

But that’s just one disturbing fact about assisted suicide in Oregon. There’s much much more to come.

Let’s not follow Oregon’s lead.

Twelve reasons to think twice about going the Oregon route on assisted suicide

Lord Falconer’s Assisted Dying Bill, due for a second reading in the House of Lords on 18 July, is purportedly based on the US state of Oregon’s Death with Dignity Act (DWDA).

Dignity in Dying, the former Voluntary Euthanasia Society, who are backing Falconer, claim that everything is wonderful in Oregon. But is that really true?

Over the next few weeks in the lead up to the bill being debated I will examine in more detail what is happening in Oregon and show that, far from being reassuring, the Oregon experience sounds a loud warning to the UK not to follow suit.

On 27 October 1997, Oregon enacted the DWDA which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal drugs, expressly prescribed by a physician for that purpose.

The Oregon DWDA also requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report.

These annual reports are all available on the Oregon government website and there is plenty of other relevant information in the public domain to draw on.

In order to qualify under the Act, a patient must be:

1. 18 years of age or older

2. A resident of Oregon

3. Capable of making and communicating health care decisions for him/herself

4. Diagnosed with a terminal illness that will lead to death within six (6) months.

It is up to the attending physician to determine whether these criteria have been met.

I have many concerns about the Oregon law which I will unpack in subsequent blog posts. Here is a list of twelve for starters:

1. There has been a steady increase in annual numbers of people undergoing assisted suicide in Oregon

2. The Oregon health department is funding assisted suicide but not treatment for some cancer patients

3. Patients are living for many years after having been prescribed lethal drugs for ‘terminal illness’ showing that the eligibility criteria are being stretched

4. There is strong circumstantial evidence of suicide contagion in Oregon with a disproportionate number of (un)assisted suicides

5. The vast majority of those choosing to kill themselves are doing so for existential reasons rather than on the basis of real medical symptoms 

6. Fewer than three per cent of patients are being referred for formal psychiatric or psychological evaluation

7. More than ten per cent of patients dying under the Act do not have terminal illnesses

8. Some doctors know the patient for less than a week before prescribing the lethal drugs

9. The fact that almost a third of patients dying under the Act report inadequate pain control or concerns about pain shows that palliative care provision in Oregon is unsatisfactory

10. The presence of no independent witnesses in over 80% of cases is a recipe for elder abuse

11. The demographic of patients dying under the Act is that of those susceptible to financial and elder abuse – white, well-educated and wealthy

12. According to research 25% of cases of assisted suicide in Oregon involve people who are clinically depressed 

The ‘Groningen protocol’ for euthanasia of disabled babies in the Netherlands

In an interview this morning on BBC Five Live (at 0705) on the Paul Lamb case (listen here) I was asked by the presenter Nicky Campbell about evidence for a slippery slope following the legalisation of euthanasia in other jurisdictions.

In my answer I mentioned the steady escalation in numbers of cases in Belgium and the Netherlands (see here and here) and said that one third of nurses had carried out euthanasia illegally in Belgium and that one third of cases in some parts of Belgium had been involuntary although the law did not allow this.

I also mentioned the ‘Groningen Protocol’ under which disabled babies had been given lethal injections in the Netherlands.

Campbell appeared not to know about this and asked me on air to email him information about it to which I agreed. Another BBC journalist phoned me after the interview to check my sources.

I sent her a link to the original paper on the ‘Groningen Protocol’ from the New England Medical Journal in 2005.

The full reference is ‘Verhagen E, Sauer P. "The Groningen Protocol—Euthenasia in Severely Ill Newborns." New England Journal of Medicine 2005; 352(10):959-62’

It says that ‘Twenty-two cases of euthanasia in newborns have been reported to district attorneys' offices in the Netherlands during the past seven years’ but also highlights underreporting:

‘Given that the national survey indicated that such procedures are performed in 15 to 20 newborns per year, the fact that an average of three cases were reported annually suggests that most cases are simply not being reported.’

The 22 babies killed all had spina bifida and/or hydrocephalus – conditions which many disabled people live with in Britain today (Here is another report on the protocol from CBHD citing the 22 documented cases).

Under the ‘Groningen Protocol’ the termination of a child's life (under age 12) is acceptable if four requirements were properly fulfilled:

1. The presence of hopeless and unbearable suffering
2. The consent of the parents to termination of life
3. Medical consultation having taken place
4. Careful execution of the termination

A more recent report suggests there has been a reduction in cases of direct newborn euthanasia in the Netherlands since 2005 because of 1. More efficient prenatal detection and late abortion 2. More use of ‘terminal sedation’ not recorded officially as euthanasia 3. Continued underreporting

Other issues I mentioned to the BBC in my email included:

1. Almost half of Belgium’s euthanasia nurses have admitted to killing without consent, despite the fact that involuntary euthanasia is illegal in Belgium and that nurses are not allowed to perform even voluntary euthanasia. 

2.  In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee. Legal requirements were more frequently not met in unreported cases than in reported cases and a written request for euthanasia was absent in 88%.

3. A recent study found that in the Flemish part of Belgium, 66 of 208 cases of ‘euthanasia’ (32%) occurred in the absence of request or consent.

4. According to a recent report Belgium is now the ‘world leader’ in organ removal after euthanasia with at least nine cases since 2005 but suggestions are that there would have been many more had more euthanasia patients had transplantable organs.

5. The stunning 5,000% increase in Belgian euthanasia cases in eleven years since legalisation.

6. Summary of recent developments in Netherlands documenting a 15-20% increase in euthanasia cases per year since 2006 (gives good overview of overall situation).

7. The latest Lancet paper on the subject giving 12.3% as the figure for terminal sedation deaths in the Netherlands and summarising other past papers in NEJM/Lancet

I gather that Nicky Campbell has since agreed on twitter with my opponent in the interview (Andrew Copson of the British Humanist Association) that I was ‘a past master in extreme and irrelevant claims’ (I'd be interested to hear his evidence for that btw) but at least he will be able to verify the truth of my claims about euthanasia in Belgium and the Netherlands from the links given above.

For ten year report on Euthanasia in Belgium see here.

Warning sounded to UK as Oregon assisted suicide deaths hit record high

Lord Falconer has just announced that he is about to introduce a new bill into the House of Lords to legalise assisted suicide along the lines of the Oregon model – assisted suicide for mentally competent adults who have less than six months to live.

Members of the House of Lords should note that statistics released just last month (full report here) show that the number of assisted suicide prescriptions and deaths in Oregon, once again, increased in 2012 and has now reached an all-time high.

Falconer’s bill, however, only requires a twelve month life expectancy and so is thereby even more liberal than Oregon’s.

There were 59 assisted suicide deaths in Oregon in 2009, 65 in 2010, 71 in 2011 and 77 in 2012; a 30% increase overall in just four years.

The number of prescriptions for assisted suicide was 95 in 2009, 97 in 2010, 114 in 2011 and 115 in 2012; 115 in 2012; a 21% increase since 2009.

Overall assisted suicides have gone from 16 in 1998 to 77 in 2012, an overall increase of 381% (see chart above).

This pattern of incremental extension is similar to that seen in the Netherlands and Switzerland, other countries that have changed the law.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC.

The Oregon numbers may not seem large but we need to remember that Oregon has a very small population relative to the UK and that they may well be an underestimate as they are based on physicians' self-reporting.

But for argument's sake let's simply take them at face value. How would they then translate to Britain?

Back in 2006, and based on Oregon’s total of 38 assisted suicide deaths in 2005, the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain.

But as the numbers in Oregon have since doubled to 77 the UK equivalent would now be 1,300. With Falconer’s more liberal interpretation of what constitutes ‘terminally ill’ the numbers here would be expected to be higher still.

Currently assisted suicide is illegal here and we see only 15-20 Britons going to Dignitas in Switzerland to die each year.

We should learn from the Oregon experience and be resisting these moves.

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed.

And once legalised there will inevitably be incremental extension as we have seen in Oregon, Switzerland and the Netherlands. Legalisation leads to normalisation.

Currently only two US states, Oregon and Washington, have legalised assisted suicide, each on the basis of a referendum.

By contrast whenever a bill has been brought before a US state parliament it has been defeated. This has happened over 120 times in the last 20 years.

Thirty-four states prohibit assisted suicide outright. Massachusetts and six other states have banned it through legal precedent.

It is often argued by the pro-euthanasia lobby that opposition to the legalisation of assisted suicide is largely faith-based. But this is not true.

In Massachusetts, a left leaning Democrat state which rejected assisted suicide in a referendum last year, the opposition of doctors and disabled people has been very significant indeed.

This is because one of the most powerful arguments against it is public safety – any change in the law will put pressure on vulnerable people to end their lives and no law can be adequately safeguarded against abuse.

I have previously blogged about the shroud of secrecy which surrounds assisted suicide practice in Oregon, the worrying trends in neighbouring Washington state, which enacted a similar law more recently and the way the Oregon law steers people toward suicide.

Also deeply concerning are reports of depressed patients being killed without being treated, doctor shopping, deaths taking place without witnesses present (raising questions about elder abuse) and the fact that 44 of the 77 who died last year (57%) said that they were concerned about being a burden on family, friends and caregivers.

The lessons are clear. Let’s not go there.

Warning to UK - Oregon Health Plan steers patients towards suicide

Members of the pro-euthanasia movement frequently point to the US state of Oregon, which legalised assisted suicide in 1997, as a model which Britain should follow.

Lord Falconer and Margo Macdonald MSP are two British politicians who have frequently sung the praises of Oregon which allows assisted suicide for mentally competent adults with less than six months to live (although Falconer’s and Macdonald’s recently proposed bills to be debated in the New Year are much more lax on their definition of ‘terminally ill’).

I have previously blogged about the huge increase in assisted suicide cases in Oregon since legalisation (see graph), the shroud of secrecy which surrounds assisted suicide practice there and the worrying trends in neighbouring Washington state which enacted a similar law more recently.

I was therefore interested to see on Margaret Dore’s ‘Choice is an Illusion’ site recently evidence of how the Oregon Health Plan is steering patients to suicide. Dore is an attorney in Washington.

Last Friday, the Canadian Department of Justice filed evidence in Leblanc v. Canada, including the affidavit of Oregon doctor Ken Stevens. Therein, Dr Stevens talks about his patient, Jeanette Hall. He also describes how with legal assisted suicide, the Oregon Health Plan steers patients to suicide.

The Oregon Health Plan is a government health plan administered by the State of Oregon.

If assisted suicide were to be legalised in Britain, a similar pattern could well ensue. If so, the taxpayer will pay for a patient to die, but not to live.

In a recent poll by Communicate Research 60% of Tory MPs said they believed that legalising assisted suicide in the current economic climate would increase the risk that vulnerable people might opt for suicide so as not to be a financial burden upon loved ones.

78% agreed that if doctors are allowed to prescribe lethal drugs to patients on request, vulnerable people could feel under pressure to opt for suicide.

The full text of Dr Stevens affidavit is here. It concludes as follows:

AFFIDAVIT OF KENNETH R. STEVENS, JR., MD

1. I am a doctor in Oregon USA where physician-assisted suicide is legal. I am also a Professor Emeritus and a former Chair of the Department of Radiation Oncology, Oregon Health & Science University, Portland, Oregon. I have treated thousands of patients with cancer.

2. In Oregon, our assisted suicide law applies to patients predicted to have less than six months to live. I write to clarify for the court that this does not necessarily mean that patients are dying.

3. In 2000, I had a cancer patient named Jeanette Hall. Another doctor had given her a terminal diagnosis of six months to a year to live, which was based on her not being treated for cancer. I understand that he had referred her to me.

4. At our first meeting, Jeanette told me plainly that she did not want to be treated and that was going to "do" our law,i.e., kill herself with a lethal dose of barbiturates. It was very much a settled decision.

5. I, personally, did not and do not believe in assisted suicide. I also believed that her cancer was treatable and that her prospects were good. She was not, however, interested in treatment. She had made up her mind, but she continued to see me.

6. On the third or fourth visit, I asked her about her family and learned that she had a son. I asked her how he would feel if she went through with her plan. Shortly after that, she agreed to be treated and she is still alive today. Indeed, she is thrilled to be alive. It's been twelve years.

7. For Jeanette, the mere presence of legal assisted suicide had steered her to suicide.

8. Today, for patients under the Oregon Health Plan (Medicaid), there is also a financial incentive to commit suicide: The Plan covers the cost. The Plan's "Statements of Intent for the April 1, 2012 Prioritized List of Health Services," states: "It is the intent of the [Oregon Health Services] Commission that services under ORS 127.800-127.897 (Oregon Death with Dignity Act) be covered for those that wish to avail themselves to those services."

9. Under the Oregon Health Plan, there is also a financial incentive towards suicide because the Plan will not necessarily pay for a patient's treatment. For example, patients with cancer are denied treatment if they have a "less than 24 months median survival with treatment" and fit other criteria. This is the Plan's "Guideline Note 12."

10. The term, "less than 24 months median survival with treatment,"means that statistically half the patients receiving treatment will live less than 24 months (two years) and the other half will live longer than two years.

11. Some of the patients living longer than two years will likely live far longer than two years, as much as five, ten or twenty years depending on the type of cancer. This is because there are always some people who beat the odds.

12. All such persons who fit within "Guideline Note 12" will nonetheless be denied treatment. Their suicides under Oregon's assisted suicide act will be covered.

13. I also write to clarify a difference between physician-assisted suicide and end-of-life palliative care in which dying patients receive medication for the intended purpose of relieving pain, which may incidentally hasten death. This is the principle of double effect. This is not physician-assisted suicide in which death is intended for patients who may or may not be dying anytime soon.

14. The Oregon Health Plan is a government health plan administered by the State of Oregon. If assisted suicide is legalized in Canada, your government health plan could follow a similar pattern. If so, the plan will pay for a patient to die, but not to live.

Assisted suicide deaths increase by 40% in one year in Washington State

The number of Washington state residents who died of physician-assisted suicide rose to 70 in 2011, up from 51 in 2010 and 36 in 2009, when the state’s Death With Dignity Act took effect.

The Washington State Dept. of Health reported in May that 103 patients requested and received lethal doses of medications from 80 different physicians in 2011.

In addition to the 70 who died after ingesting lethal drugs, 19 died of natural causes. An additional five died, but it is unclear whether they took the drugs. No reports were received for the remaining nine patients, indicating that they were still alive at year’s end.

The vast majority of the terminally ill patients who received life-ending drugs feared loss of autonomy, dignity and ability to participate in activities that make life enjoyable.

More than 90% were white, and 75% had at least some college education. Nearly 80% of the patients had cancer, said the report.

Seventy-one patients in neighbouring Oregon died of physician-assisted suicide in 2011. Since 1998, when Oregon’s first-of-its-kind law took effect, 753 patients in Oregon and Washington have died with physicians’ aid.

Just last month I highlighted the huge increase in deaths from assisted suicide in Oregon and Switzerland of 450% and 700% respectively over ten years as further evidence of the incremental extension that inevitably follows any change in the law. Washington is now showing the same pattern with almost a 100% increase in two years.

Assisted suicide thankfully remains illegal in Britain and we see only a small trickle of 15-20 Britons per year going to the Dignitas facility in Zurich to end their lives.

But with an Oregon- type law we would see 1,200 deaths annually.

It is no wonder that over 100 attempts to legalise assisted suicide in other US states have failed over the last 15 years and that Oregon and Washington remain the only states to have legalised the practice on the basis of a referendum.

Earlier this month Georgia became the latest US state to ban it.

Huge increase in assisted suicide cases in Oregon and Switzerland sounds strong warning to Britain

There has been a massive increase in cases of assisted suicide in both Oregon and Switzerland over recent years according to the latest figures.

The Oregon ‘Death with Dignity Act’ allows terminally-ill Oregonians ‘to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose’.

It also requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report.

The latest figures show that cases of assisted suicide have gone from 16 in 1998 to 71 in 2011, an increase of 450% (see chart).

The US state of Oregon legalised assisted suicide in 1997 following a referendum. Thus far over 100 attempts to get other US state parliaments to change their laws have failed and only the state of Washington has followed suit, again on the basis of a referendum.

Switzerland has seen a 700% increase in assisted suicides over the same period. Swiss authorities have recorded a steady rise of assisted suicides in recent years, from 43 in 1998 to 297 in 2009. Earlier figures are not available, even though assisted suicide has been legal in Switzerland since 1942.

These figures include only Swiss nationals and not the growing number of people from abroad who are making use of facilities like Dignitas.

The experience of both countries demonstrates that when assisted suicide is legalised there will inevitably be incremental extension.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC.

The Oregon and Swiss numbers may not seem large to some but we need to remember that Oregon and Switzerland have small populations relative to the UK.

Back in 2006 the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain. But given the increase of numbers in Oregon the UK equivalent would now be well over 1,000. Currently assisted suicide is illegal here and we see only 15-20 Britons going to Dignitas in Switzerland to die each year.

However, later this year we will see renewed attempts to change the law in this country.

Margo Macdonald is planning to present a bill based on the Oregon model to the Scottish Parliament and the pressure group Dignity in Dying (formerly the Voluntary Euthanasia) is planning a mass lobby of the Westminster Parliament on 4 July in support of a new bill they plan to introduce by means of their parliamentary wing, the All Party Group on ‘Choice at the End of Life’.

We should learn from the Oregon and Swiss experience and be resisting these moves.

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed.

And once legalised there will inevitably be incremental extension as we have seen in Oregon and Switzerland. Legalisation leads to normalisation.

Let’s not go there.

Shroud of Secrecy surrounds Assisted Suicide in Oregon

I was doing an interview on BBC Radio Wales this am on the Ottaway debate when a spokesman for Dignity in Dying (formerly the Voluntary Euthanasia Society) was again singing the praises of the law allowing assisted suicide in the US state of Oregon. The ‘Death with Dignity Act’ was passed there in 1997.

Back in 2006 the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain, whereas as currently we see only 15-20 going to Dignitas in Switzerland to die currently. But given the increase of numbers in Oregon the UK equivalent would now be well over 1,000.

Life Site News has just published a piece by Jonathan Imbody, which draws attention to the recent critique of the Public Health Department of the Oregon Health Authority’s report for physician-assisted suicides for the 2011 year by the Physicians for Compassionate Care Education.

They note the following:

•There were more prescriptions and deaths than in any previous year; the number of prescriptions written for lethal doses of barbiturates increased from 97 in 2010 to 114 in 2011, and the reported deaths from assisted suicide increased from 65 to 71. This is indicative of an increase in hopelessness and despair among a vulnerable population with serious illness.

•62 doctors wrote 114 prescriptions, with some writing up to 14 prescriptions each. Some doctors knew the patient for only one week before writing the prescriptions. It is known that some doctors are prominent prescribers of lethal barbiturates for assisted suicide.

•As has occurred in prior years, not all who attempt to take the drugs will die. Two patients ingested the medication but failed to die. Each regained consciousness and died more than a day later, 30 hours and 38 hours respectively, of their underlying illness; they were not considered to have died from the ingested drugs. These are not easy drugs to take, they are bitter and foul-tasting, and vomiting does occur despite anti-emetics.

•As in previous years, there was virtually no formal evaluation for underlying depression, anxiety or other serious mental health issue. Only one of the 71 patients was referred for psychiatric evaluation. OHSU researchers in 2008 reported that 25% of patients requesting assisted suicide were considered to be depressed.

•As in previous years, pain has not been a major concern; only one third of patients had inadequate pain control or concern about it. The most commonly expressed concerns of those dying from physician-assisted suicide were unchanged from previous reports: less able to engage in activities making life enjoyable, losing autonomy, and loss of dignity.

•In only six cases was the prescribing physician present at the time of ingestion, in 3 other cases another provider was present. Thus, very little is known or reported regarding events at the time of ingestion of the medications. For 62 patients there was either no provider present or the information regarding presence of a provider was unknown. Physicians appear to be disengaged with patients at the end.

•In essence then, complications were unknown for 59 patients, and any information regarding minutes between ingestion and unconsciousness and death was unknown for 63 patients.

•The shroud of secrecy surrounding assisted suicide is heavier than ever. With each passing year, Oregonians know less and less about what is really happening with assisted suicides in the state.

Ironic then that DID and Margo Macdonald MSP continue to pursue a law change based on the Oregon model.

Let’s learn from Oregon and not go in that direction.