Thursday, July 30, 2015

Who can get physician assisted suicide in Oregon

Under Oregon’s assisted suicide provision, the most recent official state report shows in the footnotes that a diabetic, persons with respiratory diseases, a person with viral hepatitis, and persons with HIV all obtained lethal prescriptions. These people are a far cry from those we envision as “terminally ill.”
Ann Cupolo Freeman, a board member of the Disability Rights Education & Defense Fund, explained some of the effects assisted suicide legislation could have on the disabled community. She said, “No assisted-suicide ‘safeguard’ can ever protect against coercion. In this era of managed care, will those living with a disability and the seriously ill be more likely offered lethal prescriptions in place of medical treatment? A prescription for 100 Seconal tablets costs far less than most medical treatments, especially considering the cost of long-term care for someone living with a disability.”

Wednesday, July 29, 2015

So much for Quality of Life Arguments (QOL)

Last Stand

E. Wesley Ely

The first time I saw Jessa, she lay crumpled in the ICU bed, paralyzed, expressionless and unable to speak. A military veteran, she had fought in Desert Storm, but she now was facing a deadlier and more inexorable foe: amyotrophic lateral sclerosis (ALS), aka Lou Gehrig's disease.

This disease causes progressive loss of muscle control, and Jessa was unable to speak, eat or breathe on her own. Her only means of communicating was through small facial movements--opening and closing her eyes or mouth, raising her eyebrows.

A dozen people made up her ICU team: three interns, three residents, a pharmacist, a nurse, a respiratory therapist, a social worker, a hospital chaplain and myself--the lead physician, or intensivist.

My intensivist mind, trained to seek solutions, skitters down a patient's problem list in search of answers. And Jessa's list was extensive: she needed a feeding tube, IV fluids, diapers and a special bed to prevent bed sores, antibiotics for a newly contracted pneumonia, intermittent sedation to ease anxiety and narcotics for chronic back pain.

But now, listening to the respirator pumping air into Jessa's lungs and felt her intense cobalt gaze on me, I saw one thing clearly: any concerns about antibiotics or nutrition took second place to a larger question.

"What do we know of Jessa's wishes about staying on a ventilator, now and in the coming weeks and months?" I asked the team when we stepped outside the room to confer.

"Her chart says that she wanted to be placed on a ventilator when she couldn't breathe on her own," said one resident.

"Look how long Stephen Hawking has lived that way," the nurse chimed in.

"I don't think we should look at someone else's life," another resident burst out, clearly frustrated. "She's suffering. I'd never want to live like this. She probably didn't know it would be this way when she requested life support."

I listened, having no strong opinion of my own as yet.

At that moment, Jessa's husband Zach walked into the ICU. We shared our concerns about Jessa's situation and asked him about her wishes.

Calmly, he replied, "Doctors, while it wouldn't necessarily be my choice, Jessa does want life support so that she can have as much time as possible with me and the people around her. She was raised to believe that all life, however frail, is sacred. It might seem paradoxical, but that was a key reason she joined the military--to defend life and freedom."

Later that morning, he shared his own wish: "Just make sure Jessa knows that she's not a burden, and that serving her is our privilege."

This conversation led to others over the next two weeks, and they sparked what I now see as a transformative period in my growth as a physician and in my understanding of patients like Jessa.

The next day, Zach told us more. "Jessa was born in Germany; she's bilingual. We've been married for twenty-seven years. We have no living children--we had several miscarriages. I'm all the family she has."

It had been Jessa's dream to serve as an American soldier. After they married, she enlisted and was deployed to Iraq as a diesel mechanic--one woman among over 1,000 men. "She got caught under a tank once and smashed her head getting out," Zach recounted. "They flew her to an army hospital in Germany, and she recovered and went back. She's tough as nails."

More than twenty years later, he said, she was diagnosed with ALS. "I've learned a ton from her about serving without concern for self," he added. "And now I'm learning even more. The amazing way she adjusts to whatever life throws at her....She's constantly recalibrating my vision of how to make the most of every moment. Like today, she's on that breathing machine, and she just smiled at me with her eyes."

In those few minutes, Zach revealed our silent, nearly motionless patient as a heroic person--someone I admired not only for her technological skills but for her pioneering attitude and resolve. I got an inkling of why she was fiercely holding onto the time she had left.

Still, some team members continued to see her quality of life (or QOL) as unacceptable. More than once, they called it "hellish."

When I told Zach this, he said, "Jessa once said she believes hell to be the absence of hope, just as cold is the absence of heat and darkness the absence of light. Now that you're getting to know her, can you see that she doesn't consider her illness hellish?" He whispered, "She's surrounded by love."

These discussions, as difficult as they were, marked a major shift in my understanding. I began to see how often I impose my own QOL standards onto patients--a fundamental clinical error.

Researching the empirical data, I learned that ALS and other "locked-in" patients often rate their QOL as acceptable despite their physical debility. Their focus shifts to less tangible qualities--transcendence, spirituality and security. Pondering this, I realized more and more clearly how, in this particular situation, it was Jessa's values and perceptions that mattered, not mine.

Our role, I saw, was to dive into the chaos of Jessa's life and offer her care and comfort despite our inability to cure her.

Over the next week, we worked with our palliative-care team to ease Jessa's pain, anxiety and delirium (which receded along with her pneumonia).

Every day, I made a point of remembering bioethicist Edmund Pellegrino's words: "Healing can occur when the patient is dying even when cure is impossible." With this in mind, I asked Zach if Jessa would enjoy being read to, as our team had done with other patients.

"Doc, she loves poems and the Psalms," he said immediately. We began to take turns reading to her every day.

On Jessa's last day with us before she was to leave for a long-term care facility, I chose Edna St. Vincent Millay's Sonnet XXX.

"Love can not fill the thickened lung with breath, nor clean the blood, nor set the fractured bone; yet many a man is making friends with death, even as I speak, for lack of love alone...."

As I read, Jessa's mouth opened wide, in a smile brighter than any we'd yet seen from her.

The medical student across the bed from me began to cry. "From joy and amazement," the student later said.

Seeing Jessa's smile and the student's tears, I felt my mind stop in its tracks. Time stood still.

Jessa had lifted us above the physical realities of our existence and into something mystical. I can't explain it, and I almost don't want to try. Let's just say that she gave us a private treasure, one that I will always savor as a gift I never expected or deserved.

I squeezed Jessa's hands, holding her eyes with mine. Finally she looked away and up to the ceiling, and I stood in thought beside her.

Although my team and I loomed over Jessa as she lay in her bed, I knew that in spirit she soared high above us.

About the author:

E. Wesley Ely is a professor of medicine at Vanderbilt University School of Medicine and associate director of aging research for the Tennessee Valley VA Geriatric Research Education and Clinical Centers. He has authored more than 275 peer-reviewed articles. He and his wife, Kim Ely, a surgical pathologist at Vanderbilt, have three lovely daughters. His reflective writing has appeared in the Wall Street Journal, JAMA, Annals of Internal Medicine and elsewhere. "I got into writing as an outgrowth of being raised by a single mom, Diana Ely, who was an English teacher and director of Shakespeare. Without this form of reflective writing, I'd never be able to process the immense gift of being immersed in the lives of countless wonderful patients, each of whom has a unique story and path."

Tuesday, July 28, 2015

Reverse Discrimination: Carter decision

        Held:  The appeal should be allowed. Section 241 (b) and s. 14  of the Criminal Code  unjustifiably infringe s. 7  of the Charter  and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

From the Carter judicial decision which was based on discrimination.  It seems clear to me that this means any one has the autonomy to ask for physician assisted suicide or lethal injection because the Honoursable Justices, the five of them, have said that  then according to the constitution it is legal.

Because of autonomy I am the only one that would know that I have an illness, disease or disability that would cause me enduring suffering that is intolerable.

Not just a few disabled people but now every single person in Canada can ask and get a safe and painless death at the hands of a physician.

To say otherwise, it is reverse discrimination.

Please address any comments to me:  604-321-2276, 778-689-2276,
5976 Cambie Street Vancouver, B.C., I might be wrong.  

Monday, July 27, 2015

Vermont/Belgium coerces patients towards euthanasia.

Vernont coerces patients towards euthanasia.  It is happening in British Columbia now with DNRs.  It is forcing patients into agreeing to them. Even if you get a lawyer, like we did, it will not end there.  The health authority like an agressive debt collector will batter and batter you.  I do not know what the purpose of a DNR is because a doctor will not do a heart resuscitation if you are too sick to benefit.  So no worries about broken ribs or brain damage. So what is the point.  Or maybe there isn't a point.  I would appreciate any clarification on this.  604-321-2276

MONDAY, JULY 27, 2015Are Vermonters Being Pressured to Use Act 39?

From True Dignity Vermont

Around one in five patients who choose euthanasia in the Netherlands acts under pressure from family members, according to a leading expert on the ethics of assisted dying, as reported last week in Dutch News:

 According to the report, Professor Theo Boer, who teaches ethics at Groningen’s Protestant Theological University and has for nine years served as a member of one of five review committees that assess every euthanasia case, said, “Sometimes it’s the family who go to the doctor. Other times it’s the patient saying they don’t want their family to suffer. And you hear anecdotally of families saying: ‘Mum, there’s always euthanasia.’”

Here in Vermont, where physician-assisted suicide has been legal for just two years, cases of pressure are already starting to emerge, and it isn’t always family members providing the pressure. True Dignity has spoken with the family of a 90-year-old Medicaid patient who felt pressured by caregivers in the facility where she was admitted for recovery from a fall. The patient did not have a terminal diagnosis.

According to Beth Neill, clinicians at the Berlin Health and Rehab Center informed her mother at regular intervals during her 4-month stay there that she had a “right” to use Act 39, and that, “She didn’t even have to discuss it with her family.” It was the act of repeatedly bringing up Act 39 as a health care “option” that caused her mother to feel pressure, and not overt efforts by clinicians to convince her to request the lethal prescription, Neill said. However, she said her mother made it clear she wanted nothing to do with Act 39 and was disturbed that staff re-introduced the topic repeatedly.

Neill notes that her mother was, and is, in otherwise surprisingly good health for her age, and would not have qualified for Act 39, as the extended stay in Berlin Health and Rehab was strictly for help recovering from her fall.

Neill was not made aware of the situation at Berlin Health and Rehab until after her mother had already been moved to assisted living at a Northfield facility, where she currently resides. When she did hear of it, “It blew my eyebrows off,” she said.

According to Neill, the staff at the Northfield facility informed her that her mother had reacted strongly when they began to discuss care options. “Mom thought they were going to start talking about Act 39, the way they did at Berlin (Health and Rehab), and she blew up at them. She said, ‘I don’t want anyone talking to me about killing myself.’”

That’s when it came out that the staff at Berlin Health and Rehab had talked to her more than once about her “right” to request a lethal prescription. “I recalled then that my mother had been very eager to get out of there, and I had noticed that she seemed frustrated and unhappy, but I didn’t know why,” Neill explained.

Her mother told her that the staff at the Berlin facility specifically stated that Act 39 “is the law,” and in her words, “They said she could ‘off’ herself any time she wanted to.” She told her physician, who adamantly opposes Act 39, “They want me to take a bunch of pills and kill myself.”

Clearly, confusion abounds regarding the duties of medical caregivers with respect to Act 39. Vermont’s “affirmative duty to inform” under the Patient Rights Act requires that health care providers let patients know of all available treatment options, but it is not clear how this is understood to apply to Act 39 . Beth Neill’s mother did not have a terminal diagnosis and would not have been eligible for a lethal prescription under Vermont’s law.  Asked why she was informed of this “treatment option” by health care workers at his facility, John O’Donnell, Executive Director of Berlin Health and Rehab, declined to reply.

True Dignity also was unable to get answers from Berlin Health and Rehab to explain where staff received training around the implementation of Act 39 and what the facility’s official policy is on assisted suicide.

We can only speculate about where some information may be coming from. In a letter to members, the well-funded pro-assisted-suicide group Patient Choices Vermont, an arm of the national organization Compassion and Choices, says that the group Compassion and Choices Vermont has been doing “extensive work educating patients, medical providers and institutions, as well as assisting individuals” to find the “resources they need.” The letter also states, “While details are still being determined, PCV will have an important role to play as health department regulations are developed (and) insurance coverage issues are dealt with.”

We do not know whether or not this group had a hand in helping “educate” staff at the nursing home where Beth Neill’s mother felt pressured to use Act 39. At present, there is no oversight mandated by Act 39 to prevent abuse, and the only other organization we are aware of with resources and staff to educate health care providers about Act 39 is the Vermont Ethics Network, which also receives funding from Compassion and Choices.

States are prohibited from using Medicaid dollars to cover costs associated with physician assisted suicide, but it is unclear whether there are provisions in the State-sponsored Green Mountain Care Medicaid to pay for drugs and doctor visits for patients requesting Act 39.

Because Act 39 contains few safeguards and almost no reporting requirements, it seems that questions will be more abundant than answers for the foreseeable future.

Thanks to a strong family support system and a personal physician who is opposed to assisted suicide, Beth Neill’s mother was able to resist pressure to consider using Act 39. What is unknown is how many other vulnerable individuals are feeling pressure today from family or caregivers, and may eventually succumb, as physician assisted suicide becomes entrenched in Vermont and aggressively promoted by those who may operate from motives at odds with the best interests of the patient.

The Canadian Bill 51.

I went to a talk yesterday about the passing of the Canadian Bill 51 (oka the secret police bill) by the BCCLA.  From what I understood because Bill 51 is an investigative law (not a criminal law), it does not have to share information over those that they are spying on.  If I am correct then the BC College of Physicians and Surgeons must have the same power.  When I complained to the College about Dr. James Dunne putting an unauthorized DNR on Randy, they refused to send me a copy of Dr. Dunne's response to my allegation.  How was I to rebut anything Dunne said or even appeal the eventual decision that Dr. Dunne did no wrong if I wasn't aware of what Dunne's position was. Bill 51 is over privacy; it isn't over deeming who should live or die.

Any comments phone me 604-321-2276 or email at

Sunday, July 26, 2015

Lifting the Veil on Euthanasia

This is a must read to understand what is happening with euthanasia in Belgium.  Not good.

Friday, July 17, 2015

Randy's Stuff and Ro Ang and the Carter decision

I still haven't completely unpacked Randy's stuff from George Pearson Centre. Even getting his stuff was difficult.  Ro Ang, the manageress, decided that I couldn't even get a few articles from his belongings so I could place them in his coffin as they belonged to the Public Guardian and Trustee.  She had his stuff thrown in plastic garbage bags and put in a public area so anyone could access them.

She won't even let me go to his memorial service at George Pearson Centre.  I will never forgive her for that.

I cannot understand her. A woman who is a Christian, goes to church each Sunday, and visits her mother in a rest home daily.  She is guilty of doubling.  She has two lives.  The one at work; and the one off work.  One morality for herself off-site and one for her charges who she has conduct until they die and they do die. They all have DNRs and DNTs.  A death sentence.  That is the purpose of George Pearson she told me in front of a witness. Even an undertaker has more compassion than her.  She was part of the group that decided that I should never see Randy again so he would die alone.  And he did die alone. Although I finally got a court order, it was too late, he did not know I was there. How could they do this.

Where do these ill-trained dysfunctional medical frontline professionals come from. She was part of the legion who decided that I wasn't good for Randy and she and others made sure that my power of attorney was taken away from me as well as my representation agreement. I went to see Randy every single day that they allowed me to. The reason I wasn't good for Randy was because Randy wanted to live and I fought for this and GPC wanted him to die. With all the $resources that VCH has they could not accommodate Randy so he could be with me as he died.  What was I suppose to do, go into a patient's room with a teddy bear which was what caused me to be banned in 2011.  There is no excuse for what they did.  To date I have no detail knowledge of the legal reasons for the assessment except a letter dated April 4 2014 that usurped my powers without explanation.

April 4 2014 was also the day I went to George Pearson Centre with a pro bono lawyer to see Randy and Ro said I couldn't see Randy.  Randy died April 13 2014.

I am sure it was Ro who instructed the RT who I asked to give evidence at a hearing at the College of Physicians and Surgeons not to, as to do so might change the outcome of the hearing.  GPC couldn't have anyone tell the truth to the College.

There is a saying about tangled webs being woven when one attempts to deceive.This is true of VCH.

And to think that I can get the medical profession to kill me (Carter decision) as I haven't been able to get a hearing (i.e. an independent investigation as promised by Kip Woodward, the Chair of Vancouver Coastal Health, in 2011 as to why I was bullied and subsequently banned by VCH) as the psychological pain "guilt" as not doing enough to save Randy's life is intolerable. The doctors according to the law and constitution will have to kill me: a welcomed painless death, if I asked them.  It is not their call; it is mine. This is "autonomy" of the individual. The Supreme Court decision is so broad, it is ridiculous.

And do not think this won't happen, because of confidentiality between patient and doctor, no one would know. Think again. You can die and your family need never know because as in life and in death you have the right to confidentiality and so do the doctors.

Section 241 (b) and s. 14  of the Criminal Code  unjustifiably infringe s. 7  of the Charter  and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

Audrey Jane Laferriere
5976 Cambie Street
Vancouver, B.C.
V5X  3A7
17 July 2015


Wednesday, July 15, 2015

Is the Canadian goverment behind Euthanasia to save money.

Saturday, July 11, 2015

Trust doctors and the medical associations. I think not.

Read this.  Also an account is found in Newsweek and People Magazine.

When a whistleblower attempted to bring to the attention of the Michigan medical association that Dr. Farid Fata was deliberately poisoning  his patients by over treatment, upon its investigation, the regulator said he did no wrong.

Following the money the US government was able to prove that Dr. Fata, a world renowned cancer doctor, was guilty of fraud $35 million and he was sentenced to 45 years in jail.

Dr. Fata by over treating patients caused death and injury to his patients.  His motive was money.

Considering the vastness of this fraud, hundreds of  medical professionals knew or should have known what was going on but did nothing.

When I laid a complaint with the BC College of Physicians and Surgeons I asked a professional employee from Randys medical team at George Person Center of Vancouver Coastal Health to give evidence and I was told by Risk Management that since she was an employee of VCH, VCH would not allow her to say anything.  I do not understand how this is possible. I speculate that telling the truth is against the rule of law in the medical profession. How devastating for employees to work under this tyranny.

Monday, July 6, 2015

Godelieva De Troyer and the dirty deed

Because of Metro Vancouver issuing an air quality advisory because of the climate heat and the smoke in the air, I am staying in until the advisory is lifted.  I am seventy years old and I do not do well in the heat.  The last thing I need is tiny little microns penetrating my respiratory system.  The heat is very uncomfortable.

In The New Yorker there is a letter from Belgium in the June 22 2015 issue: The
Death Treatment.  When should people with a non-terminal illness be helped to die. by Rachel Aviv It tells of a death by euthanasia in which only the doctors knew and the family was not notified until after the dirty deed.  The tragedy of this death was that the woman was not terminally ill or in her nineties. 

The son (Tom Mortier) screamed at the doctor (Wim Distelmans) who did the dirty deed .  You went along with the madness of my mother.  You went along with her tunnel vision, her defeatism.  You have taken away the suffering of one person and transposed it to another.

Belgian law allows euthanasia for patients who suffer from severe and incurable distress including psychological disorders.

The laws seem to have created a new conception of suicide as a medical treatment, stripped of its tragic dimensions.  Patrick Wyffels, a Belgian family doctor, told Rachel Aviv that he sometimes worries about how his own values might influence a patients decision to die or to live.  Depending on communication techniques, Dr. Wyffeks said he might lead a patient one way or the other.


Sunday, July 5, 2015

Read the draft of the CMA on euthanasia with fear.

This link is the draft that the Canadian Medical Association is proposing on how doctors are to handle euthanasia.

The only way to counter the Carter decision is for real doctors to refuse to do the dirty deed.  


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