Peering over the edge into assisted suicide

In today's Toronto Star, I address the issue of assisted suicide -- and the argument that euthanasia is practiced so often in hospitals in all but name, that we should consider simply legalizing it.

Starving to death in a hospital bed is a horrible way to die, says an expert on the ethics of death, and it may be time to allow more overt ways of ending the lives of the terminally ill.

Wayne Sumner, a University of Toronto philosophy professor writing a book on assisted suicide, says while euthanasia is illegal in Canada, terminally ill patients or their families can refuse food, water and life-sustaining treatment.

"We tip-toe up to the barrier," says Wayne Sumner, who will speak about assisted suicide at UofT's Joint Centre for Bioethics on Wednesday afternoon.

"We peer over the edge, but seem reluctant to take that next step."

Sumner says there is no practical difference between letting someone starve to death, as is now done when feeding tubes are removed, and the more overt act of instructing a doctor to inject a lethal dose of medication to hasten death.

"If someone is refusing food and water, it's hard to see that the intention is anything but death," he says.

As such, he says, Canada should consider taking euthanasia out of the Criminal Code.

The peg for the story is a seminar to be given this afternoon by the University of Toronto's Joint Centre for Bioethics at their new home at 155 College St., Ste. 754, in Toronto. The centre often webcasts its seminars. Sumner will outline how he came to his conclusions, by addressing the agruments against allowing assisted suicide. Dr. Lawrence Librach of the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital will provide commentary.

Moira McQueen, director of the Canadian Catholic Bioethics Institute, does not agree with Sumner that taking the next step to allow euthanasia would be the compassionate thing to do, as a way of alleviating suffering for both patients and family under the current system.

Every patient, she says,  has the right to refuse treatment or food, and let nature take its course.

"With euthanasia, you're not letting anything take its course," she says.

It is too big a leap to say that because people can refuse treatment or nourishment, they should actively take their own lives, she says.

"We all want to be compassionate, but we want to make sure we're doing the right thing, too."

A private member's bill by Bloc Quebecois MP Francine Lalonde to allow doctor-assisted suicide is currently before Parliament. Assisted suicide is allowed in three U.S. states – Oregon, Montana and Washington state – and in Belgium, Luxemburg, the Netherlands and Switzerland.

A Swiss clinic, Dignitas, has become a destination for people around the world seeking physician-assisted suicide, with more than 1,000 people travelling to Zurich since the clinic opened 12 years ago – including 10 from Canada. The Swiss government is now considering restricting suicides by foreigners, with Justice Minister Eveline Widmer-Schlumpf saying last October, "As a country, we aren't interested in attracting suicide tourism."

Sumner said the move could put political pressure on other governments to allow assisted suicide, since people will soon no longer have the option of flying out of the country for the procedure.

The ethics of birth and death

A couple of interesting stories in the Toronto Star this morning, looking at two medical ethics issues. I was out of town, so didn't write either.

The first looked at when a woman is too old to have a baby, sparked by the death of Maria del Carmen Bousada, who gave birth to twins in December 2006 at age 66.

When it comes to motherhood, how old is too old?

Fertility experts and ethicists re-examined that question yesterday after hearing that a 69-year-old Spanish mother died Saturday, leaving behind 2-year-old twins conceived with a younger woman's eggs and donated sperm.

Maria del Carmen Bousada is believed to have been the world's oldest new mother. She gave birth in December 2006, shortly before her 67th birthday, after telling a clinic in Los Angeles she was 55, the facility's maximum age for single women receiving in-vitro fertilization.

The story goes on to outline the medical reasons for most in-vitro clinics to refuse the treatment to older patients -- the children have more health problrms -- and concluded with Margaret Somerville of McGill questioning whether medical science should be used to do things that are impossible in nature, rather than just stepping in when nature fails.

The other story looked at the other end of the spectrum. Pegged to the assisted suicide death of British conductor Edward Downes and his wife, Joan, at a Swiss clinic it asked whether more countries, including Canada, should allow assisted suicide.

"Whenever it's in the news, we know this comes up again and again," said Olga Krassioukova-Enns, executive director of the Winnipeg-based Canadian Centre for Disability Issues. "This issue, this question, affects people with disabilities and seniors and anyone part of a family."

In May, Bloc Québécois MP Francine Lalonde of Montreal reintroduced a private members' bill to amend the Criminal Code to allow assisted suicide. A similar one she introduced in 2005 failed.

A number of high-profile cases in Quebec recently drove her to try to get the bill passed again.

"We need to have this in order to allow people to make their own choice under certain conditions when the time is right for them to die," said Lalonde yesterday.

Last year, a Quebec man was acquitted after he was charged with helping his disabled uncle commit suicide. A Vancouver man was charged in May with giving his friend a loaded shotgun and a demonstration on how to use the weapon to commit suicide.

Alex Schadenberg, founder of Euthanasia Prevention Coalition, said Canadians want better end-of-life care. The mindset that older people and those with disabilities don't want to live as long as possible is a misconception, he said.

Pope gives Obama a bioethics lesson

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

Pope gives Obama a bioethics lesson

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

Pope gives Obama a bioethics lesson

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

Human eggs for sale

New York State has become the first US state to begin paying women for their eggs for use in stem cell research.

The Empire State Stem Cell Board (ESSCB), which oversees New York's $600 million stem cell research program that was launched last year, came to the decision last week (June 11) following "extensive deliberation" from its ethics committee.

"The Board agreed that it is ethical and appropriate for women donating oocytes for research purposes to be compensated in the same manner as women who donate oocytes for reproductive purposes and for such payments to be reimbursable as an allowable expense" under state taxpayer-backed grants, the ESSCB wrote in a statement.

The board noted that researchers in other states that ban financial reimbursement have mostly failed to recruit women to donate eggs for free.

Ethicists are split

"I don't think it's a good idea," Arthur Caplan, a bioethicist at the University of Pennsylvania, told The Scientist. It's "more ethically acceptable" to pay women to harvest eggs for in vitro fertilization programs because donor eggs have proven successful in assisted fertility treatments. With stem cell research, "the risk benefit ratio starts to slide," Caplan said. "It's a lot iffier a proposition and I think that makes a difference. In research you don't know what you're going to get, and the odds are that cloning for research is never going to work." ...

Ronald M. Green, a bioethicist at Dartmouth College in New Hampshire, said he's "glad to see" the ESSCB's decision. Green, who serves pro bono on the ethics advisory board of Advanced Cell Technology, a Massachusetts-based biotech company, said that it's ethical and necessary to pay women to donate eggs for stem cell research if researchers want to investigate the potential of therapeutic cloning. "It's discriminatory and sexist not to pay for eggs," Green said, noting that men can be paid for sperm. "It is paternalistic and protective to say that [women] can't make this decision."

But many critics, including Father Thomas Berg, director of the Catholic think tank Westchester Institute for Ethics & the Human Person, argue that compensation will lead to the exploitation of poor and disenfranchised women. Paying women as much as $10,000 -- the upper limit under the ESSCB's directives -- will "create an undue inducement" that will put vulnerable women at risk, he said. "It's precedent setting."

 

The ultimate silk purse

Researchers in China claim to have figured out a way to coax cells from any part of a pig's body -- they used cells from a pig's ear and bone marrow -- into any type of cell in the body, just like embryonic stem cells.

The breakthough could set the stage for pigs being raised to grow organs for humans for transplantation, the researchers say.

Lead researcher Dr Lei Xiao, of the Shanghai Institute of Biochemistry and Cell Biology, said many other attempts had been made to transform adult cells from animals such as pigs into "pluripotent" stem cells, but they had failed.

He said: "Therefore, it is entirely new, very important and has a number of applications for both human and animal health."

Dr Xiao's team reprogrammed cells taken from a pig's ear and bone marrow, using a cocktail of chemicals introduced into the cells via a virus.

Tests showed that the reprogrammed cells were capable of becoming any of the cell types that make up the three layers in a developing embryo.

Dr Xiao said pigs were a potentially ideal source of organs for transplant, as their organs were similar in function and size to those found in humans.

In its blog,the American Journal of Bioethcis quipped that the breakthrough could help save the pig's reputation after the swine flu scare.

Medical researchers have long looked to pigs as a potential source of human organs in a field known as xenotransplantation, saying it could help with chronic shortages of organs from transplant.

Professor Chris Mason, an expert in regenerative medicine at University College London, said: "This breakthrough to produce pig stem cells potentially reinvigorates the quest to grow humanised pig organs such as pancreases for diabetics and kidneys for chronic renal failure.

"The clinical use of humanised porcine tissues and organs (xenografts) has moved a long way forward in recent months with successful small-scale clinical trials.

There's a certain "yuck" factor for many people, however, and animal rights activists and religious groups have objected to the idea.

Dr Sebastien Farnaud, science director of the Dr Hadwen Trust for Humane Research, said: "Persisting with highly speculative research that would see us use sentient animals as little more that living organ grow-bags, is not only ethically unsupportable but also scientifically dubious.

"Creating pig stem cells does not necessarily remove the risk of organ rejection but even more worrying is the risk of infecting patients and the wider public with pig viruses."

The ethics of death

Partly as a follow up to the saga of Kaylee Wallace at Toronto's Sick Kids Hospital and partly because I have been thinking about the issue for a while, I wrote a couple of stories published in the Toronto Star today looking at death, how we handle it and how we define it.

Dead is dead, except when it's not.

"Death used to be a little more self-evident," says Kerry Bowman, a medical ethicist specializing in end of life issues at the University of Toronto's Joint Centre for Bioethics.

"Today, you're dead when the doctor says you are."

Deciding when somebody is dead or about to die is quickly emerging as one of the top ethical issues in medicine today as technology makes it increasingly possible to keep people alive who would otherwise have died not so long ago.

"The technology has far outstripped the ethics," says Tim Falconer, author of That Good Night: Ethicists, Euthanasia and End-of-Life Care. "Feeding tubes and ventilators weren't designed to keep people alive for 15 years, but that's what they're being used for."

As well, says Bowman, with organ transplants more common, deciding the precise moment of death has become vital, since under the "dead donor rule" organs can only be harvested once the donor has died. And the sooner after death that happens, the healthier the organs will be.

Fro the rest of the story, click here.

In a companion piece, I also take a closer look at Falconer's book, which I blogged about last week.

Tim Falconer didn't set out to write a book about death. It just worked out that way.

He planned to write about ethicists and the growing role they seem to be playing in our modern lives – from business to government to medicine – and explain how they do their jobs.

But like any journalist, he was attracted like a bug to light to the most intriguing stories. Those were the ones about death and end-of-life ethical issues.

In That Good Night: Ethicists, Euthanasia and End-of-Life Care, which takes its name from the Dylan Thomas poem Do Not Go Gentle Into That Good Night, Falconer takes the reader on his journey through the increasingly ethically complicated ways death is handled in modern society – particularly in hospitals.

Few of us, he says, are prepared.

"We go through life knowing we are going to die, and then it's a surprise when it happens," says Falconer, a magazine writer and journalism professor at Ryerson University.

With all the machines that can keep us alive today, the medications and the medical advances, death, Falconer says, is increasingly more of a "negotiated event" than a sudden thing.

For the rest of the story, click here.

 

Book guides us into That Good Night

Here's something I didn't know until I read the latest book by Toronto-based magazine writer and Ryerson University instructor Tim Falconer, That Good Night: Ethicists, Euthanasia and End of Life Care:

The word Euthanasia comes from the Greek for "Good Death."

Leaving aside the question of whether I should have known the origins of the word euthanasia (today's schools aren't big on ancient Greek), it says a lot, I think, about how modern society has come to view death since this word was first coined.

In our society, post-eugenics and post Nazi-ism, the word euthanasia has much darker connotations than a literal translation would suggest. Today, it conjures up images of cruelty, designer babies and a world in which some people are ranked ahead of others (and other ranked as lesser beings).

With all that baggage, it is hardly surprising that so many people -- particularly from the disabled community -- have been so vocal in their opposition to anything that might make euthanasia possible in Canada. In North America, only Oregon and Washington state have euthanasia laws, with Pennsylvania currently considering legislation.

Falconer would like to see euthanasia and assisted suicide laws in Canada, with strict controls. He's not optimistic it will happen any time soon, however. A full story will appear int eh Toronto Star soon.

Assisted suicide considered in Pennsylvania

Pennsylvania may soon become the third state in the U.S. to allow assisted suicide.

The Death with Dignity Act is based on the Oregon law that allows physicians to prescribe lethal amounts of medication to the terminally ill at the patient's request.

"Most people do not choose to end their lives," said Dr. Arthur Caplan, the director of the department of medical ethics at the University of Pennsylvania. "Most just like having the fallback to choose to do it."

According to Oregon's annual report on the Death with Dignity Act, the average age of a person who has died under the law is 72. Among those who have died, 80 percent had cancer and 97 percent died in their homes.

Challengers of the bill argue the legislation undermines the healing and life-preserving functions of the medical system. Caplan, who did not say whether he supports the bill, said many opponents feel it'll be a "slippery slope" if the bill is passed and fear the law will be wrongly used against mentally ill or disabled persons.

Earlier this month, Washington became the second state to allow assisted suicide after voters in November approved the move. Washington's law is also based on Oregon's, which has had an assisted suicide law for more than a decade.

Under the (Pennsylvania) bill's guidelines, those who seek to end their lives would have to be diagnosed with a fatal disease that leaves them six months or less to live. Patients have to be conscious, at least 18 years of age and of sound mind to put in a request.

Doctors are also required to inform patients of alternatives to suicide, including hospice care and a variety of pain medications.

For the patient to be prescribed the lethal medications, they would have to file a verbal and written request and then be evaluated by doctors and psychologists who are unrelated to that patient's health care providers.

The suicide option would only be available for in-state residents to prevent terminally ill from collecting in the state of Pennsylvania.

A report last year found that while few people in Oregon actually chose assisted suicide, many more consider it and discussed the possibility with doctors and family members. Many also reported taking comfort from the knowledge that the option was there, even if it isn't used.

This is the second time Democratic Senator Daylin Leach has tried to get such a bill passed.