ISSN #1481-7314 Vol. 8, No. 3 Jul. - Sep. 2006

A QUARTERLY NEWSLETTER BY AND FOR THE MEMBERS OF: Choice in Dying - Ottawa Dying With Dignity Society of Canada

Sharma is free on $50,000 bail and is no husband John visited her every day; NEWS longer working as a doctor in the area. hospital staff members noticed that they were very devoted to each other. Unfortunately, John also was having in Canada Market Research Done? medical problems. He had suffered a series An August 5 Vancouver Sun story of small strokes, and since then had been Vernon Is Not Lugano or Zurich reported the theft of some drugs from a having memory difficulties. veterinarian’s car. The thief discarded At some point Lorna and John were told As was mentioned in the first 2006 much of the loot but kept 11 vials contain- that Lorna would not be able to live at home issue of Free To Go, nursing homes in ing “a number of different drugs used for any more. When she was well enough to the Swiss cities of Lugano and Zurich have euthanizing or operating on animals”. leave the hospital, she was to be transferred been allowing residents to receive These drugs likely included pento- to a nursing home. assistance (from the group called Exit) for barbital and thiopental. For aid in dying, Both partners probably accepted this, at several years now. pentobarbital (a veterinary euthanatic) is first; John spoke with the manager of his But things are not at that stage in the drug most frequently used when the apartment building about having to move, Vernon BC. substance is to be swallowed (e.g. for presumably to a smaller place since he 92-year-old Ruth Wolfe, who describes , in Oregon and Switzer- would be without his wife. herself as having a sharp mind but a failing land); the anaesthetic thiopental is norm- But in talking to CTV News about this body, lives in a Vernon nursing home. Dr. ally used when the drug is to be injected conversation, Lawrence Isaac added “I don’t Ramesh Sharma had been her physician for (e.g. for , in Belgium and the think they ever spent any time apart.” And a long time. In early July, staff at the home Netherlands). ultimately John seems to have decided that found that Wolfe was in possession of drugs Perhaps some enterprising Vancouver living separately would not really be living. which would likely have killed her if she resident has hopes of making a few sales to On August 29, when he visited Lorna as had taken them all at once and managed to people who want to escape pharmaceut- usual to join her for lunch, he shot her keep them down. ically but lack the money or the strength for fatally and then did the same thing to Dr. Sharma has been charged with a trip to Mexico . . . himself. aiding a person to commit suicide. (The A Penticton police officer was quoted as saying “The only thing we really don’t know law explicitly says that it is immaterial Separate Lives Rejected whether the suicide is completed or not.) is the motive.” Perhaps police assume that Wolfe is standing by her doctor and has 80-year-old Lorna McCadden, of death is always given out of hatred or rage, stated that she feels he should not be pros- Penticton BC, had been in failing health and are puzzled by John’s action; but many ecuted. Many Vernon residents are also for quite some time and was hospitalized others can understand it, albeit sadly. speaking up on his behalf. during the summer. Her 77-year-old The World Com es to Canada Discussion topics in other sessions in- controlling the flow of helium from a cluded: balloon-kit tank. Other presenters included In early September the Canadian group • Aid-in-Dying and Faith , Dr. Richard MacDonald, Dying With Dignity hosted the 16th Biennial • Engaging the Disability Community Russel Ogden, Dr. Aycke Smook, and Dr. Conference of the World Federation of Right • Who Decides? (taught a special “Delib- Charles Whitcher. to Die Societies, at the downtown Sheraton eration” process for raising awareness) To get a “you-were-there” feeling about hotel in . It was the first time the • What’s Working, and Why? the conference, see the photos on the next conference had been held in Canada. At the Friday evening banquet, diners page C The Federation embraces 38 groups, were edified and entertained by Dr. Robert from 23 countries. One of the groups is Buckman, a physician who has a gift for over 70 years old (the England-and-Wales sharing his broad knowledge and his deep Assorted Updates group) and one is younger than 6. Most insight in absolutely delightful ways. groups were formed during the 70s, 80s, The keynote speaker on Saturday was to 1) Regarding Francine Lalonde: and 90s. The official date for the founding have been Evelyn Martens, who needs no Lalonde has had surgery for a cancerous of the Federation is 1980, though inter- introduction to readers of this newsletter. condition in her spine. She is reducing her national right-to-die conferences had also Unfortunately she had recently undergone level of political activity while she recovers, been held in 1976 and 1978. emergency heart surgery and was advised but her friends note that she is “combative” The groups range in size from under against flying from Victoria to Toronto. Her in many ways (and in both languages). 500 (5 groups) to over 100,000 (2 groups, close friend Brenda Hurn, who had shared in Japan and in the Netherlands). In terms to some extent in Evelyn’s compassionate 2) Regarding : of what might be called “r-t-d density”, the work and also in her prosecution ordeal, There has been a small change in Latimer’s leader is Switzerland; 1 in every 114 Swiss read her speech for her. postal address. It is now citizens belongs to a right-to-die group. The The topics for the remaining Saturday 6000 William Head Road Netherlands is close behind, at 1 in 155, sessions were: Victoria, BC and Luxembourg comes in third, at 1 in • Nudging the Law V9C 0B5 518. (Canada scores about 1 in 8403.) • The New Censorship Conference delegates from outside Can- • Client Support Programs 3) Regarding refusal of food and fluids, in ada who might have been worried about • Aid-in-Dying and Hospice Quebec: bitter cold had their fears relieved: “warm • Increasing Group Membership In FTG 8:2 an article mentioned a Quebec and pleasant” would have been an accurate • Legislative Change “vs” (?) Activism woman who said she had been told “You description of the weather, and also of the On Saturday evening delegates were torn can’t refuse them (food and fluids).” From welcome from their Canadian colleagues. between watching several right-to-die films subsequent conversations it has become The conference began on the evening of and dropping in on the reception hosted by clear that the emphasis was on “You”, in Wednesday Sept. 6, with a reception for Network. To judge by traffic in the statement quoted. The woman who board members and delegates of the World the halls and congestion in the reception spoke with me suffers from a degenerative Federation. room, many people succeeded in multi- neurological condition, and the people she Thursday was devoted to special pre- tasking! queried knew this. Although refusal of food sentations sponsored by Compassion and The conference ended on Sunday morn- and fluids is theoretically possible for any Choices. Attendance was not restricted to ing with an unofficial but very popular Quebecer, in practice it is available mainly C&C members, and from the size of the event, a “show and tell” session involving to end-stage cancer patients. People with crowd it appeared that many other delegates many of the experts working on new tech- diseases such as MS and ALS may not be had responded to the open-door policy. nology for self-deliverance, or NuTech for allowed to hasten their deaths by this Friday was the first day of the conference short. Dr. showed the film method, at least not in most institutions or proper. The two keynote speakers were that was made of the first “Peanut Project” not until the facility’s staff members con- George Felos (Michael Schiavo’s attorney) (pentobarbital synthesis) weekend, and sider that the patient has arrived at “the and Lord Joel Joffe (sponsor of repeated several of his lively Australian colleagues right stage”. attempts to legalize aid in dying in the UK). explained how to make various devices for

Page 2 Free To Go Vol.8, No.3 Jul.- Sep. 2006 DWD display RTDSC display

Derek Humphry greeting Final Exit readers Boudewijn Chabot and Russel Ogden selling and other friends Guide to a Humane Self-Chosen Death

Reception hosted by Delegate Yvon Bureau Brenda Hurn reading from Quebec City Evelyn Martens’ speech

Vol.8, No.3 Jul.- Sep. 2006 Free To Go Page 3 INDIA consciousness, meaning that she could be NEWS classified as being in a vegetative state. Owen’s team used a different testing in Other Countries If Not Everybody, Then Nobody method, called functional magnetic reson- ance imaging, which measures blood flow 61-year-old Jaipur resident Vimala Devi to various parts of the brain. They found Bhansali had liver cancer and an inoperable that after they spoke to the woman and BELGIUM brain tumour. Being a follower of the Jain asked her to imagine herself playing tennis religion, she decided on September 14 to or wandering around in her house, specific take the age-old “santhara” vow, renounc- Right-to-Die Group Honoured regions of her brain “lit up” in exactly the ing food and water. Jains believe that by same ways as the brains of 12 normal In September, the doctors’ association renunciation a person escapes the bonds of people given the same instructions. The of the Free University of Brussels awarded desire and purifies the soul. tests were performed 20 times. its annual prize of 2500 Euros to ADMD However, suicide is still a crime in The scientists concluded that the wom- (Association pour le Droit de Mourir dans la India, and secular hunger strikes (e.g. as an “retained the ability to understand Dignité). Now that the principles of eu- part of a political protest) are allowed to go spoken commands and to respond to them thanasia have been accepted in Belgium, only so far; a person who fasts to the point . . . Her decision to cooperate . . . by imag- ADMD concentrates on helping with the of danger is hospitalized, given a feeding ining particular tasks when asked to do so application of the new law, primarily by tube, and prosecuted. A fellow citizen of represents a clear act of intention, which giving information to doctors and to the Bhansali’s, contemplating one person’s confirmed beyond any doubt that she was public. freedom to hasten death and perhaps feel- consciously aware of herself and her sur- ing no hope for an extension of that free- roundings.” dom to all citizens, seems to have thought Owen’s team and other neurologists “Well, if we can’t level the playing field by cautioned against generalizing the results GERMANY giving the right to everyone, we can at least too broadly, e.g. to the case of Terri Schiavo. take the right away from the privileged few Patients whose brains were damaged by a Lawyers’ Group Speaks who have it now.” This citizen initiated blow (as in a car accident) have better pros- legal proceedings aimed at having pects for recovery than patients whose At its convention in Stuttgart, September Bhansali’s fast stopped. brains were damaged by oxygen deprivation 19-22, the 8000-member German Lawyers’ A hearing was scheduled for October 5, (as was the case with Schiavo). Indeed, a Association passed two resolutions recom- but Bhansali died on September 28. July 4 Canadian Press article told how the mending legislative changes relevant to brain of US resident Terry Wallis appeared choice in dying. to have gradually “re-wired” itself during The first resolution was that patient the two decades he spent in a minimally directives (“living wills”) should be made UNITED KINGDOM conscious state after being injured in a car legally binding. accident when he was 19. The second resolution concerned the Som ebody May Be Hom e Wallis is continuing to recover, but country’s paradoxical laws about the rights the same has not been said about the UK and obligations of people who are present In the September 8 issue of Science, a woman, and the experts stress that we at a self-deliverance. Being present is not team of British researchers led by Adrian M. cannot yet employ the special imaging considered a crime, and the lawyers want Owen reported some thought-provoking techniques to predict who will recover how this situation maintained. But the com- experimental results. soon and how much, if at all. What we can panions are subject to prosecution if they The subject for the experiment was a 23- consider ourselves to know is that our usual do not intervene to stop the exit process; year-old woman who had suffered a severe ways of assessing awareness are far from the lawyers want this clause removed. head injury in a July 2005 traffic accident. perfect. And we should also consider our- At first she was in a coma but after two selves reminded that people who are mute weeks she opened her eyes and began to and motionless may nevertheless be able to have sleep/wake cycles. However, standard hear, and perhaps be hurt by, words that we tests repeated during a five-month period utter in their presence. suggested that she had no awareness or

Page 4 Free To Go Vol.8, No.3 Jul.- Sep. 2006 Update on Sliwinski • Healthcare in Oregon is provided and funded through many different frame- Note on Sources In the previous issue of Free To Go we works, and with some of these there is a reported that Valerie Sliwinski’s son Stefan financial disincentive for the doctor – a had been questioned and arrested because Most of the material for the “News” private-pay physician is not compens- and “Data Bit” sections of Free To Go is of having accompanied his mother on her ated for time spent supervising an exit, trip to Zurich to end her life with help from found by the Editor (Ruth von Fuchs) and health-insurance companies paying through the following two sources: Dignitas. On August 10 Stefan was told that a claim count only the days up until the no further action will be taken by the police. www.euthanewsia.ca day the patient exits (however, Oregon (Themmis Anno, Compiler) Stefan’s legal costs (which will now be low, doctors who are salaried or are part of www.lists.opn.org/mailman/listinfo/ fortunately) will be paid by Dignitas and by an HMO do not have financial disincent- org.opn.lists.right-to-die the British charity called TLC (The Last ives, being in much the same situation (Derek Humphry, Compiler) Choice), established by Dr. Michael Irwin to as Dutch doctors, most of whom are Readers who are hungry for more assist Britons who want to use Dignitas but salaried); news than can be fitted into Free To Go need some financial help or a travel com- • Finally, Oregon doctors know that may find it rewarding to access these panion. even if the dying does not proceed as ex- services themselves. pected (and in one 2003 case the pat- ient took 48 hours to die) there is nothing they can do about it, because the Oregon law prohibits lethal in- jections.

data bit When published: The numbers cited are contained in a booklet entitled “Helping People to Die in Dignity in the Nether- The num ber: 15 % lands”, written by Dutch doctor Aycke Smook and published in 2006 by ERGO . W hat it is: The percentage of Dutch The following letter to the editor was doctor-assisted suicide cases, in 2005, printed in The Times of London on July 3: For m ore inform ation: Copies of the which turned into euthanasia cases -- the booklet were available free at the ERGO patient-initiated dying was so slow that the Sir, booth during the World Federation confer- attending physician intervened and pro- Donald Bardoe and others make a ence, and the Free To Go office has a vided euthanasia (in 25 of 168 cases) convincing case for allowing assisted dying supply; if you would like to receive one, (letter, June 29), and as sufferers from just ask (for our contact details, see box at Discussion: This can happen in the potentially or inevitably fatal illnesses they bottom of last page in this newsletter). Netherlands because the doctor is always are in the best position to judge. present, even when the patient tries to be I have been a GP for more than 20 years the active party. In Oregon, by contrast, the and, like most doctors, my initial reaction patient’s doctor was present in only 11 of to being involved in the deliberate ending of the 25 assisted-suicide cases during 2005. life is one of horror. Further consideration There are probably many factors in- has led me to change my mind. I have to volved in the Oregon situation: accept the possibility that at some stage I • Oregon doctors know that whether or will suffer a myself and not they attend, their patients can call there are several conditions which I know upon Compassion & Choices to provide will give an unacceptable death despite the a knowledgeable and understanding best efforts of relatives and carers. companion; In the absence of help to die at a time of • Patients often choose to exit in the my choosing, I would have to end my life morning, when they are relatively strong while still able to, much earlier than ne- after a night’s sleep, but doctors may cessary. I would therefore like the option of find it hard to attend at this time of day; assisted dying for myself, and so can hardly

Vol.8, No.3 Jul.- Sep. 2006 Free To Go Page 5 deny it for my patients. There would have to Parallel # 3: shown that to all intents and purposes there be safeguards – a legal professional should A Law in a Com a was a prosecutorial silence on the contra- be involved – but the final decision should ception question for almost a quarter of a be that of the patient. century after Palmer’s case. The law in To my colleagues debating the matter, I “LAWS DIE TOO” said one of the signs question was not repealed, but it was quietly would ask that they make the decision from carried by participants in a 2004 rally ignored. their patients’ perspective, rather than their organized by Vancouver right-to-die sup- Then in 1961 charges were laid against own. porters. And just like people, laws often go Harold Fine, the owner of Prestige Drug through a period of being comatose before Products Ltd., a Toronto condom company. Dr. Stephen Warner they actually die. Feeling confident that reason had finally Mirfield, West Yorkshire What does it mean for a law to be in a prevailed, he was mailing promotional coma? It means that the law is still on the flyers to women who had recently given Ed. Note: books, because legislators have not yet birth, in case they might appreciate know- The fair-mindedness displayed by Dr. summoned the will to remove it, but pros- ing about a way to determine whether or Warner (“I would like the option of assisted ecutors have stopped laying charges against when to have another child. dying for myself, and so can hardly deny it people who do what the law forbids. Such forthrightness was too much for for my patients”) is not widespread among They have come to realize that they the Knights of Columbus. Fine was brought Canadian doctors, or at least it was not would not likely be able to get a conviction before a magistrate and fined $100. (Globe widespread in 1995. At that time, 40% of – even if strong evidence were presented, a and Mail, Apr. 26 1961, p.4) respondents to a survey of physicians said jury might well “nullify”, believing that in Editorializing about Fine’s case, the they would want the option of assisted this case the law was the offender. Globe noted “. . . he is joined in guilt by suicide if they themselves were terminally They have probably also come to doubt virtually every drug store in the country . . . ill, but less than half of these respondents that a prosecution would be in the public the products which he offers for sale are (45%) said they would be willing to interest, which is the second main con- used by hundreds of thousands, many of give suicide assistance to someone else. sideration for prosecutors. Being aware of whom do not even know that they are illegal (Source: Annals of the Royal College of the changed attitudes within their society, . . . If the police were now to prosecute all Physicians and Surgeons of Canada, June they know their fellow citizens would resent the other drug store operators who, like Mr. 1999) having their tax dollars spent on efforts to Fine, seemingly break the law against the imprison or impoverish people they do not sale of contraceptives, there would be such see as having acted wrongly. a public uproar that Parliament would have to change the law.” (Apr. 28, p. 6) Eight years later, the law was indeed Birth Control – Canada – 1937-1961 changed. Shocked by the Fine incident, OI C/OIC birth-control advocates George and Barbara The trial of Dorothea Palmer ended in Cadbury had gone into high gear and led a (Birth C o n tro l / D e a th C o n tro l) March of 1937. She had been arrested in vigorous campaign to bring Canada up to September of 1936 for handing out birth- date regarding choice in reproduction. Foreword: control instructions; after a trial lasting When Prime Minister Lester Pearson The campaign to legalize contraception nearly six months, judge Lester Clayton asked his Justice Minister to update the has many parallels with the campaign to dismissed the charges against her. He Criminal Code, in 1967, the Minister’s let people have control over the time and considered her lawyers to have clearly response included a proposal to decrim- the manner of their death. The opposition established that her actions had served inalize contraception. He agreed with to birth control was fierce because it the public good (Maclean’s Magazine, Nov. Globe writer Martin O’Malley’s December sprang from a fierce instinct, the blind 23 1957, pp.22+ ) 12 declaration that the state had “no right and cruel “life force” bred into us by Palmer was charged under a section or duty to creep into the bedrooms of the evolution. The fierce opposition to death of the Criminal Code which was number nation”. By 1969 that Justice Minister was control springs from the sam e instinct. 207(1)(c) in her day and became number Prime Minister – his name was Pierre The birth-control movement has triumph- 150(2)(c) after 1949. Law-library research Trudeau – and his revisions of the Criminal ed over its foe; this gives us hope that the on these two section numbers, in reference Code passed into law. death-control movement will also triumph. books listing “statutes judicially cited”, has

Page 6 Free To Go Vol.8, No.3 Jul.- Sep. 2006 Death Control – Canada – 2007+ (?) the article sounded very eager to have the woman charged. But well over a year has For Canada’s laws against aid in dying, now gone by, and no prosecution has been the non-prosecution period has probably opened. not started yet. Julianna Zsiros and Evelyn Finally, it is encouraging to note that Martens were both charged, as recently as even in the recent cases where there was 2002, though in Martens’ case half the both a prosecution and a conviction, there charges (the two charges of inciting or was no custodial sentence. Of the “twin Note: Viewpoints expressed in a “counselling” suicide) were dropped in terrors”, imprisonment and impoverish- particular group’s contribution to this response to sustained efforts by the defence ment, the first seems to have disappeared. section are not necessarily those of other lawyers. The 2006 case of Marielle Houle But the second will remain until pros- groups, or of the Canadian choice-in- was a bit different, since she freely told the ecutions for aid in dying become as un- dying movement as a whole. police that she had helped her son with his fashionable as jail sentences seem to have suicide, leaving the authorities with little become. choice about whether or not to charge her. And someday, perhaps when we once CH O ICE IN D YING However, the case of Andre Bergeron again have a Justice Minister of Trudeau’s provided an example of the Crown being calibre, that second terror also will fade O TTA WA somewhat compassionate. After his wife away into history. died, Bergeron could have been charged P.O. Box 1829, Almonte, Ont., K0A 1A0 with first-degree murder, if the authorities pzz@ magma.ca had been determined to see things in a 613-256-3918 certain light. But they were not so harsh. Bergeron’s lawyer Jean Couture wanted (Report by Paul Zollmann) the charge to be assisted suicide, and one is tempted to speculate that he wanted this CIDO was not active during the summer. because he thought it would help his client, A meeting is planned for the fall. the words “assisted suicide” having already Quarterly Retort become a phrase that triggers feelings of sympathy rather than outrage with most Canadians. The Crown resisted Couture’s D YING WITH D IG NITY idea (and again one is tempted to speculate They Say: that they knew about the emotional flavour CA NA D A of the phrase in question) but chose a In order to survive, a society needs to charge of aggravated assault, for which there have its laws respected by its citizens. 55 Eglinton Ave. E., # 802 is no mandatory minimum sentence and for Toronto, Ont., M4P 1G8 which the maximum sentence is the same We Add: dbabey@ dyingwithdignity.ca as the maximum for assisted suicide. www.dyingwithdignity.ca In addition, there may already be some In order to avoid corrupting its citizens, 416-486-3998 Fax 416-486-5562 instances of a decision not to prosecute aid- a society needs to have laws which its 1-800-495-6156 in-dying actions at all. Such decisions are citizens can honestly respect. not usually reported in the press, of course; (Report by Don Babey) one can only note that certain stories about the possibility of a prosecution do not have The World came to Toronto, and for four follow-up stories about a prosecution days in September a very Canadian per- actually having been started. spective was brought to the biennial This type of significant silence does gathering of the World Federation of Right occur. For example, in the summer of 2005 to Die Societies. What a treat it was for there was a report about a woman who was Dying With Dignity Canada to host so many thought to have hastened the death of colleagues, members and supporters from an elderly cancer patient. Police quoted in around the world to an event that gave

Vol.8, No.3 Jul.- Sep. 2006 Free To Go Page 7 prominence and opportunity to learn about launch of our new logo and revised com- Our table in the conference exhibit hall a topic of significance to all – the right to munications tools, we have been at work was ably staffed by Themmis Anno, my choose how we end our lives at peace and redeveloping our website, our brochures partner in many senses of the word. He with dignity. and information for specific groups had used his computer expertise to create The conference attracted over 230 (including doctors and the healthcare com- “canned” versions of the RTDSC website delegates, from 16 countries, 7 Canadian munity; hospice and palliative care vol- and the euthaNEWSia article-distribution provinces, 25 American states and 55 unteers and staff; the media; and folks service which he produces. Both products different organizations from around the looking for general and specific information could thus be demonstrated to interested world. Over 35 presenters from Canada, regarding end of life choices). We will be passersby, of whom there were many. USA, Europe, Australia, New Zealand and continuing to add new content to the We sold $220 worth of T-shirts, sweat- Japan, filled a program that was challenging website throughout the rest of 2006 and all shirts and bags. But we have plenty left, so and thought provoking from start to finish. of 2007. it’s not too late for you. The bags are a new The goal of this gathering was to provide The most exciting effort we have been item and come in two styles: tote bag (bag a safe and stimulating environment for engaged in of late is a new and positive body about magazine size, with short hand- intelligent discussion about the challenges relationship with the hospice movement in les) and market bag (bag body large enough and possibilities we have before us locally, Canada. A focus of the conference was to for lots of fruits and vegetables, with long nationally and around the globe. We engage Canadians on the issue of end of life over-the-shoulder handles). They are made participated in presentations and panel choice, and we are certainly reaping the from ivory-colour canvas, with dark-tan discussions and networked with colleagues benefits of this dialogue. We have been handles and lettering. and friends to unlock a dialogue that fos- meeting with representatives of hospice T-shirts cost $10, and sweatshirts or tered further understanding of the issues about our position on choosing when and bags cost $15; shipping adds $5. All items and the responsibilities inherent in our how we die, with some very positive con- bear the message movement that guide us toward the pro- versations ensuing. We will continue to LIFE motion of a social agenda that allows and strengthen these shared understandings. shouldn’t be a protects our freedom to choose. SENTENCE We brought together some of the world’s Our other September news was less foremost experts on the subject of end of life happy, in a way; one of our advisors, Rev. choice – those who have struggled and Dr. Cheri DiNovo, had to resign. When succeeded in implementing political action Gerard Kennedy gave up his seat in the and legislative change, and those who bring RIG H T TO D IE SO CIETY Ontario legislature, a by-election was called their own personal experiences to share. O F CA NA D A in his riding, and Cheri ran as the NDP can- To get detailed information about the didate. On election day she received 9487 conference, including a full program guide 145 Macdonell Ave., Toronto, M6R 2A4 votes, well ahead of the second-place and conference summary, visit our website contact@ righttodie.ca candidate (7970 votes) and the third-place at www.dyingwithdignity.ca. The con- www.righttodie.ca candidate (4147 votes). Her new life in ference was videotaped. These recordings 416-535-0690 politics is making her so busy that she has are available through our website at had to cut back on all her other commit- www.dyingwithdignity.ca. (Report by Ruth von Fuchs) ments. We’ll miss her but we congratulate Without doubt, these days together her, and she assures us that she remains a inspired, infuriated, illuminated and hope- We’re in! At the World Federation con- supporter. fully initiated a new energy in each of us, so ference we applied for membership in the Provincial politics is not without im- that we returned to our communities with a Federation, and we have been accepted. portance for the right-to-die movement. renewed passion to continue to educate our Our annual dues – 1% of our revenue – will Although the relevant legislation is federal governing bodies, community leaders, help support the work of this important (the Criminal Code of Canada), prosecution professional colleagues, the media and the organization. Just as individual people gain policies are a provincial responsibility. BC public that end of life choices must be strength from one another through being has already added a section on aid-in-dying discussed, protected and provided for all. part of a right-to-die group, individual cases to its Crown Counsel Policy Manual, Aside from concentrating on the World groups can assist one another by partici- and other provinces would do well to follow Federation conference, we have been busy pating in an umbrella group such as the its example. on many other fronts as well. Following the World Federation.

Page 8 Free To Go Vol.8, No.3 Jul.- Sep. 2006 barbiturates (and glutethimide); opioids right down to the bottom edge of the bag. such as dextropropoxyphene; chloroquine; This can be hard to do, and it requires you tricyclic antidepressants; and orphenadrine. to be extremely careful when you (later on) REVIEWS Problems with many of these drugs were pull the bag and headband down onto your known to Derek Humphry when he was neck. If you fail to grasp the headband writing the 3rd edition of FE, in 2002, and along with the bag, it will slide upwards on Guide to a Hum ane that book is therefore rather negative about the smooth plastic, and fly off into the air; Self-Chosen Death some of the drugs included in GHSCD. if you fail to grasp the bag along with the Pieter Admiraal and others What happened between 2002 and headband, in a sufficient number of places, ISBN: 9078581018 2006? A group of researchers analysed data parts of the bag’s bottom edge are likely to 2006 that had been collected by the Dutch right- slip up and out from under the headband, Price: $35 Cdn if shipped to-die group during the period before which will mean you do not have a good to a Canadian adddress, $35 US if shipped to euthanasia could be provided in an open seal all the way around your neck. an American address way and by a standard procedure. In those It is much safer to attach the headband early years, patients and their doctors tried to the bag, and it is easier to do so before many different drug recipes. you put the bag on your head. It is also The Peaceful Pill By carefully examining the case reports, helpful to leave a couple of inches of the Handbook the researchers discovered that several bag protruding below the headband, mak- Philip Nitschke and drugs which “had a bad press” could in fact ing a short “ruffle” which will be easy for produce a humane death. If patients took your fingers to grasp and pull. ISBN: 0-9788788-0-9 the drug along with the right kind of benzo- A simple way to do the attaching is this: 2006 diazepine (“tranquillizer”), either they did (1) Find a flat object (tray, cookie-sheet, art Price: $40 US if shipped not have the usual complications (e.g. con- book) large enough to stretch the headband to a Canadian address, $30 US if shipped vulsions) or they were unconscious when out as far as it will go (this means “as far to an American address the complications occurred, and thus did as it will go after you have nipped it in with not experience them. a big safety pin to make it snug on your (Reviews by Ruth von Fuchs) For each drug, GHSCD provides all the particular neck”); details required: (2) Take the headband off the tray, pull the These two books were for sale at the • quantities needed, of the main drug and bag down over the tray until the bottom World Federation conference, and I bought of the benzodiazepine (plus how to edge (the opening) of the bag is almost at a copy of each. For the sake of FTG adjust the quantities if you are smaller an edge of the tray, then put the headband readers who m ay be wondering about or larger than average, or if the drugs back onto the tray but with the bag in be- buying them too, I will point out the are more than ten years old) tween, this time; unique features of each book. I will also • which benzodiazepine(s) to use (3) Slide the headband down almost to the discuss both books with reference to Final • whether withdrawal from the main drug bottom edge of the bag, but stop two inches Exit (3rd Edition), which probably is is required (withdrawal from the benzo- short of the very bottom; already owned by readers who want to be diazepine is always required) (4) Tear five-inch lengths of fibre-backed well informed on the “how to” aspects of • which anti-emetic drugs will work, to duct tape into strips half an inch wide and the right to die. To save space, I will prevent vomiting (and which ones may use at least eight evenly-spaced strips to usually refer to all three books by their not work) anchor the headband in place, applying the initials: GHSCD, PPH, and FE. • how to take the drugs. strips so that they bridge the headband (one GHSCD also discusses the helium end of each strip below the headband, and Because it limits itself to methods which method, again at a very detailed level. One the other end above it); are humane according to the authors’ or two points have been omitted, probably (5) Pull the tray out of the bag. definition of that term, GHSCD omits some by accident; of these, the most important The second slight problem with GHSCD methods which the other two books do one concerns the linkage (or lack thereof) is that in some respects it is less user- discuss at least briefly. Within its chosen between the stretchy headband and the bag. friendly than PPH and FE. sphere, however, it gives the most thorough The text and drawings suggest simply The pages of FE have narrow margins and detailed coverage. placing the headband over the bag once the and large heavy type; the pages of PPH have It discusses five drugs or drug classes: bag is in shower-cap position, and pulling it wider margins but the type is quite similar

Vol.8, No.3 Jul.- Sep. 2006 Free To Go Page 9 to that in FE; the pages of GHSCD have However, the book does give a great deal this can happen, you will be all the more proportionately wide margins and small of useful information on other topics, and alarmed if it does happen in your case. The delicate type. They are lovely to look at, but some of it is indeed at the “handbook” “full disclosure” policy of PPH is kind. they will be hard to read for many of the level. Pages 66-68, for instance, provide PPH discusses many other methods in people at whom the book is presumably instructions for making devices to ensure addition to the helium method, and even directed. that the rate of flow from a balloon-kit compares them with one another in the Friendliness is also reduced by the fact helium tank never exceeds 15 litres per style of Consumer Reports. Each method that cross-referencing is done via section minute. These instructions are illustrated receives a score on 8 variables: reliability, numbers rather than page numbers, but the and they include the names and numbers peacefulness, availability (of “ingredients”), pages do not show section numbers. When of the parts needed. One step in the preparation (ease thereof), undetectability, reading about orphenadrine, in the course procedure requires a vise, and some of the speed, safety (to companions/finders), and of handling an inquiry, I was referred to tools involved are ones that most people storage (“keeping” quality of ingredients). “2.2.7" for a list of long-acting benzo- would not have (e.g. “a quarter-inch BSP In its discussion of the pentobarbital diazepines. Because I had read the table of die” or “a 4.5mm metric fine taper tap”); method, PPH again provides a very helpful contents not long before, I remembered that the Australians have handled this problem level of detail, as it did regarding the con- it was organized in terms of sections and by getting together for construction struction of a flow-controller for use with sub-sections, so I turned back to it and workshops at the home of an Exit member helium. Several pages are devoted to buy- learned that section 2.2 began on page 20. who owns a vise, with other members ing liquid pentobarbital (“Nembutal”) Section 2.2.7 turned out to be on page 25. bringing the specialized tools. All partici- at veterinary-pharmacy shops in Tijuana, The cross-referencing of drug terms pants buy and bring the necessary parts, Mexico. There are six photographs of (generic names and trade names) is also and all go home with a flow-controller. product bottles and boxes (various brands) less friendly than might be wished. If you (Similar workshops may be held in Canada; and one photograph of a store. Pointers know the drug’s generic name, you can find if you are interested, contact the head office are given about travel, talking with store all the trade names it goes by in 11 different of the right-to-die group(s) you belong to.) personnel, checking the merchandise, and countries. But quick lookups in the other The reason people want a flow-control more. (People who plan to use pentobarb- direction, from trade name to generic name, device is that the valve on the balloon-kit ital also need to acquire an anti-emetic drug are not possible. The sender of the inquiry tanks is quite crude. It is perfectly adequate such as metoclopramide or domperidon, I mentioned above wrote “Norflex”, not for the task of inflating balloons, but it was but usually this is less difficult and can be “orphenadrine”. I happened to know that not designed to permit fine adjustments of left until shortly before exiting.) Norflex was orphenadrine, but she might the gas flow. Reasonably satisfactory The next-to-last chapter in PPH is not have known, and if she had been using control can be achieved by thinking in entitled “After it’s All Over”. One could say the book herself she would have had to scan terms of turning the valve handle through that this chapter is user-friendly, but it through the 30 categories in the generic- 30 degrees (for people who are not geo- would be more accurate to say that it is name chart, checking under N until she “hit metricians, this means picturing “half a friendly to the user’s survivors (relatives pay dirt”, in category number 25. PPH and piece of pie” – a slender wedge that is only etc.). It supplies important facts about FE do not have comprehensive tradename one-twelfth of the pie, instead of one-sixth suicide notes, equipment removal, death cross-references either (though FE’s index as is customary), but a mechanical valve- certificates, investigations, , grief does have an entry under Norflex), but annex permits much more confidence that counselling, and “going public”. somehow the deficiency seems more the gas will not stop flowing too soon. One Like FE, PPH has quite a thorough serious in a book which focuses on drugs as can simply open the valve all the way, and index. GHSCD does not have an index strongly as GHSCD does. trust the “governor” to prevent the helium but this may be because the authors have If you buy “The Peaceful Pill Handbook” from “speeding”. designed the table of contents in a way (PPH) you may end up feeling that in one Besides flow-controller instructions, which they hope will enable readers to way you have gotten less than you expected PPH’s discussion of the helium method is “find their way around” well enough. but in other ways you have gotten more. noteworthy for its acknowledgment of the To sum up: I believe that these two new You may feel disappointed because the fact that some people experience a feeling of books are important supplements to FE book’s title led you to hope for detailed anxiety or even alarm, albeit briefly, during (Final Exit). For people who want a high instructions which you could follow in order the few moments of consciousness be- level of knowledge about controlling their to make yourself a gentle-death pill, but the tween pulling the bag down and passing out own death, money spent on buying them book does not provide such instructions. (pages 61 and 70). If you are unaware that will be money well spent.

Page 10 Free To Go Vol.8, No.3 Jul.- Sep. 2006 To order Guide to a Humane Self- complete transcript of her presentation (for which we have compiled supporting Chosen Death, write to the office of the would take m ore space than can be documents) and offer them to the provinces right-to-die group to which you belong, allotted by a newsletter like Free To Go, and territories that have not yet followed enclosing a cheque (made payable to the but here is a condensation of it. BC’s lead. group) for $35 Cdn or $35 US, depending on Advantages of this route: which country the book will be mailed to. a) Clarity (for the public & for healthcare (If your group informs you that it is not There are at least four possible routes to providers, as well as for prosecutors) handling the book, you can use the Right law reform that deserve attention: b) Increased even-handedness to Die Society of Canada as your group for (1) Prosecutors c) Less “politicization” of issues this purpose.) Addresses for all the (2) Juries Disadvantages of this route: Canadian groups can be found in “From (3) Courts a) Decisions still subject to personal bias The Groups” on pages 7-8 of this news- (4) Legislators. (even-handedness not complete) letter. b) No certainty about non-prosecution To order The Peaceful Pill Handbook, (1) Prosecutors c) Lack of openness and accountability write to: Provincial and territorial guidelines for US Ltd. Crown Attorneys state that prosecutors must (2) Juries 297 Kingsbury, Suite D ask themselves, when deciding whether to A little-known power of juries involves Box 4470 charge person X with offence Y, (a) “Is there “nullification”. They can refuse to convict, Lake Tahoe, Nevada a substantial likelihood of conviction?” even in the face of clear evidence about the USA 89449-4470 and (b) “Does the public interest require a actions of the accused. They may believe, Include your VISA or MasterCard number, prosecution?” for example, that the law in question is plus expiry date. Your card will be charged Answering these questions involves the morally wrong. $40 US or $30 US, depending on whether exercise of prosecutorial discretion, and The best-known Canadian example the book is mailed to a Canadian or an already we have seen considerable willing- involved Dr. Henry Morgentaler; jurors American address. ness to avoid the maximum severity – could not bring themselves to convict him even if the initial charge was murder, in a despite the clear evidence presented to euthanasia case, there is often a plea bar- them. Jurors responded the same way in gain and the charge is reduced (e.g. to many of Dr. ’s trials. , or to “administering a The reason for this power being little noxious substance”). known is that once jurors have started We can encourage the use of existing work, neither the lawyers nor the judge may guidelines in a manner that reduces or inform them of their power to nullify. They FORUM eliminates prosecutions for aid in dying. will only know about it if they have been Our arguments (involving the likelihood educated about it beforehand or they of a conviction and the serving of the public somehow learn about it from unofficial You CAN Get There interest) may sometimes be made in sources during the trial. From Here: the context of specific cases – by choice- Following this second route can involve Reflections on ways to move supportive colleagues of the prosecutor, for educating the public about (a) the existence the right-to-die instance – and we can also reach Crown of the jury-nullification option, and (b) the legal agenda forward lawyers through conferences they attend, reasons why they might want to employ it in courses they take, or literature they read. an aid-in-dying case (namely the reasons (by Dr. Jocelyn Downie) In addition, we can urge the authors of why the Criminal Code is wrong about eu- prosecutorial-discretion guidelines to ad- thanasia and assisted suicide). Jocelyn Downie is one of Canada’s dress aid-in-dying cases specifically and Advantage of this route: leading bioethicists. She is a professor of compassionately. New sections could clarify a) Possible increase in acquittals (with Law and Medicine, and Canada Research the circumstances in which an individual possible corresponding decrease in Chair in Health Law and Policy, at Dal- will or will not be charged, and might even laying of charges, since prosecutors housie University in Halifax. At the World put stricter limits on these circumstances. must consider likelihood of conviction) Federation conference she was part of a BC has already taken steps in this direction. Disadvantages of this route: panel discussion on “Nudging the Law”. A We can prepare draft guideline additions a) “Fluke” factor (which people, with what

Vol.8, No.3 Jul.- Sep. 2006 Free To Go Page 11 background knowledge, will a given jury (4) Legislators contain?) Parliament can repeal, amend and enact b) Juror rejection of law in other kinds laws. We can try to get the Criminal Code Last Words of cases could be based on discrimin- changed, e.g. by the creation of exemptions atory beliefs and could lead to injustice to the sections that (a) forbid assistance with suicide, and (b) classify euthanasia as Our Australian colleagues read their (3) Courts murder (which currently has a mandatory newspapers with a sharp eye, and this Canada’s Supreme Court can trigger minimum sentence). We can draft model item from the Manly Daily for July 5 was significant change by ruling that a given statutes and compile supporting docu- thought to be worth sharing with their law, against which a challenge has been ments for them, just as we can do for friends, through a right-to-die newsletter. brought, is unconstitutional (e.g. because it guidelines on the exercise of prosecutorial The Free To Go office was am ong those violates the Charter of Right and Freedoms). discretion. friends, and since Canadians will prob- This route was tried by . The On a few occasions in the recent past ably enjoy it too, here it is: attempt failed then, but with the passage of this route appeared to be opening up: when time the Court reversed its stand on at least Irwin Cotler was Minister of Justice, in the “One of our readers who works at a two other questions (whether or not dis- previous Liberal government, and also peninsula supermarket was more than crimination on the basis of pregnancy was when Francine Lalonde’s dignity-in-dying a little taken aback on Monday when discrimination on the basis of sex, and bill was selected by lottery for debate. But an elderly lady asked her for ‘euthanasia whether or not it was constitutional to these sparks did not ignite a flame and drops’. extradite someone without assurances similar sparks are also likely to sputter as She was gobsmacked but had the that the person would not face the death long as the present regime is in power. presence of mind to query the customer’s penalty). More than ten years have passed Advantages of this route: request. After quite a while and more than since the Rodriguez challenge. Only one of a) Even-handedness a few questions she discovered the lady the judges who decided Rodriguez is still on b) Can establish clear guidelines wanted ‘echinacea drops’, an adjunct for the bench; she was in the dissent then, and c) Can include protective regulations cold relief.” she is the Chief Justice now. Disadvantage of this route: We can try to persuade the Supreme a) Success not possible anytime soon Court (a) that the reasoning in Rodriguez was flawed (e.g. they took certain factors Conclusion into account at the wrong stage of their Reform is possible. Not today, and not Charter analysis), or (b) that even if the this year, but soon. Now is the time for analysis was correct at the time, its applic- action – preparatory action. ation in today’s context would lead to a Aid-in-dying advocates should: marshal different conclusion because of all the new arguments about the proper exercise of data that we have acquired (e.g. regarding prosecutorial discretion in cases of assisted the absence of a slide down the “slippery death; prepare alternative charging guide- slope” in places where aid in dying has lines and supporting documents; compile been legalized). arguments and gather evidence about why Free To Go Advantages of this route: the Criminal Code provisions are uncon- a) Asks about what is right, not about what stitutional; develop a robust piece of draft Contact Information: will allow MPs to have peaceful re- legislation and strong arguments to support Ruth von Fuchs, Editor election campaigns the proposed reform; and conduct a public- 145 Macdonell Ave., Toronto, b) Produces even-handedness (law struck education campaign about what’s wrong Canada, M6R 2A4 down cannot be used by any prosecutor) with the present law and what’s right about [email protected] c) Has a chance of success the proposed new law. 416-535-0690 Disadvantages of this route: When the window of opportunity for a) Process is slow reform cracks open, we’ll be ready! Design: b) Can tear down but cannot build up Gail Beglin ( is five COMMUNICATIONS) (regulatory framework needed but Court Danna Thompson cannot create it)

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