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True Dignity is a grassroots, independent, citizen-led initiative in opposition to assisted suicide. Originally started in 2010 as True Dignity Vermont, our fight has extended beyond Vermont as assisted suicide advocates are pushing their agenda across the U.S. and other nations. Vulnerable people deserve true dignity and compassion at the end of life, not the abandonment of assisted suicide. Killing is not compassion and True Dignity will work to ensure our end-of-life choices respect the dignity of all.

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For more than a year, rumors have circulated that the American Medical Association is about to change its long-held position of opposition to the legalization of assisted suicide.  Whether or not that is true, only time will tell.

A Vermont physician wrote the following eloquent letter to the AMA, expressing her vehement opposition to any softening of its opposition.  It is a perfect explanation of why, as the current position of the AMA states, “…these practices (assisted suicide and euthanasia) are fundamentally inconsistent with the physician’s role as healer.”

Here, in italics, is the letter.  Thank you, Carol Salazar M.D.  Anyone may also write the AMA at elliott.crigger@ama-assn.org.

Dear Elliot Crigger

I understand that you are the person to send comments to regarding the AMA’s upcoming consideration of withdrawing the organization’s opposition to Physician Assisted Suicide.

I am a practicing Primary Care Internist in Vermont, where sadly PAS has been legalized.  I walk with people through the end of life every day. I also have a teenage daughter.

In a world where we have seen violence, hopelessness, suicide ( especially in teens ) and addiction skyrocket, we , as physicians , will be sending the wrong message to our patients and our children who will inherit the world we leave them. What message are we sending them?

We will be telling them that autonomy trumps all… that because I want to control how I leave this world, I have the right to do whatever I want
… that there is no absolute truth…
that human life  does not matter.
That suffering should be wiped out .

Unfortunately suffering is a part of the human condition as can be seen in the literature of even ancient times . We as physicians are tasked to alleviate suffering.  We cannot always cure , but we can always comfort . We should be pouring our efforts into end of life care both at home and in Hospice institutions .

The slippery slope is real and I fear we have started our descent . We have been there before, even in our own country.  If it is ok to ask a physician to help me kill myself , it is a very short slide to extending it to the disabled and even the depressed.  The papers are FULL of stories of teen suicides and drug overdoses. It is our task to show them that we are willing to walk with them in their suffering and not give up on them.

I believe every physician should read “”The Nazi Doctors” by Dr. Ray Lifton. Proponents of PAS do not like it when I bring this comparison up. It is very painful and difficult to read because it shows how killing was medicalized and therefore came to be accepted by so many everyday physicians.

The AMA is proposing to support the medicalization of suicide… it is to be one of the “treatments” we are to offer as end of life care.

  It is a huge mistake to withdraw the opposition to PAS.  I hope that we as physicians have learned from the past and will stand firm for what is right.

Sincerely
Carol Salazar MD

 

On May 23, 2017, a US Appellate Court upheld a Consent Agreement between the state and medical professionals to protect conscience rights of professionals who oppose assisted suicide. This is a real victory and perhaps the best that could have been achieved. True Dignity cannot say that it was the victory patients in Vermont and elsewhere needed, unfortunately.  Patients have more protections than they did before this decision, but they still have far too few.

Here, briefly, is what happened.

Act 39, under which assisted suicide is legal in VT, contains protections for physicians and other medical professionals who refuse to provide assisted suicide or make referrals to doctors who will.  Two previously-existing VT laws, the Patient Bill of Rights and the Informed Consent law, however, require that “terminally” ill patients be informed about all available end of life options.  Vermont Alliance for Ethical Health Care and the Christian Medical and Dental Associations, represented by the Alliance Defending Freedom, brought a lawsuit against several “terminally” ill patients who were represented by the Vermont Attorney General’s office.  They asked for a ruling that would explicitly grant medical professionals conscientiously opposed to assisted suicide an exemption from the requirement to list it among the available“options”.

On April 5th, the US District Court for Vermont issued a ruling dismissing the lawsuit, citing “broad agreement” between the Attorney General’s office and the suing medical professionals. The Attorney General’s office had affirmed that it did not read the language of the law to require physicians to list assisted suicide among the options if a patient did not ask about it, and the medical professionals had signaled their willingness to answer patient-initiated questions and/or refer patients to other sources of information.

In its decision, the court contrasted the VT objectors’ position with that of Thomas More, who lived in what it called “a more authoritarian age”.   Perhaps the age was indeed more authoritarian, since Henry VIII did not offer More the negative option of neither agreeing nor disagreeing with the Act of Succession. On the other hand, More’s stance was perhaps more principled than that of the Vermont medical professionals.  More wrote that, were he offered the chance to remain silent, he would do so, but he refused to take the proactive step of signing the Act. The VT court decision offers a very limited right to remain silent, only up to the point at which the patient asks for information.  Once the patient has asked, the doctor is required to answer his questions with information; that seems like a proactive step to us.  Amazingly, the doctors, agreed to do that, signing the consent agreement rather than continuing to pursue the suit.

Compassion and Choices wanted complete capitulation; it appealed the Consent Agreement.  It must have soon realized it had gotten a lot of what it wanted, however; and it asked the court to dismiss the appeal. The May 23 decision was to grant Compassion and Choices’ request.

Here is the concerning language from “Civil Action No. 5:16-cv-206, Consent Agreement and Stipulation” (underlining ours) https://adflegal.blob.core.windows.net/web-content-dev/docs/default-source/documents/case-documents/vermont-alliance-for-ethical-healthcare-v.-hoser/vermont-alliance-for-ethical-healthcare-v-hoser—consent-agreement.pdf?sfvrsn=6

1.Plaintiffs and similarly situated medical providers do not have a legal or professional obligation to counsel and refer patients for the Patient Choice at End of Life process under 18 V.S.A,5281-93, the Patient’s Bill of Rights (18 V.S.A.,1871, or the Informed Consent Act (12 V.S.A. 1909(d).

2.Plaintiffs and similarly situated medical professionals have a professional obligation to provide relevant and accurate information regarding the Patient Choice at End of Life process upon a patient’s request, or if unwilling to provide the information personally, to make a referral or otherwise reasonably ensure that the patient will be able to obtain relevant and accurate information about the process.

Item No. 2, in our opinion, unacceptably requires a physician to violate his or her conscience in telling a patient where to get information about assistance in suicide.  Even more unacceptably, it violates the fundamental right of a patient to look to a doctor for care and protection.  It does not recognize that the patient may be asking about assisted suicide under pressure, perhaps pressure so subtle that he or she doesn’t even recognize it as such.  If the physician refers that patient to the internet or phone (two sources that are mentioned in various documents related to the case), that would be the equivalent of what True Dignity has always regarded as the coldest and most disinterested of responses, “It’s your decision.”   The response a patient deserves, the one we would hope VT patients would receive from their doctors, would be the proactive one given by an Oregon doctor to “terminal” patient Jeanette Hall when she asked him how to access assisted suicide under that state’s law.  He told her he would not help her, went further in telling her how it would hurt her son if she committed suicide, and urged her to get treatment for her “terminal” illness.  Today, 17 years later, she is still alive and advocating against legal assisted suicide.

True Dignity believes very sick patients deserve protection and accompaniment, not being left on their own.  This agreement does not provide adequate protections for doctors who wish to disobey this bad law, or for their patients who may desperately need them to.

Yes, the court decision is a victory.  Compassion and Choices has been telling medical professionals and patients around the state that they have to provide information to all “terminal” patients about assisted suicide as well as referrals to doctors who provide it.  If C&C had liked the agreement it would not have appealed it. It was, however, not the victory for patients that True Dignity would have wanted, and C&C’s decision to drop the appeal confirms us in our opinion.

This victory leaves patients without the possibility of the caring advocacy Jeanette Hall got from her doctor, the caring advocacy they deserve in the cold and deadly environment in which we find ourselves, an environment in which it makes perfect sense to get rid of people who cost time, emotional investment, and money.

That things could have been much worse does not mean they are not still very bad.

“The Mother Situation” https://goo.gl/7TFAuW is a darkly satirical, award winning, 7-minute film which illustrates the potential for abuse when assisted suicide is made legal. There is no question it could happen here in Vermont, where there are no requirements for oversight when prescriptions for suicide drugs are requested and filled.  When a person dies after having requested a prescription under Act 39, no investigation into the circumstances of death will be undertaken, and the cause of death will be listed as the person’s underlying illness.   This law leaves the sick and elderly vulnerable to abuse and coercion.  View this film and judge for yourself.

Eighteen months ago True Dignity ran the following story about an elderly Medicaid patient who felt pressured to request assisted suicide by caregivers in the facility where she was admitted for recovery from a fall.  The patient did not have a terminal diagnosis.  Beth Neill, the patient’s daughter, who reported the abuse to True Dignity, has since passed away.  We are running the story again, on request, in order to call attention to the dark side of Act 39, a side that is very real but unfortunately not reflected in the lopsided reporting in the mainstream media of assisted suicide deaths that are made to look almost glamorous and appealing.

From July 2013:

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 39and 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.

Peter Shumlin, the outgoing governor of Vermont, fought hard to legalize assisted suicide in the state; so it was no surprise when he listed it among other “accomplishments” in his farewell speech this week.  A big surprise, however, came when the governor revealed that his own father died from assisted suicide.  See  https://www.youtube.com/watch?v=uRBvYw3n_GA, beginning at minute 54:50.

Bristling with pride, Shumlin said that never in his wildest dreams did he imagine that his own father would die in this way.  In May of 2011, however, True Dignity commented on a speech he made at a VT showing of the film “How to Die in Oregon”.  The speech can be viewed at https://www.youtube.com/watch?v=-X7tDAr7QiI,  beginning at Minute 1:40.  Speaking about how much he hoped VT would enact legal assisted suicide, he actually used his parents as illustrations of why he felt legalization was important.

Here, in italics, are our comments at the time:

We were offended by the governor’s filmed jokes about how his apparently healthy but aged parents haven’t responded as he would have liked to his attempts to have “the conversation” to plan for their dying (in the video the audience laughs when he says he asked where they planned to be in ten years).

… We need….to fight against the seduction of his not so soothing words about how Vermonters “take care of each other”, when he speaks words like these in the context of a conversation about assisted suicide.

In 2017 we are even more offended than we were in 2011.  It is hard to believe that any governor would brag about facilitating a single suicide in his state.  It is even harder to hear that governor brag about facilitating the suicide of his own parent.

Back in 2011, we were sorry for and feared for Peter Shumlin’s parents.  It is self-evident to us that any suggestion that suicide is a viable end of life option for another person is itself pressure and can never be anything else If we heard the words Shumlin spoke in 2011 from one of our adult children, we would feel pressured, and we would not forget. No act done under pressure, even the most well-meaning pressure, is ever completely free.

We hope one day to live again in a state in which the sick and elderly are legally protected from such pressure, however well-meaning or inadvertent.  Our new governor, Phil Scott, voted against legal assisted suicide when it was passed in 2013.  Let’s ask him to work for its repeal now.  Contact information will follow in the coming weeks.

The DC City Council is holding a second and final vote tomorrow on the assisted suicide bill that recently passed in its first vote.  Those opposing this dangerous law, which will surely result in premature deaths without consent and which will influence legislators in other states, are asking people from all over the country to contact the council members asking them to vote NO.  Emphasize the fact that this proposed law will not protect anyone from coercion. There are absolutely no protections for the patient once he or she gets a doctor to prescribe the lethal dose of barbiturates. The law requires no witnesses to the ingestion of the drugs, so sick people will be at the mercy of people who will benefit from their deaths.  The law puts everyone, rich or poor, at risk.

Here is the contact information:

Phone Numbers:

Anita Bonds – Tel: (202) 724-8064 | Fax: (202) 724-8099
David Grosso – Tel: (202) 724-8105 | Fax: (202) 724-8071
Elissa Silverman – Tel: (202)-724-7772 | Fax: (202)-724-8087
Robert C. White Jr. – Tel: (202) 724-8174 | Fax: (202) 727-8210
Brianne Nadea – Tel: (202) 724-8181 | Fax: (202) 724-8109
Jack Evans – Tel: (202) 724-8058 | Fax: (202) 724-8023
Brandon T. Todd – Tel: (202) 724-8052 | Fax: (202) 741-0908
Kenyan McDuffie – Tel: (202) 724-8028 | Fax: (202) 724-8076
Charles Allen – Tel: (202)-724-8072 | Fax: N/A
Yvette Alexander – Tel: (202) 724-8068 | Fax: (202) 741-0911
LaRuby May – Tel: (202)724-8045 | Fax: (202)724-8055

Email addresses:

[email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected],

From a media release issued yesterday by the Alliance Defending Freedom:

Alliance Defending Freedom attorneys filed suit in federal court in Burlington Tuesday against officials in the Vermont Board of Medical Practice and the Office of Professional Regulation on behalf of health care professionals who wish to abide by their oath to “do no harm.” The state agencies are construing Vermont’s assisted suicide law as requiring them, regardless of their conscience or oath, to counsel patients on doctor-prescribed death as an option.

According to the agency, only physicians must refer patients to others who will counsel for assisted suicide; however, all of the health care professionals filing suit contend it is unethical for them to counsel for, refer for, or in any other way participate in suicide at the hands of medical personnel.

“The government shouldn’t be telling health care professionals that they must violate their medical ethics in order to practice medicine,” said ADF Senior Counsel Steven H. Aden. “These doctors and other health care workers deeply believe that suffering patients need understanding and sound medical treatment, not encouragement to kill themselves. The state has no authority to order them to act contrary to that sincere and time-honored conviction.”

Although Act 39, Vermont’s assisted suicide bill, passed with limited protections for healthcare providers, state medical licensing authorities have construed a separate, existing mandate to counsel and refer for “all options” for palliative care to include the option of assisted suicide. The Vermont Department of Health adopted this expansive reading.

The department’s FAQ page on Act 39 says the following: “Do doctors have to tell patients about this option? Under Act 39 and the Patient’s Bill of Rights, a patient has the right to be informed of all options for care and treatment in order to make a fully-informed choice. If a doctor is unwilling to inform a patient, he or she must make a referral or otherwise arrange for the patient to receive all relevant information.”

Echoing this position, Cindy Bruzzese, executive director of the Vermont Ethics Network, which the state has given authority to speak about the standard of care in Vermont, stated in a 2013 presentation on Act 39 that physicians have a duty to inform patients of the availability of assisted suicide.

“This is nothing but the redefinition of ‘palliative care’ to mean providing assisted suicide, an intolerable position for Plaintiffs and other conscientious physicians and healthcare professionals,” the complaint filed in Vermont Alliance for Ethical Healthcare v. Hoser states. “Plaintiffs, state and national associations of conscientious healthcare professionals whose personal and professional ethics oppose the practice of assisted suicide, bring this action on behalf of their members against the operation of Act 39 to force them to counsel and/or refer for the practice.”

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