Letter From Fabian Stahle To Maryland Committee Members Re PAS Bills.

Fabian Stahle

Letter from Fabian Stahle to Maryland Committee members re PAS bills.

Dear Senator,
I write to you from Sweden regarding HB 399 and SB 311because these
bills are similar to the Oregon law that is proposed here in Sweden.
After contact with Oregon Health Authority I found disturbing
information that was not available before and is highly relevant for HB
399 and SB 311 (below referred to as the ”Bills”).

In this letter I would like to draw your attention to a dangerous
passage in the Bills regarding the eligibility criteria that the patient
shall be diagnosed with a ”terminal illness” that will result in death
within 6 months.

Regarding how this 6 months criteria must be interpreted, I have crucial
information revealed from a correspondence I had with the Oregon Health
Authority (OHA) in the end of 2017. I believe this information is very
significant as the Bills definition of "terminal illness" is almost
identical with the Oregon definition.

In my correspondence the OHA acknowledged – for the first time
officially - that they always had interpreted the 6 months criteria as
*”without administration of life-sustaining treatment”*, A3 and A8 in
the correspondence
See also my comments

This interpretation is counter-intuitive because most people would take
for granted that the meaning of ”terminal illness” is a disease for
which there is no treatment or medication, i.e. that all hope is gone.
But the interpretation is logically inevitable also for the Bills - and
the implications are far reaching.

As a patient has the right to refuse to receive treatment, any patient
having a disease that potentially may develop into a terminal condition
can make themselves eligible for assisted death – *for any reason
whatsoever*. Hence a trap-door for suicidal patients is imbedded in the

This is unavoidable because the patient's autonomy ensures that it must
be the patient himself who has to decide when enough is enough.
For those who believe in the basic idea of these Bills, it is obviously
unreasonable to request that, for example, a cancer patient who is
exhausted by radiation and several unsuccessful chemotherapy treatments
should be forced to undergo additional painful treatments with dubious
results to gain access to assisted death.

*But where should we draw the line?* Isn’t it also obviously
unreasonable that a patient who has very good prospects to be cured can
get assisted death by refusing treatment? Shouldn’t we require that a
cancer patient accept at least one treatment before talking about
assisted death – or at least to account for reasonable motives for their
wish to die? Or what about a young diabetic who, in the despair of a
broken relationship, wants to die and stops insulin so as to be able to
obtain legal suicide assistance - shouldn't we regard that as
unacceptable and ask for some sort of limitation?

*However*, all such attempts to conditions intrude on patient autonomy –
the very autonomy the Bills are intended to expand, not decrease – and
leads to insoluble demarcation problems. The Oregon Health Authority has
also come to this conclusion
A4 and A5.

So in the face of these two contradictory positions the Bills must
surrender to the patient's autonomy - just as all other laws like the
one in Oregon already have.

As a result the obvious interpretation of the central concepts of
“terminal” does not apply – but is left open to the patient's own
decision, and hence the door is also opened to pure absurdities as to
which people can be legally killed:

A cancer patient who has very good prospects to be cured, but denies
treatment. An important reason is that she does not want to lose her
hair. We are now in Oregon a while after their law for
physician-assisted suicide came into force and the patient in question
is Jeanette Hall. Her physician, Dr. Stevens is opposed to the law but
was forced to acknowledge that his patient would be eligible to get the
death pills she wanted because her cancer was likely to lead to death
within 6 months if she was not treated. He managed however to convince
her to take treatment and many years later Ms. Hall said: "It is great
to be alive."

But nor all doctors are like Dr. Stevens.

Dr. Charles Blanke, an oncologist with Oregon Health & Science
University, told The Bulletin about one of his cases, a young patient
with Hodgkin lymphoma with a more than 90 percent chance of survival
with treatment. She did not believe in chemotherapy and feared its
toxicity, despite Blanke’s efforts to convince her otherwise. After
cleared by a psychiatrist Blanke approved her for assisted death,
holding firm to his belief that doctors should not force patients to
receive treatment. But afterwards Blanke asked himself:

/“Why doesn’t that patient want to take relatively non-toxic treatment
and live for another seven decades?”/

The answer to Dr. Blanke’s question is just as simple as disturbing in
the context of medical killing:

It is because *a law that encourages *sick people to commit suicide - by
the obvious reason that for a suicidal person a socially accepted and
smooth death administered by society is much more attractive than dying
on one's own in loneliness, just as the young suicidal Belgian woman
testifies in
this video

For ANY reason whatsoever:

A person could, as Dr. Blanke’s cases, fear the possibility of side
effects or future disabilities. But it could also be a parallel life
crisis that is indirectly linked to the disease or not. And what about
those patients who cannot pay for a potentially effective treatment?
These Bills allow and encourage people that are not necessarily dying to
commit suicide. Please

These Bills allows and encourages people that are not necessarily dying
to commit suicide. Please reject these dangerous Bills!

Fabian Stahle, Sweden

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