Contrary to Some, Medical Killings are Occurring in End-of-Life Care Settings

Ron Panzer
April 29, 2012
Reproduced with Permission
Hospice Patients Alliance

Kevin O'Reilly has written an article, "End-of-life care: Pain control carries risk of being called a killer - Accusations of euthanasia are common as patients, families and even other health professionals struggle to adjust to the new realities of end-of-life care." Mr. O'Reilly is a writer for the American Medical News, a publication of the American Medical Association. This is my response:

As a patient advocate and President of the Hospice Patients Alliance, I've spoken with many hospice and palliative care leaders, physicians, staff as well as families and patients from all across the United States. It is truly disingenuous and misleading to state that "all of these treatments" ... are "broadly accepted as ethically and legally appropriate", "even if they have the secondary effect of speeding the dying process." What is occurring in hospice and palliative care settings is not a "secondary effect" but an intended primary goal today.

Anyone involved in end-of-life ("EOL") care knows that the praiseworthy and lofty goals of the hospice and palliative care mission asserted for decades that the services provided would "never hasten death." Today, the removal of nutrition and hydration, whether artificial or not, often combined with the permanent sedation of the patient ("terminal/palliative/total sedation") is being done in EOL settings, with the intent that the patient die.

This is confirmed by hospice physicians serving as medical directors, nursing directors, nurses, social workers, chaplains and other physicians all across the country. As mentioned in the article, many oncologists are often shocked that their patients suffering from a terminal illness, but in no way in the technical "active phase of dying" and therefore not expected to die suddenly, actually die within days or weeks of entering hospice and palliative care settings. All of these professionals can not all be wrong or ignorant. They know what is really happening.

It is relevant to note that one of the foremost authorities in modern palliative care, Joanne Lynn, MD confirms this and was quoted in a NY Times article, "'Passive Euthanasia' in Hospitals Is the Norm, Doctors Say" and said "when a patient is ready to die, I can stop nutrition and hydration, I can stop insulin and ventilation, I can sedate them." This is intended death, not death from a terminal illness! If such a leading authority on palliative care as Dr. Lynn admits that passive euthanasia of this sort is the "norm" in hospitals and health care, then the author's statements about "misunderstandings" and "misperceptions" are in error. The reality is that intended death is occurring.

In addition, Timothy E. Quill, MD and Ira R. Byock, MD (a leading hospice & palliative care physician), and the ACP-ASIM End-of-Life Care Consensus Panel suggest that when patients request "that death be hastened," terminal sedation and voluntary refusal of hydration and nutrition" be used "as potential last resorts that can be used" to hasten their death. [See: "Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids," by Timothy E. Quill, MD; Ira R. Byock, MD; and for the ACP-ASIM End-of-Life Care Consensus Panel. Annals of Internal Medicine, March 7, 2000 vol. 132 no. 5 408-414] Again, this is intended death, not from a terminal illness, but the actions of the physicians, and they do not require the nutrition and hydration to be "artificial" when such intended death is imposed.

Therefore, in addition to directly causing euthanasia by a lethal agent, contrary to AMA policy, hospice & palliative care physicians are urging and actually performing such euthanasia by stealth, using a method that is not direct euthanasia, but intends death, causes death and is done using sedative medications that in themselves do not cause immediate death, but cause the conditions that knowingly result in death.

In other words, the misuse of terminal sedation to end life is another form of euthanasia, properly termed "stealth euthanasia," which I have written extensively about in Stealth Euthanasia: Health Care Tyranny in America. It is not direct euthanasia as a lethal agent is not used to immediately cause death, and it is not true "passive euthanasia" because it is not simply withholding or withdrawing treatments.

The misuse of terminal sedation to cause death creates the situation where the patient cannot take in nutrition or hydration, whether artificial or natural, because he is in a medically-induced coma, and certain circulatory collapse occurs from fluid volume deficit in a few days to a couple of weeks, depending upon the patient's condition.

It may be "justified" using several bioethical arguments that devalue the value of the patient's life and assert that the patient would be "better off dead" than suffering from their terminal illness, debility, dementia, disability, etc. It is also justified by the principle of "patient autonomy," yet many of these patients are not requesting such imposed death through any means. In hospice today, there are very real concerns that the mission is being twisted into something other than what most people expect, i.e., end-of-life care, not imposed death.

It is no accident that families, staff, hospice and palliative care professionals are themselves warning that euthanasia, direct or passive, and stealth euthanasia are being performed in the EOL setting. The National Hospice & Palliative Care Organization is the actual legal and corporate successor to the former Euthanasia Society of America, and continues the twisting of the life-affirming mission of hospice and palliative care into something other than what it represents itself to be.

Using the doctrine of the Law of Double-Effect, the author, and those like him, assert that practices such as sedating a patient permanently, while also removing artificial as well as natural nutrition and hydration, thereby assuring death, are justified under the guise of their being a "secondary effect," when actually it is the primary effect intended; these practices are therefore forbidden by the Law of Double Effect, since the primary intent, i.e., to end life, is unethical.

Whether these practices that knowingly result in imposed death are justified by principles such as patient autonomy, beneficence or justice, or the misuse of the Law of Double-Effect, such justification is exposed as unethical when the AMA's own statement on euthanasia is considered, that "the societal risks of involving physicians in medical interventions to cause patients' deaths is too great to condone euthanasia or physician-assisted suicide at this time." In other words, the AMA already condemns the practice of physicians intending and causing death.

The ambiguity created by "stealth euthanasia's" methods avoids the readily identifiable terms "euthanasia" and "assisted-suicide," but results in imposed death just the same and is condemned by the AMA's own ethical stance against intended death.