Assisted Dying:

More Information and Further Thoughts

In my first article on the topic, I wrote that there may be issues involved other than the ones I discussed. The response I received from that article inspired me, despite my initial reluctance to tackle the subject, to research further to find any other relevant issues and write this follow up article.

I wish to make it perfectly clear that I am very much aware that there are many people who suffer on a daily basis with chronic conditions, and for them I have the greatest compassion.

My purpose in raising awareness of this topic and asking questions is not to deny their experiences. My intention is to highlight as many aspects as possible that are rarely, if ever, covered by either the mainstream or even the ‘alternative’ media, especially relating to what is purported to be helping people in such situations - but has a wider and possibly more nefarious underlying purpose.

If you haven’t read my first article on the topic, I recommend reading it before continuing.

Definitions

Let’s start with understanding the terms being used.

Assisted suicide - is defined as the act of deliberately assisting another person to kill themselves. The etymology of ‘suicide’ is the ‘deliberate killing of oneself’.

Euthanasia - is defined as the act of deliberately ending a person’s life to relieve suffering. It derives from 2 Greek words, ‘eu’, which means good; and ‘thanatos’, which means death.

According to the NHS, there are 2 types of euthanasia:

• voluntary euthanasia – where a person makes a conscious decision to die and asks for help to do so.

• non-voluntary euthanasia – where a person is unable to give their consent (for example, because they're in a coma) and another person takes the decision on their behalf, perhaps because the ill person previously expressed a wish for their life to be ended in such circumstances.

Yet strangely, it seems to be legal for family members to agree to turn off a life-support system for a loved one in a coma. This to me seems to be fully in line with the definition of ‘non-voluntary euthanasia’ - except that euthanasia is illegal in England. So what is the difference?

Another term used in certain countries, specifically the US, is ‘medical aid in dying’ (MAID), which is perceived to be entirely different.

The website Compassion & choices is a staunch proponent of MAID. On their Medical Aid in Dying web page is the following,

To repeat, suicide, according to Merriam-Webster is:

“the act or an instance of ending one's own life voluntarily and intentionally”

If providing patients with the means to end their own lives is not assisted suicide, then I’m clearly missing the nuance between the meanings of these terms.

The Compassion & choices website contains a page entitled Physician-assisted suicide, suicide and euthanasia are often terms that popular media and our opposition use to describe the practice of medical aid in dying. This is misleading and factually incorrect. On that page, under the heading Medical aid in dying is fundamentally different from euthanasia, is the following,

This is the situation that applies in the US states that have passed MAID legislation, so it’s important that anyone in the US reading this article is aware of these differences!

There are also differences between the proposed legislation for countries within Britain. The Bill that I referred to in my first article that had successfully passed the first stage in Parliament only applies to England and Wales. There is a separate Bill working its way through the Scottish parliament that began the process back in March 2024.

Interestingly, the Scottish bill is different from the one for England and Wales in a few ways. One of them is that eligibility in England and Wales requires the patient to be aged 18 or over, whereas in Scotland, it requires the patient to be aged 16 or over. This is very interesting because the ‘age of majority’ in Scotland is the same as in England, i.e. 18. So why the difference?

A second difference is that, in England there is a requirement that the patient is expected to die within 6 months, whereas this is not a requirement in the Scottish bill.

I’m therefore curious why different approaches are being implemented in different countries, especially when there is an obvious effort to implement a standardised ‘healthcare’ system into all countries.

And speaking (or rather writing) of ‘standardised healthcare’, the WHO is strangely silent on the topic of ‘assisted dying’, despite the fact that it is something that is being increasingly rolled out in various Western countries. The only WHO fact sheet that has any relevance to the topic is dated August 2020 and relates to Palliative care. The main concern expressed in that fact sheet is that patients deserve access to the ‘medications’ they require, especially opioids, which they claim are ‘essential for managing pain’.

So what is this all about?

History

I found an interesting study paper, dated February 2022, entitled Euthanasia and assisted suicide: An in-depth review of relevant historical aspects that shows these topics have been discussed throughout history, citing comments found in the works of Socrates and Plato, amongst others. Although interesting, these historical references do not pertain to this discussion, the purpose of which is to highlight and discuss the increased attention to this topic in our current times.

According to the website, World Federation Right to Die Societies (WFRTDS), the first country to introduce legislation was Germany in 1871, so, even within modern times, this topic is not entirely new, although Germany was the only country to introduce legislation in the 19th century. That legislation was restricted to assisted suicide and only under certain conditions; euthanasia is stated to be strictly forbidden.

In the 20th century, there were only 2 countries, Switzerland and Colombia, and the US state of Oregon, that introduced assisted dying (AD) legislation, although of different types. The Swiss act was similar to that of Germany. Colombia’s was totally different; their legislation stated that euthanasia under certain conditions is not punishable, but assisted suicide is forbidden. Oregon was the first US state to introduce MAID.

3 European countries and 2 US states introduced AD legislation between the years 2000 and 2010. But the situation changed dramatically between 2010 and 2022, with 5 countries, 8 US states, and 5 Australian territories introducing AD legislation.

The WFRTDS website may not be up to date, because 2022 is the latest year for which there are details of new AD legislation. However, the ‘world map’ on the website indicates that other countries are considering introducing some form of legislation, although in many countries assisted dying remains illegal.

So why is this a concern?

The potential to make changes over time

Although legislation is often introduced with very specific clauses related to conditions and safeguards, it is possible for these clauses to be changed or even removed over time, as can be seen by the example of Canada.

When first introduced in 2016, the AD legislation in Canada required the patient’s death to be ‘reasonably foreseeable’, a requirement that was removed in 2021. The current situation is that a patient must have a ‘grievous and irremediable medical condition’, and that, according to the government of Canada website,

“To be considered as having a grievous and irremediable medical condition, you must meet all of the following criteria. You must:

• have a serious illness, disease or disability.

• be in an advanced state of decline that cannot be reversed.

• experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable.

This is followed by:

“You do not need to have a fatal or terminal condition to be eligible for medical assistance in dying.”

One of my main concerns about all of this is the medical establishment’s lack of understanding about ‘disease’ and what can or cannot be ‘reversed’, which I discussed in some detail in my other article.

The ethical considerations are discussed below. But before moving on, there are a few more points I’d like to make.

The first is the reference to ‘disability’ and how this may or may not be defined - and whether it is even possible to limit what each individual with a ‘disability’ experiences. Is their quality of life the same, even if they have the same disability? And who is to make that decision? These are only some of the questions in my mind about this.

The second is with reference to trauma and accident, a topic that was raised by a reader of my Instagram post linked to my Substack article. The questions this raised for me were: How would their experiences be included? Would their conditions fall under the heading of ‘disability’? There are clearly more questions to be asked.

The third point relates to what are referred to as ‘mental disorders’. At the present time, these ‘disorders’ do not seem to be included as suitable conditions within current legislation or bills. It is deemed that dementia, Alzheimer’s and Parkinson’s are not mental disorders and they therefore fall under existing AD legislation.

However, in March 2027, Canada will review the situation relating to mental disorders. Will they extend the AD legislation to include these conditions? If so, this raises yet another raft of serious questions to be asked. We’ll just have to wait and see.

Ethical considerations

This is probably the area in which the majority of the key ‘arguments’ occur.

The Anscombe Bioethics Centre is a Catholic organisation based in England, and is clearly opposed to any form of assisted dying.

On their website is an April 2022 page entitled, Bioethics in Brief: Euthanasia and Assisted Suicide, the content of which is also available as a PDF download. I am not promoting their view, but the points they raise are worth noting to demonstrate the ‘other side’ of the debate. For example,

“Some favour assisted suicide over euthanasia in part because assisted suicide is seen as enhancing choice and control for the patient, and so seems less open to abuse, given that the consenting patient must ultimately perform the life-ending act on themselves. It seems, furthermore, that some people are reluctant to carry out the act themselves. Resultantly, where assisted suicide is legal but euthanasia is not then fewer people end their lives.”

It is definitely interesting that they state fewer people end their lives voluntarily - although they don’t cite their source for this claim.

The next sentence is particularly important to note,

“Euthanasia also carries the risk that doctors might practise non-voluntary euthanasia, where the patient is unable to make a request but the doctor judges it to be beneficial.”

This of course relies on the doctor’s judgment, and this is where the ethical considerations become really keen, because how can a doctor make an assessment about the quality of someone else’s life, especially when their understanding of the human body and mind is extremely limited?

This is further highlighted on a page on their website, dated October 2024 and entitled Eight Reasons Why We Must Not Legalise ‘Assisted Dying’. Reason number 8, It is a greater threat to those who already face discrimination, relates to the point I made about people with disabilities.

The Bioethics in Brief web page raises a key point, which is that the legalisation of assisted suicide paves the way for euthanasia, which can be open to abuse.

This is expanded upon in point number 5 of their list, which I feel is the one that is probably the most important for the purposes of what may be behind the increased rapidity of the rollout of this legislation.

One of the arguments for assisted dying/assisted suicide is that it’s a compassionate response for someone who experiences intense suffering. The response to that on the Bioethics page is to suggest palliative care to help provide relief from their symptoms, usually pain.

Whilst the medical system does have certain drugs they can prescribe for pain, it operates from the basis of an inadequate understanding of the human body and is therefore limited in its ability to truly help people.

The previously cited 2022 study paper also discusses ‘bioethics’ and claims the requirement for physicians to be trained in this field, because, as it states in the Conclusion,

“It is also important to remember that life is a concept that goes beyond biology. Currently, bioethics seeks to prioritize the concept of dignity, which must be linked to the very definition of life.”

This concept of ‘dignity’ may be subject to interpretation. For example, as the Bioethics web page explains,

“Most patients who request euthanasia/assisted suicide do so, not because of pain or the fear of it, but because of reasons such as feeling like a burden on those caring for them, or feeling that their lives have been stripped of dignity by illness, or realising that they can no longer participate in activities that once made life enjoyable… In other words, euthanasia / assisted suicide often has to do, not with the fact of pain, which could be palliated but with whether life still seems worthwhile.”

As I stated earlier, I acknowledge that there are people who experience great suffering that may be more than physical pain. I’m not denying their experience nor their ‘right’ to do whatever they feel is appropriate for their lives. My concern is that this ‘right’ is being played upon to open up opportunities for its application in inappropriate situations.

So how is ‘assisted dying’ administered?

The drugs used

I was rather surprised to actually find a study paper that discusses the drugs used for assisted dying. I have to add that I find it ironic that these drugs, which are used to help end someone’s life, are referred to as ‘medications’, which just further supports the notion that iatrogenesis is the number one cause of death worldwide.

To emphasise this point, medication is defined as ‘a medicine, or a set of medicines or drugs, used to improve a particular condition or illness.’ Yet these substances are also used to help end a person’s life.

In a January 2022 study paper entitled Medications and dosages used in medical assistance in dying: a cross-sectional study, under the heading Results, is the following,

“The sample included 3557 patients (1786 men [50.2%] and 1770 women [49.8%] with a mean age of 74 [standard deviation 13] yr). The majority of patients (2519 [70.8%]) had a diagnosis of cancer. The medications most often used were propofol (3504 cases [98.5%]), midazolam (3251 [91.4%]) and rocuronium (3228 [90.8%]). The median time from the first injection until death was 9 (interquartile range 6) minutes. Standard-dose lidocaine (40–60 mg) and high-dose propofol (> 1000 mg) were associated with prolonged time until death (prolonged by a median of 1 min and 3 min, respectively). Complications occurred in 41 cases (1.2%), mostly related to venous access or need for administration of a second medication.”

I decided to look into 3 of the main drugs listed above to see why they are used and what is their mechanism of action considering how quickly they are deemed to act.

And this is what I found:

Propofol:

“Propofol is an intravenous anesthetic used for procedural sedation, during monitored anesthesia care, or as an induction agent for general anesthesia.

“Like most general anesthetic agents, the mechanism of action for propofol is poorly understood but thought to be related to the effects on GABA-mediated chloride channels in the brain.”

Midazolam

“Midazolam injection is used to produce sleepiness or drowsiness and relieve anxiety before surgery or certain procedures. When midazolam is used before surgery, the patient will not remember some of the details about the procedure. Midazolam injection is also used as an anesthesia to produce loss of consciousness before and during surgery.

“Midazolam is a benzodiazepine. Benzodiazepines belong to the group of medicines called central nervous system (CNS) depressants, which are medicines that slow down the nervous system.”

Rocuronium

“Rocuronium, a paramount non-depolarizing neuromuscular blocker, is utilized in clinical settings for inducing muscle relaxation during surgical procedures and lung ventilation during elective and emergent scenarios.

Non-depolarizing neuromuscular blockers work at the site of nicotinic neuromuscular junction by acting on the synapse.

The absolute contraindication to using rocuronium would be a documented allergic reaction to the drug. Rocuronium should also not be given to any patient who is not sedated or not under the influence of anesthesia to avoid the risk of awareness.”

In other words, they are all basically drugs used as anaesthetics and sedatives; but in doses that are so high that the body stops functioning - or at least seems to stop the body functioning.

I would add here that the exact mechanisms of anaesthetics are reported to be ‘not fully understood’.

So what does this mean?

Brain Death

It is generally perceived that a person is dead when they are declared ‘brain dead’ and that there are clear methods by which this can be determined. However, it seems this may not actually be the case.

In their February 1999 paper entitled “Brain Death” is False, Paul A Byrne MD and Rev George M Rinkowski state that,

“The truth is that a person is living until dead . No one can change this truth by saying or stating that "irreversible cessation of the function or functions of the entire brain, including the brain stem," or "irreversible cessation of cerebral activity," or anything else, is death . Death is when life on earth for this person has ended, i.e., when life has separated from the body, so that all that is left is the remains.”

This makes perfect sense.

Although the view of the authors of this paper is again from a religious perspective, that does not invalidate the relevance of their comments, especially as Dr Byrne is a medical doctor. And yes, I know I am critical of their training, but some doctors have looked deeper into certain aspects of what they learned in their training or have researched further and wider.

It seems from what Dr Byrne states that a declaration according to current assessment methods that someone is ‘brain dead’ may not mean that they are actually dead.

One of the main reasons for the medical system to assert that brain death equates to actual death relates to organ harvesting for transplants. Organs that are to be transplanted cannot be ‘dead’ - in other words, they need to be harvested while the person is still alive. This point is also discussed in the Brain Death article,

“A major question to ask is, "Is the person dead?" If the answer is no, then the person is alive and must be treated as such. If we do not know the answer, we are not free to remove organs or carry out research that will kill the person if alive. If the answer is yes, then the question is: "Which set of criteria was used to make the determination of death?"

If organ harvesting, whether for transplants or more nefarious purposes, has to occur if the patient is still alive, then we all need to know this - again, so we can make truly informed decisions.

Why the increased rollout?

There are some ideas that the increased rollout of legislation for assisted dying/assisted suicide relates to funding, which I covered to a certain extent in my first article.

With fewer people on ‘end of life’ care, which involves multiple drugs, also called polypharmacy, it may be perceived that this would be detrimental to Big Pharma profits because of the reduction in the number of customers - aka patients. However, the increasing number of people who are diagnosed with a chronic condition would ensure a continual flow of customers and profits.

But Big Pharma profits are not the only aspect to consider.

There are other ideas, one of which was suggested to me by my friend Rev Tina in our recent conversation - published on her Substack - see References below. Her idea is that this may be related to a cover-up of the continuing and inevitable rise in chronic health conditions resulting from the increased administration of vaccines, especially the Covid vaccine and all of the ‘new’ vaccines based on the same mRNA technology - whatever that actually is!

I’d suggest this is definitely an idea worth considering.

In Summary

There are a lot more details I could have included about this topic, although this is already a longer article than I’d intended it to be. I feel, however, that I’ve covered the salient points I wanted to add to my original article.

I would like to again reiterate that my purpose in writing this article, as with all my articles, is to provide as much information as I can to help people make informed decisions - or at the very least, start asking more questions and looking deeper into these topics for yourselves.

Dawn 🌹

Additional References:

The Truth About Organ Donation

the SNUG [Episode 5] - A Comet & Some Onion Soup