Medicine

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Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

On March 21, 2024, the New Hampshire House passed assisted suicide House Bill 1283 by a vote of 179 to 176 based on support from Libertarian Republicans. The assisted suicide bill was referred to the Senate where it was stopped on May 16, 2024 by a vote to 17 to 7 to send the bill for further study.  

Adam Sexton reported for wmur.com that:

After an emotional floor debate on Thursday morning, New Hampshire state senators voted 17-7 to further study a bill that would legalize "medical aid in dying," or assisted suicide, in New Hampshire.

The legislation, which already passed the New Hampshire House by a narrow margin, would allow a terminally ill adult patient of sound mind with fewer than six months to live to be prescribed a lethal cocktail of drugs, which they would self-administer to die by suicide. But now, the bill will be sidelined, likely until the next legislative session.

The President of the Euthanasia Prevention Coalition, Gordon Friesen, sent members of New Hampshire's Senate his article titled: A call to defeat New Hampshire assisted suicide House Bill 1283 (Link).

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

As several European countries debate the legalization of euthanasia, at their recent meeting, the Finnish Medical Association upheld their opposition to euthanasia.

The Helsinki Times reported on May 16, 2024:
In a recent meeting on May 16, 2024, the Finnish Medical Association's (FMA) council upheld its opposition to the legalization of euthanasia and doctor-assisted suicide, reinforcing that physicians should not be compelled to perform procedures primarily intended to hasten a patient's death.

The FMA articulated that introducing legislation to permit euthanasia would represent a profound shift in values and could lead to unpredictable developments in medical practice.

The organization emphasized that the primary role of physicians is to protect life using current medical knowledge and to alleviate suffering, rather than addressing healthcare system deficiencies through euthanasia.

This decision follows an extensive period of research, international comparison, and consultation, including a survey conducted in collaboration with the University of Tampere. The survey gathered around 9,000 responses from Finnish physicians, revealing a slight increase in support for euthanasia over the years but also significant division among the medical community. Notably, doctors with specialization in palliative care tend to be more critical of euthanasia, and a majority are not personally prepared to perform it, with only 13.5% expressing full agreement that they would practice euthanasia if it were legal.

The FMA also raised concerns about the impact of legalizing euthanasia and physician-assisted suicide on public trust in healthcare, which is currently declining. Only 58% of respondents in a recent "Citizens' Pulse" survey reported high confidence in the healthcare system. The association argued that an irreversible procedure like euthanasia demands exceptionally high levels of trust in the healthcare system's ability to assess and fulfill patients' end-of-life wishes.

In conclusion, the FMA reaffirmed its position against the legalization of euthanasia, citing ethical concerns, the potential effects on physician well-being, and the equality of patient treatment. The organization believes that Finnish healthcare is not ready to incorporate euthanasia into its practice, highlighting the complex and multifaceted nature of the issue.In May 2018, the Finish parliament rejected a bill to legalize euthanasia by a vote of 128 to 60 (Link).

A few pieces came into my inbox over the past couple of weeks around organ donation and transplantation that caught my attention. While we don’t often write about this topic, it is within our concern of medical ethics as it relates to new technologies and developments in medicine. I’ve always been both fascinated and concerned about medical ethics in this domain.  In my nursing days, I worked in university hospitals that did pediatric transplants (heart, kidney, liver, and bone marrow) so I very clearly saw the pros and cons of transplantation medicine as these issues were in front of us daily.

The first story in my inbox was a report about a woman who is the second person to receive a genetically modified pig kidney transplant.  She had suffered from several heart attacks, years of diabetes, and was in kidney failure requiring dialysis just to keep her alive.  Because of her serious health issues, she was deemed not to be a suitable candidate for a human organ transplant.  Receiving a genetically modified pig kidney seemed to be her only chance of survival and she told herself, “You know what? I’m going to do it. I have to do it – for myself and for the rest of my family.” The previous report of such a transplant was in a 62 year old man. He was in end stage kidney failure when he received his genetically modified pig kidney.

Both people had no chance of long-term survival.  These are often the types of patients who are approved to be part of a new clinical trial for a new treatment, whether it be an experimental new drug, medical device, or in this case, being allowed to receive a genetically modified pig kidney.

The ethics of xenotransplantation, the transplanting of tissue or organs between different species, has long been debated. In this new field, the ethical debate usually is framed within three categories.  First, is the concern of animal welfare and the ethical and humane treatment of animals who are often sacrificed for their organs or tissue. Next is the real and serious concern of the dangers of organ and tissue rejection and the long-term need for immunological suppression to keep rejection of the transplant at bay.  Finally, there is the always heated debate around the procurement and allocation of the organs that are available for transplant.  How do we decide who can donate, which includes the debate around living donor donation? And then decide who receives the organ and by what criteria is that decision made?  Over 100,000 people in the United States are on a waiting list to receive a transplant with 17 people dying each day because the supply can’t meet the demand.

Which brings me to another story that caught my eye, where it was reported that there was manipulation of data that made certain patients ineligible for liver transplants at a Houston hospital. Memorial Hermann-Texas Medical Center announced that they had stopped their liver and kidney transplant programs while they conduct an investigation after learning that “a doctor made ‘inappropriate changes’ in a database for people awaiting a liver transplant.” The alleged charges involved changing the acceptance criteria, which of course are serious and warrant an investigation, especially since these sorts of breeches in policy erode confidence in medical ethics. The public is already skeptical of the ethics of organ donation in general and allocation of organs in specific and many lack trust in the system. Stories like what happened in Houston only confirm the public worries.  Will the increase in xenotransplantation alleviate or heighten skepticism and distrust? Whether the field of transplant medicine expands to include xenotransplantation or not, it is clear that we need to think clearly and ethically about transplantation medicine more broadly. Ethics matter and this ethical debate will get murkier as our ability to sustain life increases.  I’d love to hear your thoughts on this.

The post The Ethics of Transplantation Medicine appeared first on The Center for Bioethics & Culture Network.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Liz Carr is an actress, comedian and disability rights activist produced a documentary titled; Better off Dead? that was aired on May 14 by BBC1.

Carr who is best known for her role as Clarissa Mullery on the BBC series Silent Witness, interviewed Alicia Duncan, the daughter of Donna Duncan, who died by euthanasia in October 2021.

Alicia explains that her mother was fast-tracked for euthanasia after experiencing depression and mental issues related to a concussion acquired in a car accident.

Alicia Duncan
Elmira Tanatarova reporting for the Daily Mail on May 15, 2024 writes:

The daughter of a Canadian woman who was 'fast tracked' for euthanasia after she 'starved herself' - because she was 'depressed' following car accident complications - broke down in tears as she recounted being given 48-hours' notice that her mother was going to die.

Alicia Duncan spoke to Liz Carr for Tuesday night's BBC documentary, Better Off Dead?

Donna Duncan, 61, from Abbotsford, was involved in a minor car accident, resulting in concussion. Her health declined in the months that followed, but the exact cause remained a mystery.

However, she was 'not terminal', nor was she 'facing imminent death' - but rather was suffering from mental health issues, Alicia stressed.Alicia Duncan explains that her mother was experiencing mental health problems. Tanatarova reports:
'What we we didn't know was that she was restricting her diet. She would say that it would hurt to eat solid foods so she was pureeing everything, having soups.'

Alicia also explained how her and her sister's worries for Donna escalated.

'She was very paranoid, she worried that if she left the house, she might be shot by a sniper at any moment.

'And I think that's when we really started becoming extremely concerned that this might be a mental health issue.'

She said the behaviour was 'completely uncharacteristic' of her mother, who 'was a highly educated psychiatric nurse'.

Alicia and her sister were shocked when learning that their mother was approved to be killed. Tanatarova reports:

Alicia tearfully revealed how little time she was given to process her mother's signing up for Canada's controversial euthanasia programme - called MAiD.

'I received a text message from my mom's common law partner he wanted us to know that my mom was in the beginning stages of looking into MAiD,' she told the documentary.

'We just thought there was no way - there was no way - she would be approved.

They were given a 48 hour notice for her death

'And my sister went to go see her and asked, "how did the assessment go". And she said "do you want to know". And my sister said yes, and she said "I've been approved".

'So we had less than 48 hours' notice that my mom was going to die.'

Alicia and her sister unsuccessfully attempted to prevent the death:

Donna was approved for track one of MAiD - the 'fast track' - on the grounds that her condition was terminal.

She and her sister managed to then 'gather enough evidence to have Donna taken into custody under the Mental Health Act'. 

Alicia 'pleaded with a doctor' because 'her mom was a psychiatric nurse who knew all of the right things to say'.

'At the end of the 48 hour hold they did another assessment,' she continued. 'We received a text message from my mom's partner that evening that my mom was dead and her body had been taken to a crematorium.'

Alicia told Tanatarova that her mother wasn't terminally ill and therefore didn't qualify under "track 1" but since she had stopped eating and drinking, she was immediately deemed to be terminally ill. Tanatarova then reports on the irregularity in her mother's death.

Alicia said that her mother had been approved by the head of the MAiD programme and a nurse practitioner.

'The second assessment, it was done over the phone,' she added. 'He never saw my mom. 

'And her general practitioner, who had been her GP for 20 years, would not approve her to die.'

Tanatarova reports that Alicia and her sister Christie launched an investigation into their mother's death that concluded without any arrests.

It is impossible for medical practitioners in Canada to be prosecuted for euthanasia since the law says that the medical practitioner only has be "of the opinion" that you fit the criteria of the law.

The Canadian law is not designed with effective oversight, as long as two doctors or nurse practitioners agree that a person qualifies under the law, then they qualify, even if many doctors and nurse practitioners say they do not qualify.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
Liz Carr is an actress, comedian and disability rights activist produced a documentary titled; Better off Dead? that was aired on May 14 by BBC1. 

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Liz Carr is on the left
Liz Carr, who is an actress, comedian and disability rights activist, produced a documentary that she titled - Better off Dead? that will be aired on BBC1 on Tuesday May 14 at 9 pm (UK). Carr may be best known for her role as Clarissa Mullery on the BBC series Silent Witness.

Carr was interviewed by Anna Moore for an article that was published by the Guardian on May 14 titled: I'm fighting for my right to live.

Moore asks Carr about the timing of her documentary, Better off Dead? Carr responds by saying that she has wanted to do this since 2011, and then she says.

“It feels like it’s coming at us from all angles,”

“I’m so incensed that there is never any balance on this topic. Of course I’m worried I’ll be slagged off, that it’ll get nasty on social media. Will people come up to me on the street? But I worry more about my friends that are in the programme. The film is full of my world, my love and support. I feel a duty of care to them.”Moore explains Better off Dead?
Better Off Dead? takes a deep dive into assisted dying and disability. Carr believes the two can’t be separated. It’s disturbing, of course, but also life-affirming and darkly funny, which isn’t surprising; Carr was a standup comic for years. In the opening shots, she and her disabled friends remember the times they have been told they would be better off dead. One, Jamie Hale, has even had someone offer to kill him. (“And this wasn’t someone I was particularly close to,” he says.)

The film is also intensely personal. Carr looks back at her childhood and the impact of having her life turned upside down by a rare autoimmune condition at seven. It’s something she has been reluctant to share in the past. “Our perception of disability is that it’s the greatest tragedy to befall you and I don’t want to compound that,” she says. “But I did want to show that I do know how your life changes so hugely when you join that camp – the most unsexy, unfun, unglamorous group. Who’d want that?”Carr grew up healthy. At the age of 7 she went with her family for two years to America where she became ill from a rare autoimmune condition called arthrogryposis multiplex congenita. Moore explains:

At 11, Carr became a wheelchair user. In her early teens, a doctor told her bluntly that she wouldn’t live to be old. For Carr, the hardest scene from the programme was the one filmed in her mum’s kitchen, in which her mum reads aloud from the diaries she kept during that period, where she recorded what her daughter was experiencing. “She is very lonely,” reads one entry. “She gets very down and often says she wants to die rather than carry on, as she can’t see any good in the future.”

“I sat and listened to every awful thing that happened for the camera,” says Carr. “I had naively thought: ‘I’m in control of this,’ and then I wasn’t. I was quite damaged by it. I couldn’t tell my mum – she thought she was doing brilliantly. My mum was proud as punch!

Carr points out that Canada is considering extending euthanasia to "mature minors" when asked the question - what if assisted suicide had been available then?

Moore provides significant information about Carr's education and the development of her professional acting and comedy career. Moore then comes back to the issue of euthanasia and writes:

Through all this, the issue of assisted dying has been there, on her mind, in the background – but it crystalised and became urgent after the case of Daniel James in 2008. James had been paralysed during rugby training and died at a clinic in Switzerland 18 months later. He was 23. “I’m not here to judge him, but what I judged about that situation was the media response, the public response,” says Carr.

“He had died 18 months after becoming disabled. Not terminally ill – just disabled. But the press and public reaction was: ‘Of course, it’s the right things to do. It’s difficult, but it’s the brave decision.’ A disabled young man wants to end his life and we don’t question that? Nobody was asking: ‘How can we change? What must we do so that someone who can’t walk or do certain things has a quality of life that’s acceptable?’ I’d always known assisted dying was about disability – but oh my God.”

Moore then reports on why Carr clearly opposes assisted suicide:

Surely, though, assisted dying is about personal choice? Even if legislation were brought in and included “unbearable suffering”, which might make someone with Carr’s condition eligible, no one would be forced to take that route. “This isn’t because we think we’re going to be grabbed and taken,” says Carr. “The biggest catastrophe is that we’d choose it ourselves because there was no more choice for us.

“If an individual chooses to end their life, I’m very sorry and sad, but it’s private and personal – it doesn’t impact me. Changing the law to legalise assisted dying does. I know so many people who are suffering, not because of their condition, but because life is so much more difficult than it needs to be, because they need more than a 15-minute visit from a care worker in which to go to the loo and have a sandwich, because they’ve grown up in a world where they’ve been devalued, maybe told they’re a burden, and expectations of their lives are so low.

Carr is proud with the final cut of the documentary, but she is not done with the issue. Moore reports:

Carr’s next project is in similar territory. She will be at Galway international arts festival in July in a play called Unspeakable Conversations, based on the debate between the late lawyer and disability rights activist Harriet McBryde Johnson and the Princeton professor Peter Singer, who has argued that parents should be able to kill disabled babies. (“It’s about the same shit,” says Carr.) After that, she has some TV lined up that she can’t yet talk about: “But it’s fun stuff.”

In some ways, she will be glad when this is behind her. “It’s a tough subject, a tough campaign – you have to be so resilient,” she says. “Life is more fun when you’re not doing this stuff. Acting is what I love and what I really need to get back to. There are those that are fighting for the right to die. I’m fighting for the right to live.”

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ewan GoligherEwan Goligher is an intensive care physician in Toronto and a researcher who focuses on mechanisms of diaphragmatic dysfunction during mechanical ventilation.

Gordon Friesen Normal 0 false false false EN-CA X-NONE X-NONE Gordon Friesen
President, Euthanasia Prevention Coalition

At the root of utilitarian death-medicine lies the idea that certain lives are not worth living, and/or collectively not worth paying for. It is often clothed in theatrical protestations of compassion for suffering, but the motivation is essentially practical, and that sort of practicality comes at a terrible price.

Unsurprisingly, the deepest social harm which is created by the practice of euthanasia (or perhaps merely revealed by it) lies in a general climate of fear and distrust.

For medically justified euthanasia creates distrust, providing a pseudo-scientific rationale for parents, spouses, children and friends --indeed for community itself-- to abandon those to whom they would otherwise owe a solemn and mutual duty of aid. It thus presents dependent individuals with the terrifying obligation of justifying their own survival. And it presents all observers to these facts with a similarly terrifying presentiment of their own future.

Or as jaded Soviet executioners were once said to joke: "You today. Me tomorrow."

We often touch on this harm obliquely, when we talk of the lost trust between doctors and patients, or more generally, between society and people who are "vulnerable". For these are the two sides of dependence most commonly exposed in a public and critical fashion.

Life supporting doctors now claim a right of continued practice, according to traditional ideals of ethical and trustworthy care; at the same time, the ill and disabled tell us of death now increasingly offered in substitution for that care. In both cases, we see a vigorous rejection of euthanasia: the ill and disabled overwhelmingly refusing this most insistently proffered "option"; and a strong majority of doctors refusing to personally provide it: both acutely aware that the willingness of some doctors --to kill their patients-- creates a corresponding distrust of any doctor at all.

But it would be a mistake to view the euthanasia problem only in this light.

For to be perfectly clear: all social relations depend upon trust. Pledges of friendship, marriage, inter-generational and community support --all must be unconditional, if they are to have any significance at all.

As stated above, the utilitarian vision of public health establishes patient viability upon "quality of life" judgments which closely mirror the more crude criteria of productivity and usefulness. Of course we all wish to be useful, but just as obviously: we will all one day lose that favored status; and so will every one that we know.

To make supportive relationships conditional on such judgments is thus to install a deep sense of fear and uncertainty in daily life.

"Is it time for me to throw my partner under the bus?", one might reasonably ask, "Or is she now preparing to dispose of me?"

Clearly, if such thoughts are admitted as possible, then they also become inevitable, and trust is no more.

There are a number of strategy games, and in particular an old board game named "Diplomacy", in which players must initially cooperate in order to prosper, but in which continued "success" eventually depends upon adroitly timed betrayals.

That, I believe, is the sort of pathological social dynamics which we are now creating with medical euthanasia.

Previous articles by Gordon Friesen:

• If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia (Link).
• An unapologetic recommendation of absolute prohibition on killing (Link).

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Liz CarrLiz Carr, who is an actress, comedian and disability rights activist, produced a documentary that she titled Better off Dead? that will be airing on BBC1 on Tuesday May 14 at 9 pm (UK). Carr may be best known for her role as Clarissa Mullery on the BBC series Silent Witness.

John Pring interviewed Carr for Disability News Service for an article that was published on May 9, 2024. Pring begins with Carr telling him how frighting the concept of legalizing assisted suicide is for people with disabilities, within the concept of the failing National Health Service (UK):
Legalising assisted suicide, she said, would be even more dangerous at a time when “we are absolutely removing our welfare state, and we are dismantling our incredible NHS”.

Last week, at a protest outside the Houses of Parliament, she told DNS she was terrified by the government’s latest proposals to cut spending on personal independence payment.

She said: “I don’t even think the other side will make the connection over how terrifying that feels to disabled people yet again.

“We know disabled people have killed themselves because of DWP reforms in the past.Carr speaks about her experience with interviewing Amir Farsoud, a Canadian with disabilities who sought euthanasia based on fears of homelessness. Pring reports:
“That’s what terrifies me: the kind of thing happening in Canada where people for socio-economic reasons are choosing to end their lives through euthanasia.”

In Canada, she interviewed Amir Farsoud, a disabled man from Ontario, who requested an assisted suicide because his landlord was planning to sell off his apartment building, and he was terrified at the prospect of being left homeless on the freezing streets.

He eventually changed his mind about seeking an assisted suicide after a crowd-funding effort raised tens of thousands of dollars to support him.Farsoud told Carr that it was easier and quicker in Canada to apply for medical assistance in dying (assisted suicide) than disability benefits.

Carr comments on Keir Starmer, the leader of Britains Labour party, who is pro-euthanasia and currently leading in the polls, if an election were to happen:
She said: “I’ve always been a little bit worried about Starmer getting in power, because he introduced the guidelines [on prosecuting cases of assisted suicide, in 2010] when he was director of public prosecutions.

“I’ve known he’s been pro, we all have, for over 10 years.”

She said this was “quite frightening” and “makes it difficult for voters like me to know what to do for the next election”.

Asked if she had a message for Starmer, she said: “I would say, please watch the documentary.Carr, who is an athiest, said that people who are concerned about the legalization of assisted suicide shouldn't sideline the opposition because they are marginalized or religious because there are many people who are concerned about legalizing assisted suicide.

Pring then spoke to Carr about her meeting with Canadian euthanasia doctor Ellen Wiebe:
She also spoke of the “chilling” attitude of Canadian doctor Dr Ellen Wiebe – who is herself disabled – who has provided assisted suicide to hundreds of Canadians since it was legalised and is shown in the documentary telling Carr she was “so glad, so glad” that they had medical assistance in dying laws in Canada.

She told her: “I love my job. This is the very best work I have ever done.”

Wiebe is also shown saying that she had never had so many grateful patients, which Carr said was “one of the most terrifying things in the documentary”.

She said: “When she says that doctors like grateful patients, that is chilling to me.

“And as somebody that’s had a lot of involvement with, you know, medics, that really frightens me.”Pring then reported on Carr's message at a preview event for the documentary:
“If we ask the question, ‘Do you want to stop dying people’s suffering?’ everybody has to say yes to that, or you’re a psychopath.

“We all, I believe, want everyone to have a good death, so the answer is how we do that.

“And the only difference between me and [those supporting legalisation] is how you do that. That’s the only difference.

“I don’t want people to suffer. I want people to have a good death. I just think people will suffer more if we introduce assisted suicide.”Carr commented on the media reports that indicate that legalizing assisted suicide is inevitable. Pring reports:
she said there was “nothing inevitable about it, nothing at all… I still think it’s time for a conversation and it’s not inevitable.”

Carr said she did not understand why those fighting for legalisation did not put their resources into pushing for improved healthcare and palliative care, or “into giving people choice and control in their lives”.

She said: “Because choice isn’t choice when you’ve got no choice. It absolutely isn’t.

“And I meet people in my life who are suffering absolutely because they do not have choices in their life.”Pring reports that Carr produced the documentary to get people with disabilities prominent in the debate:
One of the things she wanted to do with the documentary, she said, was to ensure that the disabled activists who are “a big part of my life” and “who have waited for this voice for years… feel heard and seen”.

A series of disabled actors, artists and activists opposed to legalisation are either seen on film or interviewed in the documentary, including Lisa Hammond, Ellen Clifford, Jamie Hale, Paula Peters, Eleanor Lisney, Penny Pepper and disabled peers Baroness [Jane] Campbell and Baroness [Tanni] Grey-Thompson.Pring concludes the interview with Carr stating that her interview with Melanie Reid, who supports assisted suicide, primarily focused on the experiences of being two disabled women, living in contemporary society, and the struggles and the fights to get our care needs met”.

The documentary, Better off Dead? creates common ground for people with disabilities to oppose the legalization of assisted suicide. 

As the culture wars rage around us, it is easy to be consumed. Stories make the world go round, and the social media algorithms tend to keep us in a spiral of doom and gloom. Part of this is our own desire to know what is happening in the world, and tragedy is a part of the human experience. But there is also a concerted effort for people to deny natural and fundamental realities.

The CBC Network is a light on these fundamental truths, so anyone can see the reality and necessity of biomedical ethics. The simple axiom of “Do No Harm” helps us to hold the medical field accountable when they commodify the human body into simple pieces and parts to be purchased. To further the CBC’s mission, we also tell stories – true stories!

• Hopefully you have been following Gloria’s story, which details the harrowing reality of surrogacy. You can watch her story on our YouTube channel, or read about her surrogacy experience on our website.
• And that is not all. Our film The Lost Boys: Searching for Manhood has been seen over 150,000 times. With the addition of the CBC Network’s other gender critical films, nearly half a million people have seen the stories of men, women, and families affected by gender ideology and the destruction left in its wake.

To hear these stories live, please join us for the Annual Paul Ramsey Award Dinner on June 15, 2024. We will celebrate Dr. Jeffrey Bishop, a widely recognized scholar in medical ethics and medical humanities. Our special guest speaker is the indomitable Riley Gaines, who has been a force in standing up for women’s safety, privacy, and equal opportunities.

With only 60 tickets left, DO NOT DELAY! Get your ticket on the CBC’s website. There are sponsorship opportunities that include complimentary tickets, signed books, and even a VIP cocktail gathering with Dr. Bishop and Riley Gaines. We hope to see you there!

None of this is possible without our supporters. Your gifts make our work possible. We need YOU! To connect and discuss our ongoing work, or the possibility of hosting a local event with the CBC in your area, please feel free to reach out any time.

Gratefully,

Kirstin Wallace, Esq.

Development Director

P.S. Please think about becoming a monthly donor, giving stock, or a grant from a Donor Advised Fund to help us promote our mission both locally and around the world! 

The post CBC Network Shines a Light on Truth — but We Couldn’t Do it without You appeared first on The Center for Bioethics & Culture Network.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Mark KomradPsychiatrists, Dr's Mark Komrad and Annette Hanson, Ronald Pies and Cynthia Gepert, wrote a commentary on the recent attempted expansion of California's assisted suicide law that was published by the Psychiatric Times.The article explains that Dr Jennifer Gaudiani assisted the suicides of three people with eating disorders. Komrad and Hanson explain:
The third patient—Alyssa B—was actually a coauthor of the paper with Dr Gaudiani. According to the published paper,18 “Dr. G prescribed the MAID medications about 6 weeks after Alyssa entered hospice care.”

The Gaudiani et al paper is notable in acknowledging that: “Alyssa had not completed a full residential eating disorder program; never fully restored weight; never tried newer psychedelic options such as ketamine, psilocybin, or MDMA; and hadn’t had a feeding tube. Dr. G acknowledged that all but the feeding tube might ordinarily be undertaken prior to someone’s seeking end of life care for AN. Yet, [Alyssa] had been suffering for so long, and despite many conversations about all these treatment possibilities, Alyssa would not consent to any of them. Therefore, given her clarity of understanding around these issues and her sense that she could not fight anymore, everyone had to accept that they weren’t meaningful options.”Not surprisingly, the published paper and its rationale were vociferously criticized by many in the psychiatric community. For example, Dr Angela Guarda—the director of the eating disorders program at Johns Hopkins—is quoted as saying that using aid-in-dying medication for anorexia patients is “alarming” and “fraught with problems.” This is partly because “…it is impossible to disentangle this request [for PAS] from the effects of the disorder on reasoning, and especially so in the chronically ill, demoralized patient who is likely to feel a failure.”

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Maggie Hroncich
Maggie Hroncich wrote an article on a proposed bill to permit federal funding for assisted suicide that was published in the New York Sun. Hroncich reported that Democrat Members of Congress have introduced a HR 8137 to reverse the 1997 Assisted Suicide Funding Restriction Act and replace it with the Patient Access to End of Life Care Act. The language of the bill is not yet available but the new act would permit federal funding for assisted suicide. Hroncich reports:

For nearly 30 years — since Oregon became the first state to legalize physician-assisted death — Congress has prevented federal funding such as Medicare from being used by patients to pay for the practice. A bill proposed by Democratic lawmakers seeks to change that.

In 1997, Congress passed the Assisted Suicide Funding Restriction Act, which prohibits using federal funds to provide for any health care services that assisted in someone’s death, including “assisting in the suicide, euthanasia, or mercy killing of any individual.”The sponsors of the bill, Democratic Representatives Brittany Pettersen and Scott Peters released a draft discussion which states:
“Medical aid-in-dying, an authorized medical practice, is not euthanasia, mercy killing, or assisted suicide,” a draft discussion of the new “Patient Access to End of Life Care Act’’ obtained by the Sun reads.In other words Petterson and Peters intend to get funding approved for assisted suicide by redefining assisted suicide as not being assisted suicide.

The Euthanasia Prevention Coalition is opposing the Patient Access to End of Life Care Act. Hroncich reports:
Yet, an online petition with hundreds of signatures is already forming against the proposal, noting that it “would force Americans to pay for assisted suicide (medically approved killing by poison) with their tax dollars.”

“I oppose assisted suicide and I vehemently oppose paying for medically approved killing,” the petition on Canada’s Euthanasia Prevention Coaltion writes of the American legislation. “Thank you in advance for upholding my conscience rights by not approving the use of tax dollars for killing.”

The Canadian group is outspoken in warning America not to follow its path, arguing that legalizing medically-assisted death opens a door that can’t be shut.Petition: I oppose US federal funding for assisted suicide (Link).

The post Report Cards for Embryos  appeared first on The Center for Bioethics & Culture Network.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dan Clark reported for the Times Union that assisted suicide remains on the docket in New York. Clark's article: A month left in NY's legislative session. Here's what Clark states is on deck states:
Legislation is also up for consideration that would allow terminally ill patients to be prescribed medication they could use to end their life before their illness takes them.

It’s a bill that’s struggled to gain support in the Legislature, but that may change because of a key endorsement of the legislation this year.

The Medical Society of the State of New York had opposed the bill, but reversed that position in April after an internal vote.

“(The Medical Society) supports legislation such as the Medical Aid in Dying Act and supports physicians’ choice to opt-in or decline to engage in the processes and procedures as outlined in any proposed medical aid in dying legislation,” the group said.

Advocates for the bill have been a consistent presence at the Capitol this year, usually on Tuesdays. They approach lawmakers and try to convince them to sign on to the bill.

Opponents of the legislation refer to the practice as “assisted suicide,” though some have different reasons for why they’re against it.

Some religious groups, for example, are morally against it. Some disability advocates, but not all, see it as a slippery slope that could lead to similar legislation aimed at people with chronic conditions.

The assisted suicide lobby has invested resources into getting the New York assisted suicide bill debated. We are ready to oppose the assisted suicide bill.

Contact New York representatives to oppose assisted suicide (Link).

More information on this topic:

• The assisted suicide lobby wants to legalize assisted suicide in your state and then expand the law later (Link).
• Disability leaders on New York's capital urge lawmakers to reject assisted suicide (Link).
  
• Vermont assisted suicide deaths more than quadruple (Link).

Euthanasia for poverty is horrifying, profane, the outcome of a failed social welfare system and it is indefensible. 

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

David Moscrop wrote an excellent article that was published by Jacobin Magazine on May 2, 2024. Jacobin is an ideologically left magazine, which is concerned about Canada killing people with disabilities and the poor by euthanasia, known as MAiD. The article begins with this quote:
Canada boasts one of the world’s highest assisted-death rates, supposedly enabling the terminally ill to die with dignity. However, this suicide program increasingly resembles a dystopian replacement for care services, exchanging social welfare for euthanasia.Normand Meunier
Moscrop tells the story of Normand Meunier, the quadriplegic man in Québec who died by euthanasia after suffering from horrific neglect. Moscrop writes:
For want of a mattress, a man is dead. That’s the story, in sum, of a quadriplegic man who chose to end his life in January through medically assisted death. Normand Meunier’s story, as reported by the CBC, began with a visit to a Quebec hospital due to a respiratory virus. Meunier subsequently developed a painful bedsore after being left without access to a mattress to accommodate his needs. Thereafter, he applied to Canada’s Medical Assistance in Dying (MAiD) program.

As Rachel Watts writes in her report, Meunier spent ninety-five hours on a stretcher in the emergency room — just hours short of four days. The bedsore he developed “eventually worsened to the point where bone and muscle were exposed and visible — making his recovery and prognosis bleak.” The man who “didn’t want to be a burden” chose to die at home. An internal investigation into the matter is underway.I find it interesting that the article states that Meunier chose to die by euthanasia when in fact he was put into an untenable situation. Moscrop then reinforces the concerns of the disability community:
Disability and other advocates have been warning us for years that MAiD puts people at risk. They warned that the risk of people choosing death — because it’s easier than fighting to survive in a system that impoverishes people, and disproportionately does so to those who are disabled — is real. Underinvestment in medical care will push people up to and beyond the brink, which means some will choose to die instead of “burden” their loved ones or society at large. They were right.Moscrop comments on how euthanasia is the outcome of a failed social welfare state:
A libertarian ethos partially underwrote the fact that not many people blinked when MAiD was initially rolled out. Taking a more expansive view of rights, many of those not swayed by rote libertarianism were convinced that concerns over bodily autonomy and compassion were reason enough to adopt MAiD. However, in the absence of a robust welfare state, and in the face of structural poverty and discrimination, particularly toward disabled people, there is no world in which the MAiD program can be understood to be “progressive.”

Indeed, last year, Jeremy Appel argued that MAiD was “beginning to look like a dystopian end run around the cost of providing social welfare.” Initially supportive, he changed his mind on MAiD as he considered that the decisions people make are not strictly speaking individual but are instead collectively shaped and sometimes “the product of social circumstances, which are outside of their control.” When we don’t care for one another, what do we end up with? “I’ve come to realize,” wrote Appel, “that euthanasia in Canada represents the cynical endgame of social provisioning with the brutal logic of late-stage capitalism — we’ll starve you of the funding you need to live a dignified life [. . .] and if you don’t like it, why don’t you just kill yourself?”

Moscrop then comments on that euthanasia for psychiatric reasons has been delayed in Canada based on the lack of mental health care. He refers to the reality as grotesque and writes that this is the stuff of nightmarish science fiction. Moscrop comments on the broken social welfare system in Canada.

In Canada’s most populous province, Ontario, a recipient of disability support receives about $1,300 a month — a pittance they’re meant to stretch to cover food, shelter, and other basic needs. Ontario Works — the province’s welfare program — pays a current maximum of $733 a month. Meanwhile, rental costs for a one bedroom apartment routinely push toward an average of $2,000 a month in many cities. In April, in Toronto, a one bedroom apartment averaged almost $2,500 a month.Moscrop challenges a statement by euthanasia activists James Downer and Susan MacDonald who stated:[d]espite fears that availability of MAiD for people with terminal illness would lead to requests for MAiD driven by socioeconomic deprivation or poor service availability (e.g., palliative care), available evidence consistently indicates that MAiD is most commonly received by people of high socioeconomic status and lower support needs, and those with high involvement of palliative care.Moscrop replies:
By their own admission, the data on this matter is imperfect. But even if it were, the fact that “most” patients who choose MAiD are better off socioeconomically is beside the point. Some are not — and those “some” are important. That includes a man living with Amyotrophic Lateral Sclerosis who, in 2019, chose medically assisted death because he couldn’t find adequate medical care that would also allow him to be with his son. It also includes a man whose application listed only “hearing loss,” and whose brother says he was “basically put to death.” This story came a year after experts raised the concern that the country’s MAiD regime was in violation of the Universal Declaration of Human Rights.

In 2022, Global News said the quiet part out loud: poverty is driving disabled Canadians to consider MAiD. Those “some” who are driven to assisted death because of poverty or an inability to access adequate care deserve to live with dignity and with the resources they need to live as they wish. They should never, ever feel the pressure to choose to die because our social welfare institutions are starved and our health care system has been vandalized through years of austerity and poor management.Moscrop then states that Canada has the resources to prevent endemic poverty and provide adequate care, that poor people being euthanized by the state is profane.

Trudo Lemmens
Moscrop then refers to a recent article by professor Trudo Lemmens who is a critic of Canada's euthanasia law.
In a February piece for the Globe and Mail, University of Toronto law professor Trudo Lemmens wrote, “The results of our MAiD regime’s promotion of access to death as a benefit, and the trivialization of death as a harm to be protected against, are increasingly clear.” In critiquing MAiD’s second track, which allows physician-assisted death for those who do not face “a reasonably foreseeable death,” Lemmens points out that within two years of its adoption, “‘track two’ MAiD providers had ended already the lives of close to seven hundred disabled people, most of whom likely had years of life left.”

In raising concerns about expanding MAiD to cover mental illness, Lemmens added that “there are growing concerns that inadequate social and mental health care, and a failure to provide housing supports, push people to request MAiD,” noting that “[a]dding mental illness as a basis for MAiD will only increase the number of people exposed to higher risks of premature death.”Gabrielle Peters
Moscrop continues by referring to a commentary from disability leader Gabrielle Peters.
In 2021, Gabrielle Peters warned in Maclean’s that extending MAiD to cover those who weren’t facing an immediately foreseeable death was “dangerous, unsettling and deeply flawed.” She traced the various ways in which a broader MAiD law could lead to people choosing to die in the face of austerity, adding an intersectional lens that is often missing from our discussions and debates over the issue.

She warned that we were failing to consider “how poverty and racism intersect with disability to create greater risk of harm, more institutional bias and barriers, additional layers of othering and dehumanization, and fewer resources for addressing any of these.” And now here we are. We should have listened more carefully.Moscrop ends his article by suggesting that euthanasia may be OK based on personal choice but it is indefensible when it is based on poverty.
While MAiD may be defensible as a means for individuals to exercise personal choice in how they live and how they die when facing illness and pain, it is plainly indefensible when state-induced austerity and mismanagement leads to people choosing to end their lives that have been made unnecessarily miserable. In short, we are killing people for being poor and disabled, which is horrifying.

It thus falls to proponents of MAiD to show how such deaths can be avoided, just as it falls to policymakers to build or rebuild institutions that ensure no one ever opts to end their life for lack of resources or support, which we could provide in abundance if we choose to.I agree with most of Moscrop's comments but I disagree with his statement that euthanasia is possibly defensible as a means of individuals exercising personal choice. Even though people with disabilities experience social devaluation in Canada, they may be still exercising personal choice when they ask to be killed.

The problem with modern writers is that they miss the fact that euthanasia is about killing people. Even if Canada had a greater level of equality, there would be people who ask to be killed based on their poverty or their concerns about homelessness.

The real concern is that Canada has given medical professionals the right in law to kill their patients. This is about people killing people.

Nonetheless Moscrop is right that euthanasia based on poverty or disability is rarely based on personal choice and autonomy, it is horrifying, it is profane, it is the outcome of a failed social welfare system and it is indefensible.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
Gabrielle PetersI was going through my emails and found this excellent article that was published on April 26 in Policy Options by Gabrielle Peters, a disabled writer, policy analyst and the co-founder of Disability Filibuster. X: @mssinenomine

Peters is writing from a disability perspective as to why we need MAiD free health care options in Canada. Peters explains:

Some health-care providers see MAiD-free spaces as working environments that allow them to respect their conscience and adhere to their professional understanding of doing no harm.

Disabled patients, however, have expressed different reasons for wanting MAiD-free health-care settings.

Peters continues:
To start with, we should have the right to receive medical care in places and from people who do not contemplate or participate in killing disabled people as part of a care plan.

Who wants to look up at a doctor from a hospital bed and wonder if they have just deliberately ended the life of someone with a similar condition? Or to overhear conversations in hallways, waiting rooms, nursing stations or on the other side of a curtain, about how a lethal injection preserved a relative’s dignity before she – gasp – became incontinent, like me.Peters explains that faith based facilities (for now) are the only MAiD-free spaces. She then comments on the reality of ableism:
Many disabled people can remember a time in their lives when they would or could have agreed to MAiD had it been suggested to them. The reason for this unfortunate common bond is ableism.

A brief and widely adopted definition of ableism Fiona Kumari Campbell explains it as “a network of beliefs, processes and practices that produces a particular kind of self and body…that is projected as perfect and species-typical, and therefore essential and fully human.”

As a result, disability “is cast as a diminished state of being human.” It is a short journey from believing disability makes you less human to thinking that it is better to be dead than disabled.

Ableism in Canada is structural, codified, and acts as the rebar in our economy, politics, and culture. It defines and designs access to resources, services, public space, education, housing, health and health care, employment, and fundamental human rights.

Ableism affects how others perceive and treat us and how we perceive ourselves and our experiences. In this way ableism informs how our suffering is interpreted, making causal links that are not supported by evidence.Peters then quotes from Professor Heidi Janz who commented on medical ableism:
Medical ableism is often presented as “common sense” instead of bias, University of Alberta professor Heidi Janz says. Part of what allows it to remain unexamined is it exists within a larger contested framework referred to as the medical model of disability. In this model, disability is defined as deficiency, tragedy, and the opposite of health. Suffering is assumed and, because disability is understood entirely as a problem with an individual’s body, knowledge, power, and authority are placed within the medical field.

The result of this is our entire humanity is compressed into our diagnoses. There is no examination of the inherent political oppression or the bias in treatment because the medical model assumes the inequity disabled people experience is a logical result of being disabled.

This also incidentally is one of the many reasons MAiD assessors are ill-equipped to identify social suffering and solutions.Peters writes about how health-care professionals have power over people with disabilities since the doctor are often the gate-keeper to the services and that people need. Peters continues:
That signature is shaped by their perception of us, which is shaped by how well we align with their judgment of us as a “good patient.” In recent years, medicine has moved away from the use of the word compliant to describe whether patients follow medical advice. Now they talk about adherence. But whichever word they use, the power imbalance remains, and patients and family are hesitant to ask questions or raise concerns. As well, in most interactions, patients have just 11 seconds to speak before a physician interrupts them, research has shown.

Physicians conflate disability with suffering. Some bioethicists have likened disabled people to “happy slaves” for daring to suggest that disability is not a synonym for misery. Physicians consistently rate disabled people’s quality of life lower than disabled people themselves do. This is called the disability paradox.Peters then explains why the euthanasia lobby have had such influence:
The deluge of emotionally charged MAiD coverage is driven primarily by stories crafted or at least aided by the public relations and lobby efforts by proponents. As part of its recent campaign, Dying with Dignity, a national organization that campaigns for the expansion and liberalization of MAiD, emailed supporters urging them to submit opinion pieces to media organizations and offered the help of its communications team.

The CEO of Dying with Dignity has met with senators and members of Parliament in official lobbying capacity 41 times in the last 12 months. The charity also employs lobbyists at Blackbird Communications.

In a public-relations war, money can create even more imbalance than it does in a courtroom.Peters explains her concerns with suicide contagion.
But much of the media coverage of MAiD runs counter to the World Health Organization’s guidelines for responsible reporting on suicide. The WHO warns against spreading suicide contagion through prominent placement of stories about suicide, by normalizing it or presenting it as a constructive solution to problems, and by explicitly describing the method used.

Perhaps a lot of the coverage of MAiD ignores contagion protocols because MAiD is a euphemism for assisted suicide or euthanasia.Peters then comments on the concept of the "forced transfer":
A former executive director of Dying with Dignity said in a 2019 statement of claim that it was her “creative-thinking” that is responsible for the “ground-breaking” term. The statement was part of an Ontario lawsuit in which the public-relations value of the term was highlighted, noting it has been adopted “nationally and internationally by academics, clinicians, lawyers, and others in the right to die movement.”

Patients are transferred every day to access care, equipment or expertise that is not available where they are.

And it is striking that the term “forced transfer” is selectively applied to MAiD and not, for example, patients forced to move to long-term care facilities not of their choosing, on threat of being billed $400/day by the government if they refuse.Peters comments on the reality of her deterioration of care.
In 2009, before MAiD was legalized, I was living in North Vancouver. Since the onset of my rare neuromuscular disease several years prior I had been seen by an assortment of specialists at three different hospitals. Approximately two years of that time was spent in search of diagnosis for the multiple and worsening symptoms. At first, I thought I was just run down following a virus, but a turning point was when I had to be helped out of the community centre pool by a lifeguard because I couldn’t catch my breath a quarter of the way into my first lap. Over time, I transitioned from trail runner to using a cane, then walker and eventually a wheelchair. Simultaneously I transformed from being perceived as normal but sick to disabled and “unfixable” – and fat because of the corticosteroids.

No longer able to work and unable to access benefits due to eligibility criteria that declared me a dependent of the boyfriend I had been living with, my economic situation deteriorated.

Soon, my care changed, too. Nurses stopped complimenting me on my shoes, asking about my work, and telling me not to give up. The new answer to every question was a shrug and “you’re disabled.” It took three trips to two different hospitals and a tense standoff to finally be diagnosed and treated for deep-vein thrombosis and a pulmonary embolism following an intravenous immunoglobulin treatment (IVIG).

Meanwhile my condition created a smorgasbord of symptoms and managing one would sometimes worsen or create another. There were complications, “atypical presentations,” systemic infections, superbugs, and an ever-growing list of prescriptions sometimes accompanied by allergic reactions and serious side effects. I was a “high-cost health-care user.” The term is used to describe the five per cent of health-care users who are said to account for nearly two-thirds of health-care costs.

I sensed a growing defeatism among those providing me with care. But I was certain that the danger was at least partially a result of the health-care system’s siloed and almost exclusive focus on the latest acute crisis made worse by under-funding and embedded bias.Peters explains her experience with treatment and care at St Paul's hospital in Vancouver that led to her improved health. There was a hospital employee who pressured her to accept non-treatment as a "treatment" proposal but after dealing with that employee she did find good care at St. Paul's. She then writes:
Many, if not most, disabled people would prefer the additional option of secular MAiD-free spaces. But Catherine Frazee, whose quote starts this article, has articulated the view of a great many disabled people who fervently want safety from MAiD.

Affirming support for the belief of “better dead than disabled” in health care is dangerous and cruel. Canada has made disabled people a killable class, and hardly anyone has considered the impact this would have on us. This country must maintain MAiD-free health-care spaces.

Hadamar May 5, 2024Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I spoke at a conference in Germany on May 4, 2024. Since I was going to Germany I decided to go for few days to visit some of the T-4 euthanasia killing centres.

On May 1, I first visited the Grafeneck euthanasia memorial since it was the first of the T-4 euthanasia euthanasia centres. Approximately 10,000 people were killed at Grafeneck. On May 2, I visited the Hartheim castle euthanasia memorial where 18,269 people were killed under the T-4 euthanasia program and at least 30,000 people in total were gassed to death.
On Sunday May 5 I visited the Hadamar euthanasia memorial where at least 10,000 people were killed under the T-4 euthanasia program and approximately 15,000 were killed in total. Canada had approximately 16,000 euthanasia deaths in 2023. I have been reading more about the T-4 euthanasia program because history seems to be repeating itself.

Hadamar May 5, 2024I will republish from the Hadamar killing centre website which states:

At the end of 1940, the building of the Hadamar State Sanatorium (Landesheilanstalt Hadamar) was converted into a killing centre. The contracting authority behind this was the organisation responsible for the centrally controlled “adult euthanasia” programme, which was later referred to as the “T4” programme (Aktion T4). The headquarters of this organization was located on the Berlin street address of Tiergartenstraße 4 – hence “T4”.

Adolf Hitler, Führer and Chancellor of the German Reich, had instructed Karl Brandt, his accompanying doctor, and Philipp Bouhler, head of the Führer’s Chancellery, to carry out the murders. Both men were at the forefront of the “T4” programme.

The psychiatric hospitals in the German Reich, often referred to as state sanatoriums or convalescent and care homes, first received registration forms, so-called “Meldebögen”, from the health administration of the Reich Ministry of the Interior, in which they had to report on patients.

On the basis of these registration forms, so-called “Gutachter”, often professors of psychiatry and heads of institutions, were called on as experts to assess the patients and then decided between life and death. Those who were no longer able to work or had been long-term institutional patients or had not heard from relatives in a long time had little chance of survival.

Bus at HadamarIt was in these killing centres, which had been set up for this specific purpose, that these persons were murdered at the beginning of 1940. The Hadamar killing centre was the sixth and last murder site that was set up during the “T4” programme. The 13th of January 1941 marks the beginning of these murders. These individuals were first moved to “intermediate institutions” where they awaited transport to the Hadamar killing centre.

The “intermediate institutions” leading to Hadamar were located in Herborn, Weilmünster, Idstein (Kalmenhof), Eltville (Eichberg) in what is today the state of Hesse, Galkhausen (now North Rhine-Westphalia), Andernach, Schauen (now Rhineland-Palatinate) as well as Wiesloch and Weinsberg (now Baden-Württemberg). It was from Düsseldorf-Grafenberg (now North Rhine-Westphalia) and Heppenheim (now Hesse) in particular that patients who were considered Jews according to Nazi racial policy were forcibly taken to Hadamar.

Hadamar gas chamber.As was done in the other killing centres, a gas chamber and cremation furnaces were set up in the former Hadamar State Sanatorium. The institution was managed by two doctors. During the year of 1941, the killing centre employed a total of about 100 people, including nurses, kitchen staff and administrative personnel.

Since January 1941, patients had regularly arrived at the Hadamar killing centre on buses operated by the transport company that was in itself a subdivision of the “T4” organisation. These persons then disembarked the bus inside the wooden bus garage that had been built specifically for this purpose. They were then led inside the main building and made to undress in a large hall. Afterwards, administrative staff members checked personal information and one of the killing doctors determined the cause of death that would later appear in the falsified documents.

Hadamar smoke.It was in the gas chamber in the basement that the persons were then murdered using carbon monoxide. Afterwards, special staff members of the institution incinerated the bodies in the crematorium. Rising above the killing centre, the smoke that ensued from the incineration process could be seen from afar; and, as people of that time reported, one could also smell it.

The relatives of those murdered received so called “comfort letters” typed by secretaries which included false information about the circumstances of death, the time of death and, sometimes, the place of death. If relatives so requested, they were sent urns. However, these urns did not contain the ashes of their murdered family member.

By the time the “T4” programme was halted on 24 August 1941, over 10,000 patients had been murdered in Hadamar.Wikipedia reports what happened at Hadamar in this manner:

The clinic in Hadamar, which housed a psychiatric facility, was the last of six facilities set up to implement the programme, with murders commencing in January 1941.  During the first phase of operations (January to August 1941), 10,072 men, women and children were murdered with carbon monoxide in a gas chamber as part of the Nazi "euthanasia" programme.  The gas was obtained in standard cylinders supplied by the chemicals company IG Farben.

Thick smoke from the hospital crematorium billowed over Hadamar in the summer of 1941, during which the staff celebrated the cremation of their 10,000th patient with beer and wine. Up to 100 victims arrived in post-buses every day. They were told to disrobe for a "medical examination". Sent before a physician, each was recorded as having one of 60 fatal diseases, as "incurables" were to be given a "mercy death". The doctor identified each person with different-coloured sticking plasters for one of three categories: murder; murder & remove brain for research; murder & extract gold teeth.

Families of the victims were sent "comfort letters" with falsified causes of death. Families could also request a funerary urn, but the ashes were not from their family member.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Hartheim May 2, 2024I will be speaking at a conference in Germany on Saturday, so I decided to go to Germany for few days to visit some of the T-4 euthanasia killing sites. I decided to first visit the euthanasia memorial at the Grafeneck psychiatric facility because it was the first of the T-4 euthanasia euthanasia sites.

Today I visited the Hartheim castle euthanasia memorial. 18,269 people were killed under the T-4 euthanasia program and at least 30,000 people in total were gassed to death at Hartheim. I have been reading more about the T-4 euthanasia program because history seems to be repeating itself.

The Hartheim castle is an historic property that became a home for people with mental disabilities after being donated by the Prince of Starhemberg to the Upper Austrian State Welfare Society in 1898. The German government took over the property in 1939 to convert it into a killing center.

I am republishing much of the wikipedia information about the Hartheim killing centre. Here is a link to great information about the Hartheim Castle (Link).

The Hartheim killing centre (German: NS-Tötungsanstalt Hartheim, ... was a killing facility involved in the Nazi programme known as Aktion T4, in which German citizens deemed mentally or physically unfit were systematically murdered with poison gas. Often, these patients were transferred from other killing facilities such as the Am Spiegelgrund clinic in Vienna. ... Other victims included Jews, Communists and those considered undesirable by the state. Concentration camp inmates who were unfit for work, or otherwise deemed troublesome, were also executed here. The facility was housed in Hartheim Castle in the municipality of Alkoven, near Linz, Austria, which now is a memorial site and documentation centre. (This paragraph was edited because wikipedia was wrong).

Hartheim and T-4 statistics

In June 1945, during investigations by US Forces into the former gassing facility at Hartheim, the American investigating officer Charles Dameron broke open a steel safe in which the Hartheim statistics were found. This was a 39-page document produced for the internal purposes of the Nazi "euthanasia" programme (Aktion T4), and contained monthly statistics of the gassing of mentally and physically handicapped patients (called "disinfection" in the document) carried out in the six killing centres on the territory of the Reich. In 1968 and 1970 an ex-employee of the establishment revealed, as a witness, that he had to compile the material at the end of 1942.  The Hartheim statistics included a page on which it was calculated that "disinfecting 70,273 people with a life expectation of 10 years" had saved food in the value of 141,775,573.80 Reichsmarks.

Victims of the first extermination phase in Hartheim

Hartheim gas chamberAccording to the Hartheim statistics, a total of 18,269 people were murdered in the gas chamber at Hartheim in the period of 16 months between May 1940 and September 1941:
1940: May, 633, June, 982, July, 1449, August, 1740, September, 1123, October, 1400, November, 1396, December, 947.
1941: January, 943, February, 1178, March, 974, April, 1123, May, 1106, June, 1364, July, 735, August, 1176.These statistics only cover the first extermination phase of the Nazi's euthanasia programme, Action T4, which was brought to an end by Hitler's order dated 24 August 1941 after protests by the Roman Catholic Church. (specifically Bishop von Galen)

In all it is estimated that a total of 30,000 people were murdered at Hartheim. Among those killed were sick and disabled persons as well as prisoners from concentration camps. The killings were carried out by carbon monoxide poisoning.

14f13 "Special Treatment"

Just three days after the formal end of Action T4, a lorry arrived at Hartheim with 70 Jewish inmates from Mauthausen concentration camp who were subsequently executed there.  The Hartheim killing centre achieved a special notoriety, not just because it was where the largest number of patients were gassed, but because as part of Action 14f13 Hartheim was also the institution in which the most concentration camp prisoners were executed. Their numbers are estimated at 12,000. 

Some of the prisoners at Mauthausen who were no longer capable of working, especially in the quarries, and politically undesirable prisoners were brought to Hartheim to be executed. In the papers these transfers were disguised with terms like "recreation leave". The entries under "sickness" included "German-haters", "communist" or "Polish fanatic". From 1944 on, the prisoners were no longer selected by T4 doctors; the objective was simply to gain space in the Mauthausen camp quickly.  Other transports came from the concentration camp of Gusen, and probably also from Ravensbrück during 1944, made up of women inmates who were predominantly tuberculosis sufferers and those deemed mentally infirm.

Execution Doctors

Rudolf LonauerThe Action T4 organisers, Viktor Brack and Karl Brandt, ordered that the execution of the sick had to be carried out by medical doctors because Hitler's memorandum of authorisation of 1 September 1939 only referred to doctors. The operation of the gas tap was thus the responsibility of doctors in the death centres. However, during the course of the programme, the gas valves were occasionally operated by others in the absence of the doctors or for other reasons. Also, many doctors used pseudonyms rather than their real names in the documents.

The following execution doctors worked in Hartheim: Head: Rudolf Lonauer: 1 April 1940 to April 1945. Deputy head: Georg Renno: May 1940 to February 1945

Move of headquarters from Berlin to Hartheim and Weissenbach am Attersee

Hartheim euthanasia staffIn August 1943, due to allied bombing of Berlin, the head office for the National Socialist Euthanasia Programme was moved from Tiergartenstrasse 4, Berlin, to the Ostmark region, which was then humorously described as the air raid shelter of the Reich. The statistic and documents by Paul Nitsche, correspondence, notices and reports were taken to Hartheim (office department, accounts office) and the Schoberstein Recreation Centre near Weißenbach am Attersee (medical department).

References can be found on wikipedia (Link)

Grafeneck gateAlex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I will be speaking at a conference in Germany on Saturday, so I decided to go to Germany for few days to visit a some of the T-4 euthanasia sites. Today I visited the euthanasia memorial at the Grafeneck psychiatric hospital where it is believed that 10,654 people were gassed to death. I have been reading more about the T-4 euthanasia program because history is repeating itself.

In September 2023, while I was in Berlin Germany to speak at a conference, I went to the Euthanasia Memorial located at Tiergartenstraße 4, which was the headquarters of the T-4 euthanasia program that killed approximately 70,000 people, beginning in January 1940 (Article).

I have reproduced the information from the United States Holocaust Memorial Museum about Grafeneck:

Grafeneck Castle (Link to information).

Grafeneck Castle (Schloss Grafeneck) was built near the city of Tübingen in southwestern Germany around 1560. It was originally a hunting lodge for the dukes of Württemberg. Later modernized, the complex was privatized in 1904. In 1928, it came into the possession of the Samaritan Foundation (Samariterstiftung), a charitable arm of the German Lutheran Church. The foundation established a care facility for male patients with disabilities at Grafeneck in 1929.

Establishing the Killing Center at Grafeneck

When T4 operatives began to identify sites to serve as killing centers for the adult euthanasia program, they first chose the Grafeneck complex. The isolated location of the castle in the hills of the Swabian Alb appealed to their need for secrecy. The surrounding forest shielded the site from public view and only two entrances led to the facility. On October 6, 1939, high ranking T4 officials confiscated Grafeneck “for the purposes of the Reich.” Soon thereafter, caretakers at Grafeneck, as well as the facility’s 110 male patients, were removed from the complex.

By late October, T4 operatives arrived to convert the care facility into a killing center. On the castle grounds they erected a wooden barracks with beds. A construction team transformed the old coach house behind the castle into a makeshift gas chamber.

The castle itself housed the facility’s administrative offices. It also included a special registry office which issued the victims’ death certificates without attracting the attention of local officials. The death certificates were issued with falsified causes and dates of death.