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Professor Toffler on euthanasia myths


It's a delight to be here. I'm here to try to help educate you. I'm trying to give you reasoned facts about what's going on. I'm trying to use the correct language about what's going on, the king's English, if you will.

Even as Inge used the word physician aid in dying or physician-assisted dying. If that were what we're talking about it, I would be in favour of it, because that's what I do with my patients. So I'm going to share some issues with you, but first of all, I want to just share what's going on.

If you want to change society, the first thing you have to do, all social engineering is preceded by verbal engineering. That's one tactic. So do not let any of these euphemisms for assisted suicide be used over and over again.

The second leg, if you can't fool people with just language alone, you have to create fear.

Now I'm going to share facts with you, and when I share facts that sometimes are kind of sad, people say that's causing fear. Well if it's true, you should know about those facts. But if it's not true, then you need to basically create fear that you're going to be suffering, in great pain, and the only way to relieve your suffering, the only solution to suffering, is to end the life of the sufferer.

That's the second tactic. And when you allow reasoned dialogue like this in legislatures here or elsewhere, generally the assisted suicide movement loses. Because as much as we like to bash politicians, they have hearings, as you all know who are here in Parliament, sometimes for hours, days, months, and there is a time to go past drive-by debate, and generally when you look at the facts, as Margaret said, worldwide, it's not pretty.

So if you can't win with reasoned dialogue, then you go ahead and shift the issue to faith, and church, and you attack the church or the faith of the individual who's espousing the reasonable arguments that make this not a good fit for society.

So those are the three legs of the stool, euphemisms, fear, and don't talk about the subject but talk about the fact that I might have faith or I might not have faith.

One of the more powerful spokespersons for the opposition to assisted suicide in society is a secular humanist lawyer in Seattle, Margaret Dore, who has a website that I'd encourage you to look at if you want facts about this. It's called Choice is an Illusion. She resents the fact anytime brings up issues about overall life or death or choice. She wants to talk about the facts, as many times, lawyers and barristers and judges do, just the facts. And she'll chastise me if I drift apart from that topic.

So I chose the title of this little presentation, I made it a little terser than the ones I've given in the last two days, because I believe your time's valuable, I want to give you plenty of time to talk. If I don't make something clear, please feel free to interrupt me. I didn't title this “The 10 Myths”, I titled it “10 Myths” because there are more myths about assisted suicide. But I want to go through those things, and my goal with this is to show that when you exercise this so-called right, in Oregon or Washington, you are displaying dispassion rather than compassion, and I'll show you some specific examples that illustrate that.

Now don't get me wrong, I'm not attacking people individually, but I'm telling you when you're apathetic about what people choose, it isn't being willing to suffer with, that's the roots of the word, it's being dispassionate. It's colluding with that feeling.

I want to mention that it's dangerous because there have been cases where people are going after ulterior motives. Not everyone is a Boy Scout or Girl Scout in the world, and certainly not in medicine. In the U.S., there are over a million doctors. They all don't have the same ethic.

It has numerous problems, I'm going to only in the brief time I have, highlight some of them. And there are alternatives. It's Physicians for Compassion and Care. We chose the name deliberately. We're not an opposition group. We're trying to enhance end-of-life care, but never compromising our integrity to embrace situational killing at the end of life. We have the technology and the capacity, we have the humanity to do that.

In Australia, I've read in your paper where you're cutting back on home deliveries, not home deliveries, it's home care out of cost saving. In just yesterday or the day before's paper, Margaret talked about how things are getting cut back because in Australia, like in the United States, costs are going up in health care faster than the rate of inflation.

So Myth Number One, you'll hear this over and over again of it's because of pain.

Actually, pain is seldom the reason, and I'm going to show the data that supports with I'm contending. If anything, it's the fear of pain.

Now I agree, there is fear of pain. I'm not just talking theoretically either. You know, I've lost five of my closest loved ones in the last 15 years, beginning with my father in 2002, 2003, my mother, three and a half months later. My mother and father-in-law had a brain tumour, and she followed six or seven months after my father-in-law died, and 37 months ago, my wife of 40 years, I lost.

All of the them died with dignity. None of them took an overdose. So I'm not talking theoretically. I'm talking in real terms of applying the facts and the information I'm sharing with you. It is true that virtually all pain can be controlled.

My father, after an emergency colectomy, got a propofol drip. That's where the ICU nurse administers intravenous medication to keep you sedated so you don't fight the respirator, you don't pull out tubes inadvertently. And by the time they lightened the drip to bring him back to consciousness, he had no pain whatsoever. I had to tell him what went on because he was doing so well.

The sedation was used as a technique to control his pain, make him comfortable, with a goal of having him be more robust as he recovered from surgery. So we have that technology, it was used on my own family.

We can use radiation, my wife got this for some of her cancer, trying to hopefully help the pain in her spine. When that wasn't totally effective, she had what's called palliative surgery. Palliative surgery is where that metastatic fracture of her spine, that's where cancer goes into the bone, weakens the bone, the spine collapses, is threatening to make her a paraplegic for the last few months of her life. And because we had private insurance, the palliative surgery made her able to walk without pain. The surgery was nothing compared to the pain that she had before it.

We attended our son's graduation two weeks before. He graduated from the University of Dallas, which was a life-changing experience for my son, who still talks about how special that was. That would not be possible if we were covered by the Oregon Health Plan, which would restrict useless surgery, because she's going to die anyway.

Now I'm not making this up, I'll show an actual case of this. And again, people will say these are anecdotes. These are the things that have leaked out from the shroud of secrecy in the state of Oregon, because the state doesn't report this kind of thing.

There's a shroud of secrecy. What I mean by that, you have no capacity as a citizen or a reporter to go into the details of what the government's recording. The information given to them is all second and third-hand, because the doctor's not present 86% of the time. So who really knows what's going on? And if you're not bothered by that, the records are actively destroyed within a year after they've collated the data.

There's no ability or authority or finance for the Oregon Health Division to look into the records. And yet you'll hear over and over again, if you haven't already heard it, everything's going swimmingly in Oregon.

46% of the time, the space for complications on that form the doctors are supposed to fill in doesn't say none, it's blank. It has to be blank, because if they said none they would be lying. They don't know what happened, they weren't there.

There's an inverse relationship between pain and the desire for assisted suicide. It's the fear of pain.

Am I making this up? No, this is published in the Lancet, 1996, it's been known for a long time. As people actually experience pain, and we are able to work with them in controlling it, their desire for suicide actually drops, as is displayed in this graph outlining what the article showed.

The desire for suicide is on the vertical axis. And experiencing pain up to 10 on a scale of 10, is on the horizontal axis. While the data is flawed, as I said, what data we have supports what I just said. It's not pain, it's losing autonomy or so-called dignity.

Now I believe in death with dignity. I believe in aid in dying. I believe in choice in dying. I believe in options at the end of life. If that's what we're talking about, we have no debate. I don't believe in empowering doctors to end the lives of patients with massive overdoses or with injections.

Can we be clear about the king's English? Can we break through the euphemisms, and be honest about what we're talking about? Because currently, people have the right to kill themselves as was shown in the Queensland just yesterday, or the day before. I was talking about it with the press yesterday. I think it's a tragedy.

I think they were enabled by Dr. Nitschke, who sells canisters of nitrogen because apparently the helium people don't want to be in the business of killing. And I think it's a tragedy, and I think it's good that the reporter put at the end of it, if you're having suicidal thoughts or you're depressed, here, call this line. I think that's the way society, I think that's the way Oregon should, and Australia already is, helping people who might have those thoughts. It's trying to avoid suicide contagion.

Unfortunately, in Oregon, we've dropped the money for suicide prevention, now the only suicide prevention we have in Oregon is for adolescents. Apparently, once you get past 21 you're not as valuable as are young people is what the message we're saying. But what are we telling young people when we tell them the solution to suffering is to end life, to end your own life.

In the U.S., we just had somebody indicted and actually convicted of aiding somebody's suicide, when online relationship, she actually encouraged him to go through it and gas himself with carbon monoxide. And appropriately, she's being charged with manslaughter. But this whole notion of thinking it's okay with your radical autonomy to do this is dangerous, and that's what I said at the outset. I'm trying to show you this has got consequences besides the private issue of the individual.

By the way, look at the other reasons. Decreases in the activities that make life enjoyable. Loss of dignity, again there's that term.

This is an insult to people who are disabled with incontinence, with paraplegia. There is a group called Not Dead Yet, who recognises the threat to their well-being with this paradigm. Now think of this, men obviously have difficulties with obstruction of their bladder sometimes because we got too much anatomy between us and the outside world. As we age, that becomes more of a problem. Almost all my mine over 65 or 70 have changes in the way they urinate. Women, on the other hand, have a different problem. They don't have enough anatomy between them and the outside, and they actually step off a curb, you sneeze, you laugh, whatever, and so is this making you less dignified? I'd like to see a show of hands. No. And yet that was raised by Judge Goodwin in a 110-page opinion in the Ninth Circuit Court that that might be a reason, beyond being terminal, to have assisted suicide.

The Ninth Circuit Court. Fortunately, it's one of the most overturned courts, federal courts in the United States. But that kind of reasoning is dangerous is my point. You see what I'm saying?

Myth Two, there are no problems in Oregon.

I've already mentioned the reporting system’s flawed, the doctor's not present 86% of the time, it's second and third-hand information. There is never any investigation by the Oregon Health Division. This is a quote from Katrina Hedberg herself. "We don't have the authority nor the finances to investigate."

So if you are going to go there, and I'm not recommending it, ask what they're going to do and who's going to be doing the investigation, who's going to pay for it, who's going to triangulate, do the morbidity and mortality, to be sure that things were aboveboard? Who's going to be the witness at these things to be sure it's happening correctly? Because they say it's so safe.

Is any procedure without problems? The UK Select Committee, which was much like your committee that's gone around and looked at these issues, had the wisdom, because they had at least two doctors, a palliative care doctor and a surgeon, and the surgeon on that committee said, Any time I hear someone say there's no complications with a procedure, I know they're either not aware of it, they're ignorant, or they're lying. I'm paraphrasing him.

Do you know people who can take an aspirin always with no problem? And that's what's being said. For 20 years, the promoters of assisted suicide have repeated this untruth over and over and over again. So do not allow the ministers who are in favour of this to keep reciting this untruth.

Often the reports that are given, of course, are not only by doctors who engage in it, but people who actually promote it. I know because I work with some of them. I know the doctor who actually gave Brittany Maynard her overdose. He works in my department. He works in palliative care. I know at least three or four doctors in my own department who participate in this, and I know some of them have been featured in television commercials, some of them have written articles about it in peer-reviewed literature. So you're asking the very people who are in favour of this to tell you that there are problems with it. And that's a little bit like asking the Tobacco Institute to say what's wrong with tobacco smoking.

In fact, as I said, the blank spaces on the complications are on 543 out of 1,127 reports turned in by doctors who are participating in this. That's almost half, 48% of them are blank. Again, that's actually honest because they weren't there, how could they fill it out? We really don't know what's happening, yes, yes.

[Man] In the Oregon system, do you need two doctors? Do you have to get a companion to support? The question is, in the Oregon system there are two doctors. Do you have to get a companion to, yes. The way, that so-called safeguard is, you have to agree that it's your decision that this is a good idea for that patient, fitting the criteria, and you have to get a colleague to say yes as well.

It can be any doctor. It can be a pathologist, it can be a paediatrician. It can be a psychiatrist, it can be a palliative care specialist. It could be someone who knows nothing about anything about end-of-life care. And yet if they have an MD or a DO, or in the UK it would be an MB, whatever, you're okay to do this.

And there's a network now, and it's fueled by so-called Compassion and Choices, the group that's promoting this worldwide. They have a network of doctors, and they're all too eager to help you connect with a doctor, who also knows other doctors who will be a second signatory. When somebody doesn't use these known doctors, and a doctor refuses, they simply keep shopping for another doctor.

Myth Three, you have only six months to live.

My wife was told we have three to nine months to live, two or three years before actually died. She thankfully lived for almost four times that long. Every day was precious. Our lives in our last five years, while I wouldn't wish cancer on anyone, were actually among the best of our 40 years together. We had great suffering at times, but we also had great joy at times, because we knew every day was special, that we might not have another time to do whatever we were doing, and it changed everything.

I think I had one argument with my wife in the last five years of our marriage. I think that was a very different rate of arguments than we had in the first 35. It was over in about 20 minutes, because we realised how out of proportion our being upset with each other was relative to all the good that we had, and that we had fragile time left. So again, I wouldn't wish cancer or suffering on anybody, but it brought us closer together.

There are no crystal ball reading courses in medical school. The reality is doctors become pretty good, and I say pretty good, when it gets down to the last couple days of life. But we're lousy when we're talking three months. You might as well ask weathermen what's the temperature going to be in three months from now. And you know that'd be pretty silly.

Well doctors don't have any crystal ball reading courses. We're not genies or gipsies, and we're wrong a lot of the time. We're wrong even about the diagnosis sometimes. And I've been wrong about patients, and I regret that I was wrong. I gave up on people sometimes who lived, and every time I see this person 10, 20 years later, I'm embarrassed that I gave up on him. But that's true.

Six months is arbitrary. If you believe this, that six months is okay, it's going to control it, why not seven months? What right do you have to keep somebody with seven months? Or seven years? Because if you believe the solution to suffering is to end the life of the sufferer, then you have no moral, ethical basis on which to deny someone who's suffering for seven years with their rheumatoid arthritis or their lung disease. Or their cancer like my wife had, from having it done, and indeed that is why in the Netherlands and Belgium, they have opened it up, so literally if you feel that you've lived a complete life now, this is the bill being debated, very different than Australia's, but it's exactly where you go, because it was only legalised in the Netherlands in 2002.

They've been doing it illegally since 1971 to 1973, when the Postma case, was extand. He's a GP in the Netherlands, his wife was a GP, and they injected her mother because of her, quote, suffering. The wrist of his wife was slapped. She was given a year in gaol, which was suspended, and she had probation for a year.

And indeed the country then went from that hard case to doing it essentially suicide on demand, where parents in the Netherlands can end the lives of their kids, up to the age of 12, according to the Groningen protocol, where you have people whose lives are ended without permission, there's a category. Over a thousand people a year in the Netherlands have end of life without explicit request.

Now what is ending your life without requesting it? I'll let you describe it. I'm not trying to be pejorative. And when you ask doctors, why did they do that, on what basis did you take it upon yourself to end someone's life? Well, I knew they were going to die anyhow. And I needed the bed. This is published in the Journal of the American Medical Association by Herbert Hendin. I'm sharing with you facts.

Another doctor was taking care of a religious, a nun. “I knew it was against her religion, she was Catholic. So I didn't tell her about it.” So much for openness and transparency. And it's over a thousand times every year in two different reports by the government of the Netherlands.

I'm sharing facts, not hyperbole. I'm sharing appropriate knowledge, so you as citizens of Australia, can make informed choices about this coming paradigm.

In Oregon, about a year and a half, two years ago, two of my colleagues who now are legislators, Mitch Greenlick and Elizabeth Steiner, and one other legislator, proposed that we expand it from six months to 12 months in Oregon, predicted life. And both sides were opposed to it. Now you might suspect that someone like me would be opposed to expanding what I believe is a misguided paradigm.

Why would the proponents of assisted suicide be against expanding, since some of them really want suicide on demand? Like Nitschke, like Kevorkian, like Governor Lamb of Colorado. They didn't want to expose, when they're trying to pass it in 25 other states and the District of Columbia, the truth that there is no way to control this. All it takes is a legislative fiat that says, you know, six months is too restrictive.

In Canada, they're already going from physician-assisted suicide to euthanasia. And Quebec's asking all of us to carry not only one euthanasia kit, but a second one for backup because it may not work. At least they acknowledge that these things don't always work. But sadly, that's where we're going.

The ink's hardly dry no the Canadian judges' 9-0 decision that somehow, physician-assisted suicide and euthanasia is contained under the right to life in the Canadian Constitution. You can't make this logic up, but that's what they're saying. Essentially, anyone is eligible, any time for any reason in the Netherlands and Belgium.

The EU is against the death penalty, and I'm not arguing death penalty here, I'm talking about end of life.

So there's a prisoner with a life sentence for rape and murder just in January about two years ago, who thought his life was not worth living because he had no hope of parole and he's in for a life sentence. So he requested euthanasia, and within a couple months, he's dead. So the same government that abhors the idea of ending the lives of convicted felons, murderers, rapists, whatever, allowed him to be killed with euthanasia. There are no abuses.

In Oregon, we've already had nurse-assisted suicide, this was only found out because of astute reporters in the paper, the Portland Tribune. You can look it up online. They were actually fighting over this individual, who had had a sex change, was same-sex attraction, and the editors were wondering about whether they should report these things.

I'm not here to talk about these issues. I'm telling you that there are ulterior motives among some people in this paradigm. They were not given orders by the doctor, by the way. Opioids are a controlled substance in every state in the United States. One nurse said we were just doing pain relief with him. The other nurse said they were doing assisted suicide. All I can say is, one of the nurses is not telling the truth. This went unreported for almost two years before it leaked out, not by the government, but it leaked out by an astute reporter.

I mentioned there are no witnesses, so once you get the overdose, it's the perfect murder. Because you've already been labelled as terminal, you've been labelled as having the right to assisted suicide, and all the person who's a survivor has to say is that it was an assisted suicide, and you really don't know what happened because no witnesses, nobody's there. Nobody asks,

I've never asked a patient in my 40-year career, what life insurance policy do you have, and who's the beneficiary? One out of 10 people in the United States, I don't know if it's true in Australia, one out of 10 have a problem with elder abuse. The ultimate elder abuse is taking the life of the elder.

There's suicide tourism. This is not me making it up. If all of you have heard about Brittany Maynard, who had a brain tumour. It was inoperable, it was lethal, there was no cure for it. She confirmed that at Stanford University, then she decides to become an Oregon citizen and comes to my colleague, Eric Walsh. I can name names because he said it on 60 Minutes when we were both on that programme about a year and a half ago, and he was the one who facilitated Brittany Maynard to have a hastened death with massive overdose of pills. There's doctor shopping for the right answer. Am I making this up, no. This also leaked out.

The cases I'm sharing with you are not being exposed by the Oregon Health Division. It's not being controlled because there is no control, but again an astute reporter interviews two people only because they were frustrated that the system held them back.

On your right is Erica, with the Race for the Cure shirt. And she's next to her mother, Kate Chaney, who was a survivor of one of the Holocaust prisoner of war camps, or not even prisoner of war, Holocaust death camps.

Let me correct myself. She was somewhat demented, her mother, and she went to one of my colleagues who is clearly claiming to be neutral about this topic, and it wasn't clear to the psychiatrist, Linda Ganzini. I can mention names because all this is published now, who was really asking for the suicide because the daughter, Erica, seemed to be coercive.

So she goes to a different doctor, and that doctor doesn't use the word coercive, but he also will not sign the process, begin the process for assisted suicide.

She goes to a third doctor then, who works for a health care capitation system, where you're giving coverage for everybody for whatever, and yet that doctor thought she was a good candidate for assisted suicide.

So the capitated system will actually save money by ending the life of Kate Chaney. And indeed she was dead within a matter of weeks from that opinion. And getting a second opinion is no trouble because they actually sent a letter around to the Kaiser Group about who would participate in this, and they sent it to 800 doctors in the Portland, Oregon, area to find out who would be a co-signer.

Myth Number Five, death is dignified.

If anyone's worked in an emergency room and seen overdoses, it is not the prettiest way to die. In the Dutch experience, they don't generally do this, they don't recommend it because it doesn't work a lot of the time. In fact, they say somewhere between 17 and 23% of the time they have to be standing by as doctors, and they generally do, with an injection, to be sure they die.

It does cause nausea and vomiting because the pills are extremely bitter. The dying can be prolonged with agonal breathing, with noisy respirations as you're not clearing your secretions from your windpipe.

And again in the newspaper, David Pruitt awoke 67 hours after taking the cocktail. And I'm quoting, his first words were, "What the hell happened? "I thought I was supposed to be dead." His wife, who had gone along with him and said, ‘whatever you want’, trying to, quote, “respect his wishes”, was elated that he was still alive. He had an epiphany, feeling like, well, God must want me to live, and he actually had a good next 11 days before he died naturally with dignity. So the co-opting of the word dignity is somewhat, no, it's totally misleading. And the reason why I say that is because my own wife died with dignity. At home, surrounded by family.

And if you say that you have to take an overdose to be dignified, what does it say about the rest of us who don't take an overdose? Implicitly, you're saying something special about killing yourself with an overdose.

Suicide parties are happening. They reflect again, I said at the outset, so-called compassion by taking overdose is really apathy, and I'll share with you that in a minute here.

This is a picture that was on the Oregonian website, OregonLive.com, and if I were to just show you this picture, you would not know if anybody's really sick here. These two people are having a very good time.

The one on your left, though, is Lovelle Svart. And she died in 2007, after having for months been on a video log, posted by the Oregonian, because she used to work for the Oregonian five years earlier, showing the deadly potion she was ultimately going to drink, and she schedules this suicide party in her home. And they're doing the polka, and they're obviously having a good time, and if I didn't give you this background, you'd say these are two people who know each other well and care about each other.

And the next scene, within 30 minutes, is in her bedroom, where you see her taking the deadly overdose of barbiturates, and next to her is not her husband, not her doctor, not a loved one. It's George Amey, who's a lawyer, who's the executive director for the so-called Compassion and Choices.

He's already done, at this point, at least 30 of these, where he's become expert, and he's now being sure that she wants to go through with it, and he says, and I'll paraphrase the conversation. He says, “Now, you're sure you want to go through with this?” She replies, “I'd really rather go on dancing”. To which he replies, “Well, you can.” She says, “No, I've already taken the antiemetic to keep from vomiting, and we were all planning this”, so she has this pressure to go through with it. And she does, and she starts drinking the overdose.

And he coaches her, telling her not to drink it too fast because if you drink it too fast, you're more likely to vomit it and not be successful. If you drink it too slowly, you might fall asleep before you take a deadly overdose.

And then he becomes very dispassionate and clinical in describing her reduced respiration to the rest of the people in attendance, like you're watching a dog lab and sharing with medical students what's happening to the dog's breathing and pulse.

Now what if George Amey, instead of doing what he did, which was a vending machine, well, you can go dancing polka or not, what if he said, “Lovelle, I've come to know you in the last few weeks, and you're really a special person. If you want to go on dancing, that's a good idea. Don't worry, we can give you this sometime in the future, but you've got a lot of life left in you, don't do this. I care about you. In fact, I've come to love you.”

Now which of the two responses, well, you can, or the one I just described as a possibility, is the compassionate response to one another as humans? Which is encouraging that you're worthwhile even when you don't feel like it, and maybe you're wrong-headed in feeling your life has no value, or you're fearful about being able to get it?

Which is the compassionate response, I ask you. And what do you want for Australia in the future? What kind of response do you want from your doctors, because I'm a doctor, and what kind of response do you want from me?

Do you want me to be a vending machine? And if Australia wants to embrace this, I want you to know that I would not be in favour it, but I want it not to be in the House of Medicine.

Perhaps you should have veterinarians, who have training and skill in giving overdoses to living things, living animals. I'm not recommending that, I want to be sure, don't misquote me. But at least then you'd keep the House of Medicine from an inherent conflict of interest. And you'd have trust in your doctors.

It's the most profound secular argument, and I heard from the sitting dean at the time, of Oregon Health and Science University, because he's very clear and to the point about the inherent conflict of interest for medicine.

Myth Six, it improves end-of-life care, and look what's it done in Oregon, it's gotten much better.

Well the perception of the adequacy of pain control was actually studied by one of my colleagues and published in a peer-reviewed journal. He's a palliative care specialist. His name is Erik Fromme, F-R-O-M-M-E. He actually took care of my wife, and I selected him specifically because I knew he did not promote assisted suicide. I want doctors like that for me and my family. What kind of doctor do you want?

He published a study that said family's perception of pain at the time that it was studied, before and after assisted suicide, perception of pain in their loved one, their dying one, was worse after passage of assisted suicide.

Now I'm intellectually honest enough, I'm not blaming assisted suicide. Because you cannot do that. That's not cause and effect data. It's epidemiological data, but it's not reassuring, and it does not suggest that pain relief has improved in the state of Oregon. Do you follow me?

I was misquoted by that also by one of the promoters of death here in Australia years ago, because they're so bent on the agenda that they will not listen to reasoned dialogue. And you did not hear me say that assisted suicide caused this, but you did hear me say, it is not reassuring in Oregon that this is improving pain relief.

And in fact the opioid use per capita in Oregon was high well before the passage of assisted suicide. It's still high, but it's even higher in states that have specifically made it illegal to have assisted suicide.

There's no correlation between passing appropriate laws that circumscribe the power of physicians to support an enhanced life until you die naturally; to extend life, and circumscribe it so you never cross that boundary to actively end lives.

By the way, opiate prescribing per capita is actually not a great marker for good health care at the end of life because there's such abuse of it that almost every state now is trying to limit opioid use because we've been so seduced by a doctor back in the '70s and '80s who thought that we could give opioids successfully to treat pain in non-terminal patients. And now we've found that we are killing more people with too many opioids in people who aren't terminal that we are actually having more people's lives end than on highway accidents in the United States.

But it is a marker and a surrogate when you say, oh, people are going to be fearful about giving appropriate doses of opioids. That's false, that's not true. Even in states that have made it illegal to do assisted suicide.

Myth Number Seven, it expands patient choice.

As I said, patients have the right to end your life now, it's not illegal in any country that I know of. There are 43,000-plus that happen in the United States. Margaret alluded to every three hours. It may even be higher than that with the math I would do, but the point is that we have a problem. Houston, we have a problem.

Suicide, non-assisted suicide, is all too common. So you say what difference does it make? We're only talking, Dr. Toffler, about the limited few numbers that are happening in Oregon, Washington, and it'll only be a few numbers here in Australia. This is the data.

One of the ministers said they wanted to not talk to me because they want to do evidence-based discussions. This is the data.

[Source:Jones A, Paton D. Southern Med J;2015 108(10):599-604.]

The suicide rate in the bottom is the United States. It's gone up slightly. The blue and the red are both Oregon and Washington. They were above the national average before a passage of assisted suicide, and the slope of those lines is not reassuring.

Again, you're not hearing me overstate the case, saying that assisted suicide caused this, because that would be beyond the evidence. But it's not reassuring. And you know there's suicide contagion.

That's why the reporter told me, “oh, we always have to put that thing at the end of the story about the three women in Queensland who took their lives. We always have to do that.” Why do they have to do it? Because they're fearful of suicide contagion, of spreading Dr. Nitschke's false approach to suffering. They're fearful of that, appropriately fearful of that.

And we all should be. And you should increase your spending on suicide prevention, not on assisted suicide. And it is spending by the way.

California allocated $2.4 million for MediCal, that's the welfare system, so they could be sure they could cover the cost of the drugs to kill yourself. So where did that $2.4 million come out of? Was it out of prenatal care? Well-child care? Well, their math in their budgetary session to legalise assisted suicide in the state of California, obviously is that we'll save money by spending $2.4 million to end the life of the sufferer rather than paying for the expensive drugs that might come forth. So in truth, it's not empowering patient choice.

It's not rocket science to kill yourself. As I shared with one of your ministers, I was in aerospace engineering before I went into medicine. And it's not rocket science, I didn't take any courses in this. I don't recommend it.

Patients have the right to refuse treatment. At one time, medicine might have been guilty, and I came into medicine in the '70s, of doing things that were not reasonable relative to the overall situation.

Today, that's not the problem. The problem is accessing care. Patients who desire coverage have been denied coverage, and I'll share at least one of those stories here today.

Barbara Wagner is a 64-year-old woman. At the time, she had a recurrence of her cancer, she went to her oncologist, her cancer doctor, who wanted to give her the drug Tarceva. Tarceva's a drug that now has been around for 15 or 20 years, it doesn't cure the cancer, just like the six drugs my wife took before she died wouldn't have cured her. We were hoping that it would extend her life.

Tarceva has statistically a 45% increased chance of keeping the person alive and being alive in one year, if you take it, versus not taking it. Kind of like a woman with breast cancer, if you take Tamoxifen, you're more likely to be alive than if you don't after you have your breast surgery. Same kind of deal, doesn't guarantee a cure.

She was given a letter, which went to at least one other person, we don't know how many because the Oregon Health Division will not tell us. It's under a shroud of secrecy. But at least two people we know got this letter. It said, we cannot cover your chemotherapy that you want, your oncologist, your doctor wants, but we will cover 100% for your assisted suicide, under the euphemism of pain relief and relief of suffering. In the same letter, it says this.

So let's hear from Barbara and what she has to say.

[Reporter] Her doctor offered hope in this bottle, the new chemotherapy drug, Tarceva.

[Barbara] Like my doctor said, maybe this can put the lid on it and stop it.

[Reporter] That hope shattered with this letter from the Oregon Health Plan, telling her, We were unable to approve the cancer treatment. It will pay for comfort care, including physician aid-in-dying, better known as assisted suicide.

[Barbara] I told them, you know, I said, Who do you guys think you are? To say that you'll pay for my dying, but you won't pay to help me possibly live longer.

[Reporter] We took her concerns to Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan. She says, to say to someone, we'll pay for you to die but not pay for you to live, it's cruel.

[Representative] I don't think anyone's saying that. I don't think anyone's saying that. That's, I think, maybe an unfortunate interpretation of the letter.

[Reporter] Assisted suicide critic Dr. William Toffler calls the message disturbing.

[William] People deserve relief of their suffering, not giving them an overdose.

[Reporter] And he says the state has a financial incentive to offer death instead of life. Chemotherapy drugs like Tarceva cost $4,000 a month. Drugs for assisted suicide cost less than 100. Is it cheaper to pay for somebody to die than to help them live?

[William] That is a not a question that we think about. We don't think about, we don't think about investing our health care dollars in that way.

[Reporter] Yet when thinking about patients like Barbara Wagner, Dr. Saha admits they must consider the state's limited dollars. If we invest thousands and thousands of dollars in one person's days to weeks, yet we are taking away those dollars from someone.

So look at the body language and the uncomfortableness of that man in trying to defend the indefensible. Often, people say, gee, these numbers, you got to look at it realistically. $4,000, well Tarceva hasn't changed that much. Suicide pills have gone up greatly in cost. And in fact, the pills that used to cost $100 are now over 3,000. Why? Because the drug companies don't like manufacturing these drugs for death penalty patients, and they don't like to be associated with this. And so there's only one making the product, and they're charging a lot for it.

So the suicide promoters are actually actively looking for other cocktails in which people can kill themselves. Just as Nitschke is no longer using helium, he's using nitrogen. They're working overtime to try to find massive overdoses, so they're suggesting that you take a thousand times the normal dose of morphine and two other pills to be sure you do yourself in. This is sad research, I think, and that's what they're doing.

You say, well, Dr. Toffler, that's just an anecdote, that's in Oregon. Well, in California, it only passed a year ago today. The ink is not hardly dry, and look what's happening in California.

[Woman] I am a wife and a mother of four, and I've been diagnosed with a terminal illness. We've been trying to get me on a different chemotherapy drug for the infusions. And when the law was passed, a week later, I received a letter in the mail saying that they were going to deny coverage. They didn't want to pay the money for it. On my letter, it didn't say anything about physician-assisted suicide, as far as you know, why they were denying me. So I called the insurance company, and I was asking them why I didn't get approved for this drug. So I said, well what about the drugs that they're using for the new law, you know, this physician-assisted suicide, there are these pills that I could get. Would you cover that for me? She says, yes, we do provide that to our patients. You would only have to pay a dollar and 20 cents.

You'd only have to pay a dollar 20 cents is what she said. 80% of the insurance companies in California now cover assisted suicide, paying for the drugs. Yes.

[Man in audience] “Excuse me, Dr. Toffler, are you saying that now, though, the price of the drugs has gone up so much that really the comparison is the same between treatment and the cost of the suicide drugs?”

So the question is, the cost of the suicide drugs have gone up so much that the comparison is the same between the two. I'm hearing the question correctly?

[Man] “Yes, so that governments perhaps won't be influenced in the way that you're expressing.”

So the implications are the governments wouldn't be influenced because it's a wash, it's six of one, half a dozen of the others? Wrong, because, when I say $3,000 a month, $4,000 a month, one of my wife's drugs was $8,000 a month, it's per month. The overdose, even if it was $3,000, is a one-time expense.

[Man] “Thank you.”

Caring is more costly than killing. I believe in caring, not killing. I believe in caring, not empowering doctors to kill people. And if society wants to go down that path, I would encourage Australia to licence veterinarians to do the deed, because they have the most expertise.

I often in the past have asked that question, and I get a blank stare. Well, who would do this? Well, they have some expertise. Now I think, if I were a veterinarian, I wouldn't do that, because I think humans are different. And I think we're a different species and deserve to be treated.

Now, some people might debate that as well, but I do think there's a solution if society believes this should be, I think you should avoid compromising the integrity of your doctors.

Myth Number Eight, patients are screened for depression and mental illness.

Actually, that's not true. Is it just my perception? No, there was actually a study, again by Linda Ganzini, who's written a lot about this, probably as much about this and what's going on in Oregon as anybody. She also claims to be neutral, she certainly is not coming from one camp or the other.

But the so-called Compassion and Choices folks gave her the right to interview 56 people who had been given massive overdoses by their doctors. And 25% of those people fit the criteria for major depressive disorder. 23% fit the criteria for anxiety disorder. Yet they were given prescriptions for overdoses.

Now many doctors are starting to say, just like Dr. Nitschke did yesterday with the three women who killed themselves, “Well, they'd been thinking about it for months, therefore it was rational.” And if it's rational, it's okay.

Well, I teach about depression to medical students, and residents and even practising doctors. And I'm good at it. I like to do it because it's so efficacious. It doesn't matter if a person is depressed because they had a heart attack, because they have a diagnosis of cancer, or they're like my son who was suicidal a couple months ago because he had had bad things happen in his life. And no matter which one of those people I help take care of, my help with their depression changes their thinking about the worth of their life.

Part of it is my skill in being able to detect it, ask appropriate questions, tell me what's going on, this must be really troubling, I want to hear about it. I become a doctor as drug, if you will. I know how to use the tools, whether it's behavioural therapy, cognitively, or it's the tools for anti-depressant.

And they work. It doesn't matter if you're depression's because of cancer like my wife, or because of other reasons and exigencies in your life, they work. I work with psychiatrists if I have to, with people who are really difficult to manage. There are all kinds of tools.

I'm not trying to get into that, I'm just simply saying all doctors don't have that interest, or that skill, and yet they're licenced to take people's lives, essentially practising vending machine medicine as Dr. Ganzini proved with her peer-reviewed publication in a psychiatry journal. It's on Medline, I've got the references here. You just click on the link. Hopefully, Mary will give you the handout so all these things, you can actually look and check on yourself.

And I would offer to you now, too, if you are in doubt about where to get these resources, so people can be informed with what are the facts rather than the hyperbole, the euphemisms, the fear mongering, then please contact our organisation or me personally directly, and I'll be glad to try to help you.

Only five percent of the doctors over the past 17 to 20 years have been referred to psychiatrists despite the fact that we've documented that 25% of them, based on Linda's study, are depressed. In some years, zero are referred. In fact, some doctors would say, well, of course they're depressed, they're terminal. Well, I would ask you, who in this room is not terminal?

Even the Supreme Court of the United States had that argument, what is the point here? If you're a diabetic and you stop taking your insulin, you're terminal. If you're somebody needing dialysis, and you decide not to use, which, by the way, these are your right, you're terminal. So you can have a juvenile diabetic who's terminal, simply by him or her not taking her prescribed medications.

Myth Number Nine, it involves doctors who don't know the patient well.

Often, this was pushed because it's important the doctor be involved because we can do it with real intimacy, because we know the person personally, we can prevent the abuses. Well, last year, one doctor did 25 deaths.

I can assure you that's not the statistical frequency of people who are terminal in your practise, even if you're a palliative care specialist. Let alone someone like me who's a family physician who sees all comers from conception to natural death.

The average length of time over the entire course of Oregon's experience is 13 weeks and falling. Because when you have people like Brittany Maynard come to Oregon as a suicide tourist, you don't have a lot of time to know who that patient is.

You don't have the ability to do what I can do with my patients when I know them for 18 years and they get in a funk and they're thinking about just not having even treatment, and they'd be dead in hours if they don't have treatment. And I can convince them that their life's worthwhile because I have a history with them and can reflect their worth even when they don't have their worth in their own minds.

Already, the ink is not dry as I said in California, and there's a drive-in clinic that's opened in San Francisco. It'll be $200 for the first visit, and if you qualify and he follows through with it, it'll be $1,800. There is the website of Dr. Lonny Shavelson, who believes he's doing a service to people with a drive-in death clinic.

You can't make this up. I mean, they say there's no slippery slope. You have to have your eyes closed, your head in the sand, your ears closed to say that. Again, even if there is a hard case that might bring your sympathy, aren't we also supposed to look at the societal impact of these measures?

So finally, I want you to understand that I believe there's a difference when people say these things and what they're really saying, so when patients say to me, “I want to die”, tell me about that, because what they might be saying is “I feel useless”.

Margaret mentioned the burden. “I don't want to be a burden.” Are you a burden? And my response is, No, Mom, you're not a burden. This is literally my mother.

And I said, Mom, what's going on, what's wrong? I have hip pain. Well, Mom, did you take your medication? Yes. When? Yesterday. So I go and get her a pill, a simple, first-step pill before we get to the opioids. 20 minutes later, she says, Oh, I can't believe it, my hip doesn't hurt.

Because her mentation was not clear enough to know that she had to take it consistently to be free of pain. And then she starts feeling like, I might as well be dead, I'm a burden, why doesn't God take me? All of these messages which are the content expressed, but the real issue is I'm hurting, and the response to hurting is to try to help the hurt.

I don't want to be on a respirator like my patient Lonnie, (he said I could use his name). I said, you're not going to be trapped on a respirator, and I have to reassure him about his fear.

My wife was concerned about air hunger, because she had the spread of her cancer from the womb and the muscle in her womb to her lungs. I said, Marlene, we can get through this. We have drugs that help with the air hunger. And we did, we got through the air hunger. And the last night of her life was actually one of the most peaceful.

By the way, I had no idea she was going to die the next morning. Even when we woke and I helped her go to the bathroom, I did not know she was going to die in two hours. Again, I knew she was imminently going to die sometime in the next few weeks, month. But I didn't know it was that day, because doctors don't know. I didn't know, and I lived with her, I knew her.

I've lived a long life already, that's the completed life argument. Well, they're afraid you can't go on, no, we can do this, and you've got to encourage each other. I might as well be dead. Maybe you're saying nobody really cares about me.

So here's a person, and this is a real-life story of how does a doctor respond.

This doctor on the left is Dr. Ken Stevens. He was the head of the radiation oncology department for 40 years at Oregon Health and Science University. He's also a co-founder of Physicians for Compassionate Care.

Jeanette Hall is a patient who was diagnosed with terminal colon cancer, and she had voted for assisted suicide. It was Measure 16 in Oregon. She was not wanting treatment. She came to Dr. Stevens saying, I'm not here for treatment, chemotherapy, I'm just here for the pills. This is what she has to say.

[Jeanette Hall] I couldn't believe death was at my door. And it thought, surely that can't be right. Death, he's saying six months to a year to live. It was life and death. I just knew I didn't want to suffer. One day I was bleeding so bad that they had to take me by ambulance to the hospital. The doctor came in and said, Jeanette, you have colon cancer, and it didn't hit me. I just went, I have to go, I have to take care of my mother, I have to do my work, I have to go. And they said, you don't understand. You have cancer.

[Dr. Ken Stevens] When I first met Miss Hall, she had been evaluated by her surgeon. Her surgeon had determined that the cancer was inoperable, meaning that it could not be cured with surgery. So he referred her to me for radiation and also chemotherapy. She immediately told me, she said, I'm not here for the treatment, Dr. Stevens, I'm here for the pills. Two years ago, I voted for Oregon's assisted suicide law, and that's what I want, I'm here for the pills. I don't want radiation, I don't want chemotherapy.

[Jeanette Hall] I reached that point without hope. I was sinking into depression.

[Dr. Ken Stevens] I said, Miss Hall, would you came back and see me next week, let's talk about this some more. I was able to get better acquainted with her, and I learned that she had a son who was attending the Police Academy, he was in his late 20s. And I said, Miss Hall, wouldn't you like to see him graduate? He was single, I said, wouldn't you like to see him get married? Does he know what you're considering here?

[Jeanette Hall] It made me realise, there was hope. There was something to live for. And I thank him for that one sentence that brought me back to reality and made me try.

[Dr. Ken Stevens] So she did accept the treatment. She received chemotherapy and radiation. She lost her hair temporarily, but the tumour just melted away.

[Jeanette Hall] Dr. Stevens, if you had believed in physician-assisted suicide, I wouldn't be here. You didn't give up on me, you didn't abandon me, and that's why I'm still here. These are the kind of doctors we need that give you hope when your hope is gone. Here I am, 15 years later, and I want to my son's graduation. It's great to be alive.

So on the Mac (laptop screen showing end of video) it says, "I took the ancient oath to do no harm. "I'll always care for my patients "and never abandon them. "For me, helping them commit suicide "would be the ultimate abandonment," Dr. Ken Stevens.

It's now 18 years for her.

All of us know patients who were told they only have three to six months, nine months, a year to live, and they were alive and kicking sometimes a year or two later, 17 years later, or like Jeanette Hall, 18 years later at this point. It's kind of funny when she actually talks about, he talked about, don't you want to see your son graduate, get married, and son quips back, well, I did graduate, but I haven't gotten married yet.

So Number 10, physician-assisted suicide is the solution to suffering. No, it's not.

If a person's in physical pain, treat the source of pain. If a person's lonely, provide companionship. That was what the original hospice, that's what Mother Teresa was about, that's what we should be about. If a person doesn't value their lives, work to reflect their inherent value. That's what Chochinov, a palliative care specialist in Canada, the Chochinov technique, espouses. It's in the peer-reviewed literature.

This is what we should do, follow Chochinov, not follow Nitschke.

If a person doesn't value their life, work to reflect their value just as we do everyone who's not labelled terminal, even though we're all terminal. And if a person's fearful, like my wife was about air hunger and her lungs not being able to breathe with the cancer that had spread there, reassure them and address those fears with the best technology we have today.

The solution to suffering is not to end the life of the sufferer. So just to review, assisted suicide is dispassionate care by doctors who often promote assisted suicide.

Now don't get me wrong, I'm not saying they want to be dispassionate, I'm just saying their behaviour ends up being that way. Whether you live or die is your choice. And you're essentially acting like the individual on an island.

It's dangerous, I've shared with you some of the problems. There are people who are standing to inherit wealth, caregivers who deposit $90,000 in their account a day or two after he died. She was indicted, she had other nefarious activities which is why she was found out, not because of this issue of the caretaking.

She took the house of the man and put it in her name and was going to sell it. This happened in Bend, Oregon. I can only share the ones that leak out because the government is doing such a lousy job of following these things, even though worldwide Oregon is reported as everything's going swimmingly.

There are numerous problems, I said.

There are no safeguards, as Margaret said at the outset, and if there are, they're like tissue paper and really like wet tissue paper. They really have no basis for being enforceable. And I believe there are compassionate approaches to hard cases and difficulty at the end of life. And even if I'm wrong and there's some hard case that is outside of my 40 years' experience, fair enough, but it's not worth the danger to society and the change in the doctor-patient relationship and trust in the doctor-patient relationship.

I thank you all for your time. I'll be glad to stay as long as you like to answer questions or hear your comments.


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