2001 Voices: Bioethics Watch by Nancy Valko, R.N.

Voices Online Edition
Lent – Easter 2001, Volume XVI, No. 1

Bioethics Watch by Nancy Valko, R.N.

California Respiratory Therapist Arrested in Alleged “Mercy Killings” |
Britain’s ‘Dr. Death’ may have killed 297 patients |Elderly Florida Man Charged in Mercy Killing of Wife but, Autopsy Negative | North Carolina Court Orders New Guardian for Mother who Withheld Food and Water | Study of Kevorkian Victims Raises Questions | Assisting Suicide-An Act of Love? | Dutch Court Allows Physician-assisted Suicide Without a Medical Disorder | Doctors `Help Kill” one in 10 Belgians | Canadian Father Honored after Killing Daughter | Maine Miracle

California Respiratory Therapist Arrested in Alleged “Mercy Killings”
Three years ago, a respiratory therapist named Efren Saldivar,confessed-then recanted- that he had killed several patients at a California hospital between 1989 and 1997 because he was angry at seeing terminally ill patients kept alive.

After a long investigation, autopsies of six patients showed that a muscle-paralyzing drug had been injected into their IV lines causing their deaths. 14 others suspicious deaths have been found.
Saldiva, who initially called himself the “Angel of Death”, had lost his license as a respiratory therapist March, 1998.
(Source: “California Therapist Arrested in Deaths” by Louinn Lota.
1/10/01. Associated Press)

Britain’s ‘Dr. Death’ may have killed 297 patients
Dr. Harold Shipman was already convicted of murdering 15 elderly women with lethal injections but now a British government report says he may have murdered hundreds more.

Prosecutors said at his trial that Dr. Shipman hid his killing spree behind the mask of a much-loved suburban doctor and that his drive to kill was fed by a God-like belief that he had power over life and death. It was said that he would often caringly pat the hands of his victims as he
injected them with heroin overdoses while assuring them that their illnesses would soon be over.

The British medical establishment came under heavy fire after Dr. Shipman’s conviction for failing to protect patients after it was disclosed that the doctor had a serious drug addiction and was convicted in 1976 of forging prescriptions for his own use. Despite the forgery conviction, Shipman was allowed to continue to practice.
(Source: “Britain’s `Dr. Death’ May Have Killed 297 Patients.” Reuters
News Agency)

Elderly Florida Man Charged in Mercy Killing of Wife but, Autopsy Negative
Eva Visco survived 6 hours after being shot in the head by her husband, Leo, aged 80, in what Mr. Visco said was an act of compassion.

Mr. Visco said that, after shooting his wife, he couldn’t follow through
with killing himself.

A son, who said his father was a saint to his mother, claimed that
his mother’s bladder, hearing and vision failed in recent years, and she
was nearly bedridden from pain.

However, an autopsy found no cancer or any other terminal illness and
she was taking no medication for a serious illness. Mr. Visco was charged with first-degree murder.
Source: “Elderly Man Charged in Mercy Killing”. Deltona, Florida. on the
DeathNet website (pro-euthanasia). December 28, 2000.

North Carolina Court Orders New Guardian for Mother who Withheld Food and Water
A Mechlenburg court ruled that the mother of a physically and mentally disabled 28 year old woman neglected her daughter when she asked doctors to stop giving her food and water. The court appointed a new guardian who works for the Arc of North Carolina, an advocacy agency
for the mentally retarded.

Tina Cartrette has cerebral palsy and mental retardation and has lived in a residential facility since age 5. Her mother said she “never has been able to sit up, walk or talk or anything.” In the past year, Ms. Dianne Arnder said, her daughter has suffered from recurrent urinary tract infections that cause fevers and seizures and result in repeated hospitalizations. “Tina has been in and out of the hospital,” Arnder said. “I feel like her health is just going to keep deteriorating.”

During the most recent hospitalization, Ms. Arnder requested that Tina’s food and water be removed after she survived being removed from a ventilator.

Four doctors from Carolinas Medical Center testified about their disagreement over Arnder’s request to remove Cartrette from a respirator and withdraw food and water although other doctors testified that they believed Ms. Arnder was acting in her daughter’s “best interests.” The ventilator was turned off Nov. 24 and food and water were stopped Nov. 26.

After receiving complaints about Cartrette’s care, the Governor’s Advocacy Council for People with Disabilities intervened Nov. 29 and persuaded the court clerk to reverse that decision until a hearing could be held. In North Carolina, the clerk of has authority in guardianship

Lawyers for the governor’s advocacy council pointed out that N.C. law permits removal of food and water if a patient’s condition is terminal and incurable or if the patient is in a persistent vegetative state. No one testified that Cartrette fit that description.

Lance Stell, the hospital’s medical ethicist, who was called in to help resolve the doctors’ disagreement, said doctors may act outside those conditions, but if they do, they are not immune from prosecution.

He said he didn’t offer advice on the mother’s decision but received reassurance from the doctors that she was a competent guardian.
(Source: “Disabled woman gets new guardian, Court replaces mother who
withheld food, water” by Karen Garloch. Charlotte Observer. December 13,

Study of Kevorkian Victims Raises Questions
In a letter to the editor in the December 7, 2000 New England Journal of Medicine, Dr. L.J. Dragovic, the Oakland County, Michigan medical examiner and several coauthors described the results of a review of all 69 Kevorkian-assisted suicides in Oakland County.

The study found the following:
Seventy-five percent of those assisted by Kevorkian otherwise would have lived for at least six months. Seventy-two percent of them had recent declines in health, such as a new symptom or slightly more pain, that may have clouded their judgment.

Sixty-seven percent were divorced, widowed or never married, a strong indication they had no social or family support. Only thirty-five percent of them were in pain. Five people had no evidence of disease, suggesting mental distress drove them to Kevorkian. Seventy-one percent were women.
Kevorkian is serving a 10-to15-year sentence for the 2nd degree murder of Thomas Youk, whose “assisted suicide” was broadcast on the TV show “60 Minutes.” Kevorkian has tried to appeal this conviction and even asked a judge to release him until his appeals were completed,
citing “poor health” from high blood pressure and frequent nosebleeds.
(Source: “A study of deaths raises questions on Kevorkian image” by
Raja Mishra. Boston Globe, 12/7/2000)

Assisting Suicide-An Act of Love?
On September 10, 2000, TV’s Public Broadcasting System (PVS) heavily promoted its four-part special called “On Our Own Terms: Moyers on Dying” hosted by famous journalist Bill Moyers. The special was
touted as a “watershed event” in the discussion of better care for the dying and their families. Churches were recruited to sponsor showing of the special and facilitating discussions. Organizations such as the Catholic Health Association and Supportive Care of the Dying encouraged
Catholics to watch and participate.

The special heavily promoted “living wills” and other advance directive to refuse care and treatment when a person is dying or severely incapacitated but the most controversial aspect concerned Part 3, which was seen by many as supporting assisted suicide.

For example, a man who was dying of ALS (also known as Lou Gehrig’s disease) said he wanted his doctor to prescribe a lethal overdose when he could not longer feed himself but the law in Louisiana prohibited assisted suicide. The man’s wife, despite saying that she could not bear
giving him the overdose herself, nevertheless called physician-assisted suicide an “act of love” and a “kindness”. Bill Moyers sympathetically replied, “But the (Louisiana) law won’t let him (the man’s doctor) love like that.”

Comment: While pain and symptom control, support services for patients
and families, spiritual ministries, etc. are worthy goals of end-of-life
education programs, too often such programs include a “right to die”
perspective which promotes hastening or even causing death not only for
the terminally ill but also for those who are mentally or physically
disabled. NV

Dutch Court Allows Physician-assisted Suicide Without a Medical Disorder
In a landmark decision on Oct 30, a court in Harlem, the Netherlands, acquitted a general practitioner accused of assisting in the suicide of 86-year-old E Brongersma in 1998. Brongersma, a former senator for the Dutch Labour Party, did not have a physical or psychiatric illness, but
“suffered from life itself”. He had neither relatives nor friends left, had the feeling that “death had forgotten him”, and found life unbearable, his defense said. His doctor decided to respond to his call for help with suicide after consulting with another general practitioner and a
psychiatrist, who both agreed that Brongersma’s suffering was indeed unbearable and hopeless.

Because of these consultations, the court opined that the doctor had acted according to the requirements of care in the Netherlands. The new aspect is that the court accepted the subjective judgment of unbearable suffering of the patient himself as sufficient grounds for assisted

In a previous case in 1984, the Dutch Court of Appeal ruled that a 95-year-old woman suffered unbearably. She had neither terminal disease nor intractable pain, but could no longer tolerate being dependent upon other people because of her incurable handicaps.

In addition, in the so-called “Chabot case” in 1994, the Appeal Court ruled that a 50-year-old woman with depression but no physical illness was suffering unbearably, which provided sufficient ground for euthanasia. Mrs. Chabot’s only surviving son had recently died.
(Source: Edited from The Lancet, a British medical journal. 11/11/ 2000)

Doctors `Help Kill” one in 10 Belgians

Experts now believe than more than one in 10 deaths in Belgium are due to euthanasia or drugs given by doctors to hasten death.

A survey of deaths registered during the first four months of 1998 revealed that thousands of deaths resulted from the administration of lethal drugs “without the explicit request of the patient.” Researchers from the Free University Brussels and Ghent University reviewed a random
sample of all deaths registered over the four-month period and extrapolated the results for the year.

They concluded that 705 deaths a year (1.3% of the total) could be directly attributed to euthanasia or physician-assisted suicide. In 1796 deaths, lethal drugs had been given without the request of the patient. And in 3261 deaths, treatment had been withheld with the express
intention of ending the patient’s life.

Euthanasia is illegal in Belgium but intense efforts are underway to change this.
( Source: “Doctors `help kill one in 10 Belgians’. BBC News. 11/24/2000)

Canadian Father Honored after Killing Daughter
Robert Latimer, a Canadian farmer, was convicted in 1997 of killing his severely disabled 13-year-old daughter, Tracy by placing her in a truck and piping in exhaust fumes. During his trial, he said he took her life to free her from chronic pain.

Despite Canadian law mandating minimum sentences for murder convictions, Latimer was given a very light sentence at first but, after the outcry from disability advocates, Latimer was given 2 years in jail. (The sentence was upheld in February, 2001, by the Canadian Supreme Court.)

But a museum exhibit in Alberta, Canada on Jesus included him in a 15-minute video based on the Beatitudes from Christ’s Sermon on the Mount called Jesus in the Age of Television. Latimer is shown under the title Blessed are the Merciful, while Gandhi is shown under Blessed are the Meek, and Mother Theresa is talked about under Blessed are the Pure in Heart.

Pro-life and disability groups strongly protested the inclusion of Robert Latimer as an example of Christian mercy.
(Source: 11/3/2000 Canadian News Briefs, Associated Press)

Comment: “Mercy killing” is a misnomer for euthanasia and Tracy’s death
was particularly cruel. Ironically, euthanasia supporters in Canada have
led a very effective campaign for mercy in sentencing for this
unrepentant father. NV .

Maine Miracle
After a hard-fought campaign to make Maine the second state to legalize assisted suicide, Maine voters rejected a “Death with Dignity” referendum 51% to 49% on November 7, 2000. This was despite polls consistently showing the bill would win easily.

“We were behind by 50 points five weeks ago,” Gordon H. Smith, executive vice president of the Maine Medical Association, said in a telephone interview after a local TV station declared the question defeated. The Maine Medical Association helped lead the fight against the assisted
suicide initiative along with pro-life and religious organizations.
(Source: Pro-life Infonet. 11/8/00)

Comment: When Oregon voters passed its assisted suicide referendum, the
Oregon Medical Association was persuaded by “right to die” supporters to
remain neutral on the issue. The squeaker in Maine shows that opposition
to assisted suicide by the medical and nursing professions is critical.

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