MD Magazine 7 July 2018Family First Comment: An excellent summary…#protectwww.rejectassistedsuicide.nzIntroductionIn an age of “alternative facts,” it’s hard to sort out myth from reality when it comes to so-called “medical aid in dying” (MAID), also called physician-assisted suicide (PAS). By whatever label we attach to it, this practice involves a physician’s prescribing a lethal drug for a patient with a putatively terminal illness who is requesting this “service.” Some form of MAID/PAS is now legal in 5 states and the District of Columbia.People of good conscience, including many physicians, are sharply divided on the ethics of MAID/PAS. Unfortunately, much of the support for this practice is founded on several myths and misconceptions regarding existing MAID laws and practices. Here are 12 of the most common.1. Everyone has a “right to die,” including a right to take one’s own life, acting alone or with assistance. In contrast to “liberties,” rights entail the cooperation or assistance of others.1 Mentally competent people may be at liberty to end their own lives (ie, will not be prosecuted), but there is no recognized right to suicide that involves the cooperation of others. In Washington v Glucksberg (521 US 702 ), the US Supreme Court (USSC) denied that there is a constitutionally protected “right to commit suicide” or a right to PAS. To rule otherwise, the majority held, would force them to “reverse centuries of legal doctrine and practice, and strike down the considered policy choice of almost every state.”That said, the USSC has held that all competent persons have the right to refuse unwanted or “heroic” measures that merely prolong the dying process.2 Similarly, in Vacco v Quill (521 US 793 ), the USSC held that there is a legal difference between withdrawal of care and provision of a lethal intervention; ie, everyone has a right to refuse medical care, but no one has a “right” to receive a lethal means of ending one’s life.2. People who request MAID usually do so because they are experiencing severe, intractable pain and suffering.Most requests for MAID are not made by patients experiencing “untreatable pain or suffering,” as data from Oregon have shown; rather, the most common reasons for requesting medical aid in dying were loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%).3Many patients who request assisted suicide are clinically depressed and could be successfully treated, once properly diagnosed.3. In states such as Oregon and Washington, where PAS is legal, there are adequate safeguards in place to ensure proper application of the PAS law. In Oregon, reporting to the state is done solely by the physician prescribing the lethal drugs, who has a vested interest in minimizing problems. Moreover, if a physician was negligent in making the initial diagnosis or prognosis, there is no way to track this, since, by law, all death certificates will state that the person died of the putative underlying disease. At the same time, the physician is rarely present at the time the patient ingests the lethal drug, so the possibility of abuse—eg, by coercive family members—cannot be adequately assessed.The Oregon department of human services has said it has no authority to investigate individual death-with-dignity cases,4 and Oregon has acknowledged that its law does not adequately protect all people with mental illness from receiving lethal prescriptions.5 Thus, it is nearly impossible to determine cases in which, for example, terminally ill patients were pressured to end their lives by family members. A study in Michigan Law Review (2008) found that “seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented…[and that]…the Oregon Public Health Division (OPHD), which is charged with monitoring the law…does not collect the information it would need to effectively monitor the law…OPHD…acts as the defender of the law rather than as the protector of the welfare of terminally ill patients.”6Kenneth R. Stevens Jr, MD, and William I. Toffler, MD, both of the Oregon Health & Science University, point to other actual or potential abuses in PAS-permissive states, including “physician shopping” to get around safeguards; nurse-assisted suicide without orders from a physician; and economic pressures to use PAS, such as Oregon Medicaid patients being denied cancer treatment but offered coverage for assisted suicide.7Furthermore, an investigative piece by the Des Moines Register revealed that mandatory reporting requirements were not followed by hundreds of doctors in states where MAID/PAS is legal.84. In the United States, only people with terminal or incurable illnesses are eligible for PAS.Most PAS legislation applies to an adult with a terminal illness or condition predicted to have less than 6 months to live. In Oregon and Washington State, nearly identical criteria are interpreted to mean less than 6 months to live—specifically, without treatment. Thus, a healthy 20-year-old with insulin-dependent diabetes could be deemed “terminal” for the purpose of Oregon’s Death With Dignity Act.So, too, patients refusing appropriate treatment may be deemed “terminal” under current interpretation of the Oregon law. Thus, a patient with anorexia nervosa who refused treatment could be eligible for PAS under Oregon law, even though she could recover with intensive therapy. As Swedish investigator Fabian Stahle observes, “This is in fact an alteration of the traditional meaning of the concept of ‘incurable.’”95. Slippery slope arguments against PAS are overblown. In European countries that allow PAS, there is no evidence that patients are being euthanized improperly. People with nonterminal illnesses have been legally euthanized at their own request in several countries for nearly 15 years. This has included certain eligible patients who have only psychiatric disorders. In 2002, Belgium, the Netherlands, and Luxembourg removed any distinctions between terminal and nonterminal conditions—and between physical suffering and mental suffering—for legally permitted PAS. Between 2008 and 2014, more than 200 psychiatric patients were euthanized by their own request in the Netherlands (1% of all euthanasia in that country). Among them, 52% had a diagnosis of personality disorder, 56% refused 1 or more offered treatments, and 20% had never even had an inpatient stay (1 indication of previous treatment intensity). When asked the primary reason for seeking PAS/euthanasia, 66% cited “social isolation and loneliness.”Despite the legal requirement for agreement between outside consultants, for 24% of psychiatric patients euthanized, at least 1 outside consultant disagreed.10-12The United States has not been immune to the slippery slope, either. For example, in Oregon, a psychiatrist opened a fee-for-service death clinic where, for $5,000, “terminally ill patients who are eligible to take advantage of…Oregon’s suicide law can book a death that might look a lot like a wedding package.”136. The method of “assisted dying” now used in Oregon and other PAS-states assures the patient of a quick, peaceful death, without serious complications. A peaceful death is by no means guaranteed using current methods of PAS, as a recent piece by Lo pointed out14: “Physicians who support PAD need to consider how to address the potential for adverse outcomes, including longer time to death than expected (up to 24 hours or more), awakening from unconsciousness, nausea, vomiting, and gasping.”Data collected between 1998 and 2015 showed that the time between ingestion of lethal drugs and death ranged from 1 minute to more than 4 days. During this same period (1998-2015), 27 cases (out of 994) involved difficulty ingesting or regurgitating the drugs, and there were 6 known instances in which patients regained consciousness after ingesting the drugs. However, it is difficult to know the actual rate of drug-induced complications, because in the majority (54%) of cases between 1998 and 2015, no health care professional was present to attend and observe the patient’s death.157. “Death with dignity” comes down to the patient’s autonomy and the right of patients to end life on their terms.In the first place, under current legislation permitting so-called medical aid in dying, the patient is completely dependent on the judgment, authorization, and prescriptive power of the physician—hardly a state of autonomy.1 Moreover, autonomy is just 1 of the 4 “cornerstones” of medical ethics; the others are beneficence, nonmalfeasance, and justice. As Desai and Grossberg observe in their textbook on long-term care:“The preeminence of autonomy as an ethical principle in the United States can sometimes lead health care providers to disregard other moral considerations and common sense when making clinical decisions…we strongly feel that the role of the medical profession is to understand but not to support such wishes [for physician-assisted death]. Every person’s life is valuable, irrespective of one’s physical and mental state, even when that person has ceased to deem life valuable.”168. Doctors who conscientiously oppose PAS are perfectly free to refuse participation in it. In theory, the California guidelines state, “[a] healthcare provider who refuses to participate in activities under the act on the basis of conscience, morality or ethics cannot be subject to censure, discipline…or other penalty by a healthcare provider, professional association or organization.”17 However, prior to its PAS law being declared unconstitutional, physicians in California could be compelled to participate in PAS under certain circumstances.California’s health department regulation requires a state facility to provide PAS. If the request is denied, the patient has a right to a judicial hearing on the matter. If the court determines the patient is qualified, the attending physician must write a prescription for lethal drugs.18 Moreover, there is evidence that physicians are sometimes pressured or intimidated by patients to assist in suicide.79. Terminally ill people who request MAID are not suicidal and don’t commit suicide. They are dying and simply want “hastening” of an inevitable death. In contrast, genuinely suicidal people are not dying of a terminal condition, yet they want to die. This argument plays fast and loose with language, logic, and law. In fact, it turns ordinary language on its head, thereby eliminating suicide by linguistic fiat. As the American Nursing Association states, “suicide is the act of taking one’s own life,”19 regardless of the act’s context. There may indeed be different psychological profiles that distinguish suicide in the context of terminal illness from suicide in other contexts, but that does not overturn the ordinary language meaning of suicide. Thus, when a terminally ill patient (or any other person) knowingly and intentionally ingests a lethal drug, that act is, incontrovertibly, suicide.Most suicides occur in the context of serious psychiatric illness. Yet patients who express suicidal ideation in the context of a condition such as major depression rarely want to die; rather, as numerous suicide prevention websites note: “Most suicidal people do not want to die. They are experiencing severe emotional pain, and are desperate for the pain to go away.”2010. People requesting PAS are carefully screened by mental health professionals to rule out depression. Most PAS statutes modeled after the Oregon Death with Dignity statute do not require examination by a mental health professional, except when the participating physician is concerned and decides to do so. Specifically, “[t]he patient is referred to a psychologist or psychiatrist if concern exists that the patient has a psychiatric disorder including depression that may impair judgment.”21A study of the Oregon law concluded that “[a]lthough most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death With Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.”21 In Oregon, 204 patients were prescribed lethal drugs in 2016 under the Death with Dignity statute, yet just 5 patients were referred for psychiatric or psychological evaluation.22 11. Doctors who participate in PAS are almost always comfortable doing so and rarely regret their decision.Many doctors who have participated in euthanasia and/or PAS are adversely affected—emotionally and psychologically—by their experiences. In a structured, in-depth telephone interview survey of 38 US oncologists who reported participating in euthanasia or PAS, nearly a quarter of the physicians regretted their actions. Another 16% reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.23 For example, 1 physician felt so “burned out” that he moved from the city in which he was practicing to a small town. Similarly, reactions among European doctors suggest that PAS and euthanasia often provoke strong negative feelings.2412. For terminally ill patients, the only means of achieving death with dignity is by taking a lethal drug prescribed by one’s doctor. Just a small minority of persons with a terminal disease seek a physician’s prescription for a lethal drug. It is not clear why self-poisoning confers more dignity to one’s death than more traditional and much more common ways of dying. Many people who are dying choose to “bear with” their pain. Some seek hospice care and—in cases of severe, intractable pain—merit palliative sedation.25Some choose voluntary stopping of eating and drinking (VSED), which, according to a study involving hospice nurses, results in a more satisfactory death than seen with PAS. In fact, “as compared with patients who died by PAS, those who stopped eating and drinking were rated by hospice nurses as suffering less and being more at peace in the last 2 weeks of life.”26A form of VSED called “sallekhana” has been practiced in Jainism for centuries and is regarded as an ethical and dignified means of achieving a “natural” death.27ConclusionThe case for PAS legislation rests on a number of misconceptions, as regards the adequacy, safety, and application of existing PAS statutes. The best available evidence suggests that current practices under PAS statutes are not adequately monitored and do not adequately protect vulnerable populations, such as patients with clinical depression. The American College of Physicians,28 the American Medical Association, the World Medical Association, and the American Nurses Association have all registered opposition to PAS.It is critical that physicians inform themselves regarding the actual nature and function—or dysfunction—of medical aid in dying legislation. The first step is to recognize and challenge the many myths that surround these well-intended but misguided laws.https://www.mdmag.com/medical-news/twelve-myths-concerning-medical-aid-in-dying-or-physicianassisted-suicide
That’s the word from manager Dave Martinez, who says surgery could be an option but adds he has yet to talk with the 2019 World Series MVP. Strasburg was put on the injured list on Aug. 15, a day after he recorded just two outs at Baltimore. After going 18-6 with a 3.32 ERA in 33 starts in 2019, the right-hander is 0-1 this season with a 10.80 ERA in two starts.In other MLB news:— Slumping Chris Davis has been put on the 10-day injured list by the Orioles, who recalled highly touted prospect Ryan Mountcastle and put him in the starting lineup against Boston. Davis headed to the IL with a .122 batting average and patellar tendinitis in his left knee. COLLEGE ADMISSIONS-BRIBERYLoughlin, Giannulli get prison time in college bribery plotBOSTON (AP) — Lori Loughlin and fashion designer Mossimo Giannulli have apologized for using their wealth and privilege to bribe their daughters’ way into the University of Southern California as crew recruits.Accepting plea deals struck in May after the pair admitted paying $500,000, a judge sentenced Loughlin to serve two months behind bars while Giannulli was sentenced to five months.Prosecutors say the couple funneled money through a sham charity to get their two daughters into USC as crew recruits, even though neither was a rower. Amazingly, he is two shots behind leader Dustin Johnson, who finished with a 60 and is at 15-under. PGA-MICKELSONMickelson eliminated from FedEx Cup, now to try ChampionsNORTON, Mass. (AP) — Phil Mickelson has missed the cut at the Northern Trust and is all but assured of being outside the top 70 who advance to the BMW Championship next week south of Chicago.Instead, Mickelson said he would make his debut on the 50-and-older circuit at the Charles Schwab Series at Ozarks National. Mickelson turned 50 in June. Associated Press WOMEN’S BRITISH OPENHolmqvist leads British OpenTROON, Scotland (AP) — Dani Holmqvist braved the wind-swept links at Royal Troon to take the lead through two rounds of the Women’s British Open. Holmqvist shot 1-under 70 in windy morning conditions to be the only player under par after 36 holes.A 1-under total of 141 left Holmqvist a stroke ahead of American Austin Ernst and Sophia Popov of Germany. First-round leader Amy Olson shot 81, 14 strokes worse than Thursday. Stars like Lexi Thompson, Brooke Henderson and defending champion Hinako Shibuno missed the cut. — The Phillies have acquired right-handed reliever David Hale from the Yankees to help their league-worst bullpen. Hale has appeared in 95 games over six seasons with the Braves, Rockies and Yankees. — The Royals placed catcher Salvador Perez on the injured list with lingering vision problems and recalled Randy Rosario to add a left-handed arm in the bullpen. Perez woke up with vision problems Sunday.NFL-NEWSWashington coach diagnosed with cancerUNDATED (AP) — Washington football coach Ron Rivera has been diagnosed with a form of skin cancer. A team spokesman confirmed Rivera has squamous cell carcinoma. The 58-year-old is expected to continue coaching while undergoing treatment. Share This StoryFacebookTwitteremailPrintLinkedinRedditNBA SCHEDULERaptors trounce Nets for 3-0 series leadLAKE BUENA VISTA, Fla. (AP) — The defending NBA champs are on the verge of sweeping their first-round series. In other NBA playoff action:— The Jazz are up two games to one in their NBA first-round series after blowing out the Nuggets, 124-87. Mike Conley made a career playoff-high seven 3-pointers and scored 27 points in his return from quarantine. Rudy Gobert (goh-BEHR’) grabbed 14 rebounds and had a career playoff-high 24 points courtesy of numerous easy dunks and layups. Nikola Jokic (nih-KOH’-lah YOH’-kihch) had a team-high 15 points for the Nuggets, who tied the third-worst playoff loss in team history.MLB NEWS-NATIONALS-STRASBURGStrasburg might require surgeryUNDATED (AP) — Washington Nationals pitcher Stephen Strasburg has been diagnosed with carpal tunnel neuritis on his throwing hand after seeing a nerve specialist. PGA TOUR CHAMPIONSBertsch eagle gives him Schwab winRIDGEDALE, Mo. (AP) — Shane Bertsch eagled the first hole of a four-man playoff to win the Charles Schwab Series in Missouri.Bertsch hit an approach from the rough near the back edge of a bunker that took some big bounces in front of the green. It rolled to 20 feet from the back pin on the par-5 first hole, giving him a victory in his second PGA Tour Champions start.Glen Day, Bernhard Langer and Kenny Perry shared second, one stroke ahead of Tom Byrum and Vijay Singh (VEE’-jay sing). The Toronto Raptors have a three-games-to-none lead for the first time in their history following a 117-92 dismantling of the Brooklyn Nets.Toronto never trailed and led 57-42 by halftime. Pascal Siakam (see-A’-kam) scored 26 points and chipped in eight rebounds and five assists. Fred VanVleet shot 6-for-10 from 3-point range and finished with 22 points. Serge Ibaka (ih-BAH’-kah) had 20 points and 13 rebounds, while Kyle Lowry had his own double-double with 11 points and 10 boards.Tyler Johnson had a team-high 23 points for the Nets.Game 4 is Sunday. August 21, 2020 In other NFL news:— Wide receiver Tyreek Hill has only a minor hamstring strain and the Chiefs intend to be cautious with their dynamic playmaker. Wide receiver Sammy Watkins was back for the first time in nearly a week along with Pro Bowl defensive tackle Chris Jones. Both of them had groin strains.— Bills cornerback Josh Norman is out indefinitely after hurting his left hamstring in practice. Coach Sean McDermott couldn’t provide a timetable on time Norman will miss, in saying the team is still determining the severity of the injury. — Seahawks cornerback Quinton Dunbar says he understands he could still be punished by the NFL even after armed robbery charges against him in Florida were dropped. Dunbar declined to speak in detail about what led to him being arrested and charged in Broward County, Florida. — The league has hired Jonathan Beane as senior vice president and chief diversity and inclusion officer. He serves on the Board of Directors of GLAAD and has held senior diversity roles at Roche, 21st Century Fox and Time Warner, among others. The league said Beane will “spearhead diversity, equity and inclusion strategy, and will collaborate with senior leadership to drive actionable change” throughout the NFL. PGA-NORTHERN TRUSTBlazing hot rookieNORTON, Mass. (AP) — PGA Tour rookie Scottie Scheffler has become the 11th player to shoot a 59 or better in Tour history.The 24-year-old from Texas made a birdie putt from just outside 4 feet on the last hole for a 59 in The Northern Trust. He played bogey-free at the TPC Boston and finished with four birdies over his last five holes. Update on the latest sports
Support for Propositions 30 and Proposition 37 is falling among California voters, according to a USC Dornsife/Los Angeles Times Poll released Thursday.Only 46 percent of respondents said they were in favor of Prop. 30, Gov. Jerry Brown’s tax initiative, marking the first time support has fallen below the 50 percent margin. Prop. 37, which would require foods containing genetically modified ingredients to be labeled, dropped to garnering 44 percent support from California voters.Prop. 30, which would raise revenue for public education and public safety by temporarily increasing the state sales tax by one-quarter cent and raising personal income taxes on citizens who earn more than $250,000 a year, has continually declined in the polls from a level of 61 percent support in March. Experts, such as Dan Schnur, the director of the USC Dornsife/Los Angeles Times Poll and the Jesse M. Unruh Institute of Politics, attributed this decrease in support to the public perception of the state government.“Governor Brown has successfully convinced voters that more spending on the state’s public schools is a good thing,” Schnur said. “What he has yet to do is convince them that state government can be trusted to spend their tax dollars wisely.”Additionally, Drew Lieberman of the Democratic polling firm Greenberg Quinlan Rosner, which helped conduct the poll, said that though voters want to protect education, they do not have enough trust in the measure.“Nobody likes to cut education,” Lieberman said, “but there is a lack of trust as to how the money will be allocated.”Schnur also said a large amount of negative advertising by proponents of Prop. 38, the direct competitor with Prop. 30, could have hurt its approval. Similarly, experts said negative messaging directed at Prop. 37 knocked it down in the polls.“The most significant driving force behind this shift is the amount of money that the opposition has put into the campaign,” Schnur wrote on the Dornsife website. “When voters hear a message so much more strongly from one side than the other, it’s not surprising to see the poll numbers move like this.”The USC Dornsife/Los Angeles Times Poll is conducted at regular intervals. The poll, which was conducted by Democratic polling firm Greenberg Quinlan Rosner and Republican polling firm American Viewpoint, surveyed 1,504 registered California voters.
If MLB offenses continue it’s current streak into the second half of the season, players could hit a total of 6,668 homers, which would break the previous mark of 6,105.Verlander said this is intentional.”Yes. 100%. They’ve been using juiced balls in the Home Run Derby forever,” he said. “They know how to do it. It’s not coincidence. I find it really hard to believe that Major League Baseball owns Rawlings and just coincidentally the balls become juiced.”Cubs starter Jon Lester, a 14-year veteran, previously said something is up with the balls, as well. “The numbers are through the roof,” Lester told USA Today in May. “I think there’s something up with the ball. It seems almost like the ones they use in the Home Run Derby with the way it flies.”Lester ranks 42nd in home runs allowed (15) and he admitted it’s what brings people to the sport. “It’s a f—ing joke,” Verlander said, via ESPN. “Major League Baseball’s turning this game into a joke. They own Rawlings, and you’ve got (commissioner Rob) Manfred up here saying it might be the way they center the pill. They own the f—ing company. If any other $40 billion company bought out a $400 million company and the product changed dramatically, it’s not a guess as to what happened. We all know what happened. Manfred — the first time he came in, what’d he say? He said we want more offense. All of a sudden he comes in, the balls are juiced? It’s not coincidence. We’re not idiots.”Verlander has allowed a major league-high 26 home runs in 2019. But it’s not just the 2011 Cy Young award winner. A total of 11 pitchers have allowed 20 or more homers and players are on pace to break the 2017 record by a whopping 600-plus home runs. Related News Justin Verlander has an answer for this home run-heavy season.There have been 3,691 home runs already hit by the All-Star break to mark a historically high rate of 1.37 per game. This led the Astros pitcher to say that the league is “100%” juicing balls for more offense. MLB All-Star 2019: Home Run Derby matchups ranked Christian Yelich breaks boat window during Home Run Derby practice, someone calls police (really) “That’s the thing baseball people want to see, all of these homers, and how far they went,” Lester said. “It gives the millennials something to look at and talk about with all of the stats, spin rates, launch angles and all of that stuff.”This, however, is a cause for concern in Verlander’s eyes.”I don’t know if it’s bad or good for the game,” he said. “That’s for them to decide. I don’t think it’s great — that the true outcomes of strikeouts, homers and walks is best for the game. That’s for somebody else to decide. I talk about time a lot — how do you stack up in history? If you’re going to change something so dramatically, I think you need to make people aware.”
Jeremiah Dupuy, 32, of Wellington died Saturday, April 26, 2014, at his home in Wellington.Graveside Funeral Services will be held at 2 p.m., Friday, May 2, 2014 at the Oxford Cemetery in Oxford. Visitation will be Thursday, May 1, 2014 from 9 a.m., until 8 p.m. with the family receiving friends from 3 to 5 p.m. at the Shelley Family Funeral Home. A memorial has been established to help with funeral expenses and may be left with the Shelley Family Funeral Home in Wellington. For further information please visit www.shelleyfamilyfh.com.Jeremiah Steven Dupuy was born the son of Brian Dupuy and Traci (Bredengerd) Billups on June 30, 1981 in Satanta, Kansas. He graduated from the Haysville High School in 1999.Â Jeremiah was a tow truck driver, cabinet maker, and currently was a maintenance man at the Chisolm Trail Motel in Wellington. Jeremiah was very mechanical and enjoyed taking things apart and putting them back together. He loved spending time outdoors fishing and was a good natured guy.Jeremiah is survived by his father, Brian Dupuy and his wife Patricia of Augusta, KS, and his mother, Traci Billups and her husband Bob of Wichita, KS; brother, Clint Billups of Wichita, KS, and a sister, Kelly Billups of Wichita, KS; step brother Tony Blunck of Wichita and step sister Samantha Sanger of Goddard; grandmothers, Linda Bredengerd of Wichita and Dalene Charles and her husband Dave of Wichita; as well as several aunts, uncles, nieces, nephews and cousins.He is preceded in death by his grandfathers, Glen Bredengerd and Loren Dupuy.