Hospice Patients Alliance: Consumer Advocacy

"Listening to The Mindless Gibberish
Of A Right-to-Hasten Death "Leader"

by Ron Panzer Feb 2, 2004

I was "present" the other day for an online internet radio "debate" between Nancy Valko, RN, spokesperson for the National Association of Prolife Nurses and Doug Aberg, RN, founder of Hospice for "Choices" (formerly Hemlock) and life member of the Hemlock Society (now called End-Of-Life "Choices." I actually hosted the "debate" but found myself continually surprised by the lack of rational justification for the right-to-hasten death side. It was supposed to be a real debate between two opposing points of view!

I say "debate," (in quotation marks) because it was fairly one-sided. Well, two sides were presented, but there was no rational argumentation or reasoning that was discernible on the part of Mr. Aberg, representative of the right-to-kill patient side of the debate. Whenever a question was asked by Nurse Valko, Mr. Aberg went into "broken record" mode and repeated what he had said before:

Mr. Aberg stated he "supports" a patient's right to kill himself in hospice and that the reason why he supports that right is because he supports that right of a patient to kill himself in hospice!

When Mr. Aberg was asked why a patient should have the right to kill themselves in hospice, Mr. Aberg stated "because" he supports the patient's right to kill himself. He stated they "should have" the right to do so. Repeated attempts were made to get Mr. Aberg to explain his rationale for promoting the right of a patient to commit suicide within hospice (or anywhere).

When it was pointed out that traditionally, medicine had a code of ethics which required doctors and nurses to "do no harm," Mr. Aberg ignored the ethical implications and patient protections afforded by the principle of "doing no harm." He simply kept repeating he felt that it was right for patients to kill themselves if they chose to do so, that assisted suicide should be just one of many options a patient could select within hospice.

To make assisted suicide just one of many "options" within hospice and healthcare is like putting good food in a refrigerator along with poison and letting individuals choose what they want:

"Have some salad!
Have a sandwich!
Have some poison!"
"You have a right to all the poison you want,"
I can imagine Mr. Aberg stating.
"Just so long as assisted suicide is legalized, there is no problem!" he has said. The absurdity of the refrigerator scenario above is no more absurd than adding "killing" into the mix of services to be provided within healthcare!

When Mr. Aberg was asked about the danger of nonterminal patients being placed in hospice and then sedated and dehydrated to death, he stated that he had never seen it happen. He did not say it didn't happen. He didn't say it never happens. He didn't say it couldn't happen. He simply said he had not seen it happen at the hospice where he worked. He did not suggest safeguards to prevent such problems.

When I mentioned that we have reports from families about it happening, he only responded by asserting that because there are (supposed to be) two physicians involved in hospice (the attending physician and hospice medical director) it was not possible (in Mr. Aberg's thinking) for a nonterminal patient to be admitted to hospice. Mr. Aberg did not respond to the question about a nonterminal patient being harmed in a hospice. He did not address the complete denial of patient/human rights of having a person in hospice against their will and illegally euthanized against their will. He attempted to "explain away" the question by implying that it does not happen, when it obviously does! Evading the questions presented to him, he merely restated his position about assisted suicide.

Mr. Aberg's assertion (that because there are two physicians involved in a hospice setting, nonterminal patients cannot enter hospice) falls flat on its face. First of all, in many real cases, there is only the medical director of the hospice, since many hospices (wrongly) encourage the patient's own attending physician to completely sign off and let the medical director take complete charge of the case. Secondly, if there is still an attending physician who remains on the case and who has "certified" that the patient actually is terminal, in reality, many hospice medical directors merely "rubber-stamp" the attending physician's "certification" that the patient is "terminal."

There is a conflict of interest inherent in the medical director's role which may motivate the hospice medical director to look the other way when a nonterminal patient is admitted into the hospice: the hospice medical director is an employee of the hospice; the salary paid to the medical director depends upon a steady supply of patients that justify billings to Medicare, Medicaid and other health insurers for services claimed to be provided.

If a patient was not terminal, but was falsely declared terminal by the attending physician (and there are many reasons why some physicians do that) hospice medical directors are absolutely not going to get into a disagreement with a referring physician who is bringing revenue into the hospice by sending a patient to the hospice! Even if the attending physician created a completely fabricated admission diagnosis such as "lung cancer" (when the patient was actually a chronically ill emphysema patient), no medical director in hospice is going to argue! If a medical director did so, or if a hospice staff member did so, their employment at the hospice would be terminated immediately! Guaranteed!

In addition, there are many hospice medical directors that subscribe to the right-to-die mentality that many people are "better off dead" since their quality of life is declining. These physicians do not subscribe to a belief in the sanctity of life; neither do they subscribe to the dictum to "do no harm." They have no qualms about hastening the death of a patient who though nonterminal, may be chronically ill, medically complex or severely disabled.

Many doctors admit that they will increase the dosage of morphine (not just for pain management) when a patient is very weak, feels that his life has lost meaning or fears becoming a burden on his family. Increasing the dosage of morphine when there is no medical justification to do so, i.e., no uncontrolled pain to be managed, is a sure recipe for sudden death! See "Questionable Deaths, Assisted Suicide: Mercy Killing (& Involuntary Euthanasia)"

Mr. Aberg ignored the reality that there are problems in every industry, including hospice, and that things can go wrong, that people may have other motivations, that the "ideal" is not always the reality. In Mr. Aberg's twisted version of reality, hospices have no problems and are not prone to have the kinds of problems that every other niche in health care so obviously does.

When confronted with the examples of serial killer nurses, such as a Swiss nurse who killed 24 patients, he chose to not even comment. Amazingly, he had nothing to say about it! Mr. Aberg didn't want to talk about the effect of assisted suicide upon the professions, the field of health care or how easy it is for medical people to just let people choose death rather than meeting their physical, spiritual and emotional needs, which is really what hospice is all about. He did not want to talk about the effect his proposed changes would have on society as a whole!

Mr. Aberg spoke about the excellent services of hospice, that address the patient's needs on all levels. He never admitted that any wrongdoing occurs in hospices.

When questioned about statistics that show that depressed patients are some of those who seek assisted suicide, Mr. Aberg did not suggest that the patients might change their minds if given psychiatric counseling and support from their families and the health care team. He did not emphasize that sigificant efforts should be made to make sure the patient received proper psychiatric help and medications to overcome their depression.

It appeared clear that Mr. Aberg, as hospice patient care director, would cooperate fully with a depressed patient's request to have her death hastened! It also appeared clear that he would not ask the physician involved for a psychiatric consult or for significant counseling for the patient. Rather, he repeated that he "supports" the patient's right to kill herself in hospice for just about any reason!

When Mr. Aberg was asked about disabled patients (like Terri Schiavo, who are NOT terminal) being dehydrated to death, he refused to take a stand, or even to comment, and again repeated that he "supports" a patient's right to choose to kill herself.

Mr. Aberg started out saying that it is "well-known" that 95% of patients with pain have their pain well-managed in hospice and that the National Hospice and Palliative Care Organization had officially gone on record saying that "95%" of patients had their pain well-managed. He pointed out that the conclusion to make is that for 5%, there were problems resolving or managing their pain. He cited this statistic repeatedly (at the beginning of the "debate") as the main reason patients might choose to kill themselves in hospice. And he again affirmed his support for the patient's right to kill herself in hospice. Remarkably, he later admitted that almost all cases of a suicide within hospice (through terminal sedation or self-starvation and dehydration) do not involve physical pain.

Mr. Aberg's admission exposes the lie involved in the legalization of assisted suicide in the state of Oregon. Oregon's Death with Dignity Act was legalized under the pretense that patients in severe uncontrolled pain could opt for assisted suicide as a "last resort" option and that in all cases, other physicians would be consulted and psychiatric counseling provided before any "assistance" with suicide might be provided.

In reality, the statistics show that uncontrolled pain is not the reason patients may choose to hasten their death. Arguing for assisted suicide's legalization under the pretense that pain may be uncontrolled just does not stand up to scrutiny. Hospices and pain management specialists are extremely successful in relieving pain. Even in the difficult cases, research shows that experts can make pain bearable, according to the patient's own estimation of their pain.

Mr. Aberg did not elaborate upon the research which shows that even in the 5% of cases which may be more difficult to manage, specialists in pain management can reduce the pain and satisfy the patient's need for pain management. He did not mention, for example, that palliative radiation therapy can be done to reduce the size of a tumor causing pain, nor did he mention that even surgical procedures could be done.

Mr. Aberg admitted that most of the patients who chose to kill themselves in hospice, that he has witnessed, did so by self-starvation and dehydration and that in these cases, they were motivated by a desire to control their death and the timing of that death, not because they were in severe pain. He admitted that a major reason for patients to choose physician-assisted suicide was that they had a fear of becoming a burden to their families. He thus contradicted his earlier statements about pain being a significant reason for assisted suicide. Mr. Aberg went on to state that he "supported" assisted suicide in hospice and would favor legalization of euthanasia and assisted suicide.

Mr. Aberg never affirmed the basic belief in medicine that one is to "do no harm." Mr. Aberg never affirmed any basic reverence for life or a belief in the sanctity of life. In fact, Mr. Aberg never admitted that hospice should allow a death in its own natural timing. Mr. Aberg asserted that patients should be allowed to hasten death, for just about any reason.

When asked if he would support patients killing themselves by using guns or knives, Mr. Aberg said that he would not, but that killing through overdosage or poisoning or dehydration and starvation should be allowed. He could not and did not explain why he suported one type of killing and not the other type. Again, his reasoning was that he supported assisted suicide and "patients should have that right." No reason is given; no logical defense of his position, just a repeated assertion that it's "ok" for patients to kill themselves in hospice.

Mr. Aberg did try to say that assisted suicide should be allowed because we allow people to refuse food and water. When Nancy Valko pointed out that the Quill v. Vacco Supreme Court case was a unanimous decision that disagreed with that argument, he dropped that point.

Unlike most Hemlock supporters, Mr. Aberg didn't propose any safeguards to prevent misuses of assisted suicide within health care.

A striking point Mr. Aberg made almost in passing, was his admission that he would hide assisted suicide from relatives if necessary even though he emphasized how he and his hospice work "so well" with relatives. It was clear that when he admitted "hiding" assisted suicide from families, he was admitting that if necessary, he would lie to the families so they would never know or understand the truth that the patient was killing herself through self-starvation, dehydration and by taking unnecessary sedatives or pain medications. Mr. Aberg stated such medications were commonly taken when Mr. Aberg's patients killed themselves in hospice.

Nancy Valko confirmed that terminal patients she worked with would also sometimes request assistance to hasten their death. However, she explained that when she listened to the patient without judging and allowed the patient to talk it out, after she refused to assist their suicide, the patients would state they felt relieved that they had gotten that off their minds, knowing that it was not a real option. They went on to die a natural death, receiving the loving support not only of the staff but also their families.

Mr. Aberg ignored these stories about the patients and relatives who were grateful after staff refused to hasten death in hospice. He did not comment on the devastating effects of guilt on the bereavement process for those relatives who witnessed the self-starvation and dehydration of their loved one.

When asked about the reported coercion of non-terminally ill patients and disabled patient to be admitted into hospice, rather than condemn that coercion, he unbelievably insisted that not allowing the disabled to choose PAS was discrimination.

Mr. Aberg admitted having participated in cases where patients were assisted to death through self-starvation, dehydration and sedatives as well as pain medications, even though assisted suicide is illegal in California where Mr. Aberg practices. The reality is that Hospice Patients Alliance gets reports of such hastened deaths in hospices from families all over the USA. What Mr. Aberg reported, patients who choose to end their lives, hasten their deaths within hospice and who choose to do so by stopping to eat and drink is much more common than may be imagined. In fact, recent research about dying and hospice nurses in Oregon showed that the hospice nurses were aware of (just as Mr. Aberg is aware of) many patients who hastened their death through self-starvation, dehydration, sedatives and pain medications. The Oregon nurses called these deaths "peaceful." See: Physician-Assisted Suicide: Is it Still a Possibility? by Barbara A. Olevitch, Ph.D 01/12/04 Catholic Exchange

And while Mr. Aberg attempted to appear "respectful" and calm during the "debate," making his claims calmly does not make what Doug Aberg said any less mindless, irrational or downright dangerous! To allow assisted suicide into health care turns the very nature of health care upside down. Allowing assisted suicide into health care violates the laws against killing and violates the commandment not to kill! Allowing assisted suicide negates the basic relationship of trust in the health care provider as one who will care for the patient under all circumstances. Patients entering a hospice need to know that they will be cared for, not killed.

Allowing assisted suicide into health care has the potential to usher in horrific abuses of patient and human rights, realistically leading into another Holocaust type nightmare right now in the 21st century. Not one of these problems was even mentioned or addressed by Mr. Aberg who is either historically naive or disingenuous when he presents such a "syrupy sweet" interpretation of what assisted suicide in hospice is all about!

- Ron Panzer

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