Keith Olbermann opened his emotional Special Comment on health care Wednesday with the story of his father’s six-month-long hospitalization suffering through a colon removal, pneumonia, kidney failure, liver failure, and many infections.  

After a particularly difficult week, Olbermann said he went into his father’s hospital room to find him “thrashing his head back and forth” and mouthing the word “Help.”  “It was just too much for my father,” Olbermann said. “‘Stop this,’ he mouths. ‘Stop, stop, stop.’”

Olbermann said he resorted to gallows humor, asking his father, “What, you want me to smother you with a pillow?” And his father responded, mouthing, “Yes, kill me.”

“And as I left the hospital that night, the full impact of the last six months washed over me,” Olbermann said. “That conversation, that one, was what these ghouls who are walking into Blair House tomorrow morning called death panels. Your right to have that conversation with a doctor. Not the government, but a doctor. And your right to have insurance pay for his expertise on what your options are when dad says ‘Kill me’ or what your options are when dad is in a coma and can’t tell you a damn thing.”

Olbermann then laid into those who spread fear about death panels.

“That, right now, is the legacy of the protests of these subhumans who get paid by the insurance companies, who say these things for their own political gain, or like that one fiend, for money,” Olbermann said. “Betsy McCaughey told people tht this conversation about life and death and relief and release…she told people that’s a death panel and she did that for money! It’s a life panel. A life panel. It can save the pain of the patient and the family. It’s the difference between you guessing what happens next and you being informed about what probably will. And that’s the difference between you sleeping at night or second-guessing and third-guessing and thirtieth-guessing yourself.”

“It’s a life panel, and damn those who call it otherwise to hell!” he said.

Olbermann closed the comment with news that his father has not awoken since Friday, and that it’s now possible he never recovers.

“So considering that if he does not recover you will not see me here for a while, I have some requests,” he said. “Please, have this conversation with your loved ones. Don’t wait. Do it now. It’s tough. It acknowledges death, and it also narrows the gray area you and they will face from infinity to a foot wide. It is my greatest comfort right now and I want it to be yours. And to the politicians who go into Blair House tomorrow, for that summit, I have some requests as well. Leave your egos at the door. I want, I demand that you give everybody in this country a chance at the care my father has gotten. And I demand that you enact this most generous and kind aspect of the reform proposed, the right to bill the damned insurance company for the conversation about what to do when the time comes. The life panel.”

Ray Gosling was arrested on Tuesday after he told a BBC documentary that he smothered the man. The admission and investigation has added to an already heated public debate in Britain on the issue of assisted suicide or euthanasia.

Dr Evan Harris is a UK parliamentarian and a member of the British Medical Association’s Medical Ethics Committee. Dr Peter Saunders is General Secretary of pressure group ‘Care Not Killing’. The BBC’s Roger Hearing brought them together and began by asking Dr Saunders why the issue was so prominent now.

Listen to BBC broadcast here which explains the case and the differences between murder, euthanasia, and assisted suicide.

Rom Houben, trapped in his paralysed body after a car crash, described his real-life nightmare as he screamed to doctors that he could hear them – but could make no sound.

‘I screamed, but there was nothing to hear,’ said Mr Houben, now 46, who doctors thought was in a persistent vegatative state. ‘I dreamed myself away,’ he added, tapping his tale out with the aid of a computer.

Doctors used a range of coma tests before reluctantly concluding that his consciousness was ‘extinct’.

But three years ago, new hi-tech scans showed his brain was still functioning almost completely normally. Mr Houben described the moment as ‘my second birth’. Therapy has since allowed him to tap out messages on a computer screen.

Mr Houben said: ‘All that time I just literally dreamed of a better life. Frustration is too small a word to describe what I felt.’ His case has only just been revealed in a scientific paper released by the man who ’saved’ him, top neurological expert Dr Steven Laureys.

‘Medical advances caught up with him,’ said Dr Laureys, who believes there may be many similar cases of false comas around the world. The disclosure will also renew the right-to-die debate over whether people in comas are truly unconscious.

Mr Houben, a former martial arts enthusiast, was paralysed in 1983. Doctors in Zolder, Belgium, used the internationally accepted Glasgow Coma Scale to assess his eye, verbal and motor responses. But each time he was graded incorrectly.

Only a re-evaluation of his case at the University of Liege discovered that he had lost control of his body but was still fully aware of what was happening.

He is never likely to leave hospital, but as well as his computer he now has a special device above his bed which lets him read books while lying down.

Mr Houben said: ‘I shall never forget the day when they discovered what was truly wrong with me – it was my second birth.

‘I want to read, talk with my friends via the computer and enjoy my life now that people know I am not dead.’

Dr Laureys’s new study claims that patients classed as in a vegetative state are often misdiagnosed.

‘Anyone who bears the stamp of “unconscious” just one time hardly ever gets rid of it again,’ he said.

The doctor, who leads the Coma Science Group and Department of Neurology at Liege University Hospital, found Mr Houben’s brain was still working by using state-of-the-art imaging.

He plans to use the case to highlight what he considers may be similar examples around the world.

Dr Laureys said: ‘In Germany alone each year some 100,000 people suffer from severe traumatic brain injury.

‘About 20,000 are followed by a coma of three weeks or longer. Some of them die, others regain health.

‘But an estimated 3,000 to 5,000 people a year remain trapped in an intermediate stage – they go on living without ever coming back again.’

Supporters of euthanasia and assisted suicide argue that people who have lain in persistent vegetative states for years should be given the opportunity to have crucial medical support withdrawn because of the ‘indignity’ of their condition.

But there have been several cases in which people judged to be in vegetative states or deep comas have recovered.

Twenty years ago, Carrie Coons, an 86-year-old from New York, regained consciousness after a year, took small amounts of food by mouth and engaged in conversation.

Only days before her recovery, a judge had granted her family’s request for the removal of the feeding tube which had been keeping her alive.

In the UK in 1993, doctors switched off the life support system keeping alive Tony Bland, a 22-year- old who had been in a coma for three years following the Hillsborough disaster.

Dr Laureys was not available for comment yesterday and it is not clear why he thought Mr Houben should have the hi-tech screening when so many years had passed.

“Dad’s not doing very well,” he said. “If you want to see him before he dies, you’d better fly up here.”

I didn’t believe him. At age 88, my dad had weathered crises before, and he had told me many times that he didn’t want to die and wasn’t ready to die. For a decade, my saintly mother had nursed him as he progressively declined. But always before, during his crises, he had rallied.

My father was the son of a lawyer. After one brief year in the undergraduate medical curriculum at Washington and Lee University, he switched to law, where he earned his degree. After a stint in the U.S. Army in World War II, he ended up in the Patent and Trademark Office, serving 30 years as a trademark examiner. He and my mother grew up in the small farming town of Woodstock in the Shenandoah Valley, where their grandparents were farmers. After the war, they moved to Montgomery County, Md., a suburb of Washington, D.C., and began a new, big-city life, having five children.

To my regret, my dad and I hadn’t talked about his dying. My father had always feared death, but had met this fear abstractly. From the age of 5, I remember Victor Frankel’s “Man’s Search for Meaning” and Ernest Becker’s “The Denial of Death” near his reading chair. Over the next decades, he accumulated more books like these.

So after his 50 years of pondering death, I expected some wisdom from him about how he would face his own death. I hoped it would, in turn, help me face my own. Maybe every adult child hopes for this, but Dad and I never had that conversation.

On the other hand, his obsession and those books surely had something to do with my decision to get a Ph.D. in philosophy. And so with my ending up in bioethics, whose primordial issue is death and dying.  After I had taught in a medical school for 25 years, my father’s last illness occurred. It also came to pass that my father’s dying taught me wisdom about dying, but of a different sort than I’d expected.

In bioethics, philosophers for decades had argued the distinction between killing and letting die. James Rachels famously attacked this distinction in a 1975 article in the New England Journal of Medicine.

Whereas legally, it matters in most states whether physicians cause someone’s death or fail to aid a patient in distress, bioethicists criticize the distinction, claiming the difference carries no moral weight. For if physicians intend to kill a patient and the result is death, does it matter if physicians did something active or merely omitted normal treatment in life-or-death contexts? Either way, death was intended and death occurred.

But I oversimplify. Not all bioethicists thought this way. Indeed, I searched the literature once and turned up hundreds of articles, graduate theses and books about the distinction. (Thanks to Rachels for creating a small, cottage industry in academe.)

But I believed the distinction didn’t matter until that singular day when my father’s doctor called from the Hebrew National Home in Washington, D.C., where my father spent his last days. The doctor said dad’s condition had worsened and the only stopgap was a feeding tube; otherwise, Dad would soon die.

Because I was a medical ethicist, my family had — perhaps incorrectly — left this decision to me. I talked to my father by phone: He could barely talk, but said he did not want to die, was not ready to die. Patel said my father would soon be too sedated to talk. And indeed, short as it was, that was my last conversation with my father.

So I allowed the feeding tube. After all, it was my father, and he didn’t want to die.

About an hour after I made that decision, a nurse called: “Aren’t you the medical ethicist? Are you sure you want to put your father on a feeding tube? Do you realize what that means for him and your family?”

And, of course, I had forgotten what it meant, because the issue was no longer the abstract one, but the death of my father. I agonized that afternoon. I talked to my relatives and then, reluctantly, called to rescind my decision. Don’t put in a feeding tube; let him die. I said I was packing and on my way.

My father’s death was philosophically a hard death. He didn’t want to die, and he wasn’t ready to die. Yet, he was getting worse and worse.

The next morning, I was still feeling ambivalent about my decision when the doctor called to say my father had just died.

In that moment in Alabama, 1,000 miles away, enormous guilt wracked me: I had killed my father. I had made a decision resulting in the death of a man I loved who didn’t want to die, and my dad’s consciousness had ceased to exist. No conversation between us would ever occur again.

For the first time, I felt why some physicians find it so hard to remove patients from respirators and why decisions to remove feeding tubes cause such guilt in families.

Intellectually, lest terminal patients suffer in dying in hideous ways, I know someone must make these decisions. One study says 80 percent of deaths in America involve a decision to limit some kind of medical care.

Looking back, I understand I made the right decision, but I am also now wiser. Perhaps, as my wife, Pat, says, my emphasis on withdrawing or not withdrawing the feeding tube merely intellectualized my real feelings of helplessness and loss (after all, I am my father’s son). Looking back, too, I understand that ending the life of one you love tears you apart. Nothing prepares you for it — not even 25 years in bioethics. And you always want one more conversation with your dad.

Gregory Pence, Ph.D., is a professor of philosophy and director of the Early Medical Student Acceptance Program at UAB. Web site: www.uab.edu/philosophy/faculty/pence/

By Special to The Birmingham News  November 15, 2009, 5:39AM  By GREGORY PENCE

Ten years after the notorious Michigan doctor was ultimately jailed for killing a patient — one of 130 he helped die through lethal injection — Philip Nitschke, a new renegade physician, is spreading the gospel of assisted suicide — and he’s coming to the United States next month.

Nitschke is the 61-year-old Australian founder and director of the pro-assisted-suicide organization, Exit International. (Motto: “A Peaceful Death Is Everybody’s Right.”)

Based in Melbourne, Australia, the vocal advocacy group has gone beyond the legislative projects of other right-to-die organizations, who want to decriminalize euthanasia, to develop an array of educational tools for people considering ending their lives on their own terms.

These include public meetings (”free and open to all”), “ExiTutorials” (formerly called “Workshops”), private home visits, and, most recently, an “Exit kit,” which is best described as a do-it-yourself lab test for people who wish to commit suicide but want to make sure they do it right.

The battle over health care reform may be raging too intensely for Americans to notice right now. But while end-of-life questions are distorted into wild and ominous claims that “death panels” will “pull the plug on Grandma,” elsewhere in the world, from Australia to Canada, the right-to-die debate is heating up.

It’s not the same debate it used to be. Reuters reported this spring: “It used to be an issue just for the terminally ill. Now, as populations around the world age, governments are increasingly being confronted with the taboo idea of dying as something people can volunteer to do.”

Foolproofing Sucide?

At $50 a pop, the Exit kit was developed to help people who have already procured lethal drugs — specifically, the barbituate Nembutal, which is sold over the counter in Mexico — to ensure that they are still potent enough to kill after spending time in storage.

Time magazine explained earlier this year: “When someone with a terminal illness decides to end his or her life by overdosing on barbiturates, they may hope the drugs will lull them into a peaceful and permanent sleep. But if the drugs have passed their expiration date or lack a sufficiently lethal concentration, the would-be suicide victim may actually survive — risking an array of complications, including coma, reduced physical functioning and the opprobrium of disapproving friends and family.”

“Now, in an effort to provide certainty to those contemplating suicide, one of the world’s leading euthanasia advocates plans to sell barbiturate-testing kits to confirm that deadly drug cocktails are, in fact, deadly.”

Exit International also sells a book ($35) called The Peaceful Pill Handbook, a sort of suicide tutorial that, in addition to defending suicide as a legitimate choice that can be made by lucid people (whether they are terminally ill or simply “tired of life”), provides readers with eight ways to kill themselves. (The group boasts a research-and-development arm, which is focused on coming up with “various end-of-life approaches that are reliable, peaceful and dignified.”)

Some of these methods are spotlighted on Exit International’s Web site through an assortment of (admittedly weird and, really, pretty creepy) instructional videos featuring a grandmotherly “nurse educator” named Betty, who gives short, cheerful lessons on the finer points of suicide, all to a jaunty instrumental soundtrack.

(In one, titled “Doing It With Betty,” she shows you how to make an “Exit Bag,” which consists of a plastic oven bag with a drawstring. “What I usually do is just reinforce with two piece of tape …” she says, as if death by self-asphyxiation is a hobby of hers.)

The videos carry the disclaimer: “This Material Is Not Suitable for Children or Anybody Suffering From Depression or Mental Illness.”

In March, the Australian government, which has banned The Peaceful Pill Handbook, also banned two of the “Betty” videos, prompting an angry response from Betty.

“My generation has lived through a lot, including WW II,” said 78-year-old Betty Peters, an Exit International volunteer. “We, more than most people, know about death, and many of us don’t want to suffer the pain and indignity of illness or a prolonged period as a vegetable in a nursing home.”

A former physician, Philip Nitschke has been working on end-of-life tools for years. In 1996, he achieved fame by helping four people kill themselves through a computerized lethal-injection system he called the Deliverance Machine. At the time, it was legal under Australia’s short-lived Rights of the Terminally Ill Act.

As he described in the introduction to The Peaceful Pill Handbook, “the computer presented a short series of questions” before administering the lethal injection:

1. Are you aware that if you go ahead to the last screen and press the “yes” button you will be given a lethal dose of medication and die?

2. Are you certain you understand that if you proceed and press the “yes” button on the next screen you will die?

3. In 15 seconds you will be given a lethal injection … press “yes” to proceed.

“After pressing the button for the third time, the machine started up and delivered to each patient a lethal dose of the barbiturate Nembutal,” he wrote. “At the time of their choosing, the Deliverance machine enabled those four people to die, peacefully and with dignity.”

Nitschke recalls the inevitable aftermath of these physician-assisted deaths as the end of a promising era when people had the option of “dying with dignity.”

But the Rights of the Terminally Ill Act was repealed and replaced within nine months of its passage, at which point Nitschke gave up medicine and devoted himself full time to the fight for assisted suicide.

Like other assisted-suicide proponents, Nitschke considers the “right to choose” a human-rights issue, as well as one of free speech. “It is because of … deliberate attempts by the State to further restrict, control and censor end-of-life information that The Peaceful Pill Handbook has been written,” he said.

‘Death With Dignity’ vs. U.S. Healthcare?

It’s difficult to untangle the layers of controversy surrounding the topic of physician-assisted euthanasia in the U.S., from alarm at “playing God” to a more general fear of confronting death, to the very real question of how it would work logistically to decriminalize it.

As a recent Reuters report put it, the issue is “littered with ethical red flags.” But it’s a topic that is not going away. As aging Americans face the prospect of making difficult end-of-life decisions, two states (Washington and Oregon) have already passed “Death With Dignity” legislation to allow doctors to prescribe lethal doses of barbiturates to patients who are terminally ill.

Although the measures have not led to a spike in suicides as some predicted, they have nonetheless been controversial. In Oregon, the Death with Dignity Act has its own Web site that takes pains to distinguish between its law and still-existing laws that ban euthanasia. (”Euthanasia is a different procedure for hastening death,” according to the FAQ section. “In euthanasia, a doctor injects a patient with a lethal dosage of medication. In the Act, a physician prescribes a lethal dose of medication to a patient, but the patient — not the doctor — administers the medication. Euthanasia is illegal in every state in the U.S., including Oregon.”)

Some might argue that it is a distinction without a difference; and no doubt the debate will heat up when Nitschke comes to North America to peddle Exit International’s philosophies and products, which he’s scheduled to do in November.

A visit to Canada scheduled at the same time is already generating controversy; a planned workshop at the Vancouver Public Library was recently canceled over concerns that it would violate Canadian law, which prohibits the encouragement of suicide. (Nitschke disputes that the workshops actually encourage suicide.)

Proponents of assisted euthanasia often point to religion and all its moral strictures as the root behind this kind of controversy — and in one sense they’re right. Their real foes are the doctors and nurses who provide hospice care — a movement with a strong religious tradition.

Dr. Helen Watt, director at Linacre Center for Healthcare Ethics in London, told Retuers, “It is good holistic palliative care, not medical killing which is the answer to the real distresses of so many people when contemplating natural death.”

This echoes the belief of Cicely Saunders, the pioneering British doctor who founded the modern-day hospice movement. Saunders, who was deeply religious, died in 2005, but her firm opposition to laws allowing physician-assisted suicide lives on.

“Freedom to take one’s life as a private matter is very different from a legalized ‘right to die,’ which all too easily can lead to a presumed duty to die,” Saunders argued in a letter to the London Times in 1991. “All those who work in palliative medicine know well how most requests for a speedy end to life fade away once good care has been instituted. … To suggest killing before we have done all we can in caring would, to me, be the wrong answer to the present question.”

That present question, more than 15 years later, is as relevant as ever. Yet, as we have seen all too clearly in the past several weeks, in the United States, even the most superficial changes in our for-profit health care system have proved polarizing beyond reason; a meaningful attempt to address the fraught topic of end-of-life care seems nearly impossible.

With another round of controversy over the “right to die” on the horizon, hysteria over so-called death panels must be abandoned in favor of a less distorted, more empathetic discussion over the right to health care — in all its forms.

Liliana Segura is an AlterNet staff writer and editor of Rights & Liberties and World Special Coverage. http://twitter.com/LilianaSegura

© 2009 Independent Media Institute. All rights reserved.
View this story online at: http://www.alternet.org/story/143059/

[BBC] The advice allows food and fluids to be withdrawn from patients, who are then continuously sedated, if they are judged to be close to death.

In a letter to the Daily Telegraph the six doctors and campaigners criticise a “tick-box approach” to care. The government says the guidance helps deliver high quality care for people.

Among the signatories on the letter are PH Millard, Emeritus Professor of Geriatrics at the University of London and Dr Anthony Cole, chairman of the Medical Ethics Committee.

Dr Peter Hargreaves, a consultant in palliative medicine, Dr David Hill, fellow of the Faculty of Anaesthetists of the Royal College of Surgeons, Dr Elizabeth Negus, a lecturer at Barking University, and Dowager Lady Salisbury, chairman of Choose Life, were the other signatories.

Their letter says the new treatment pattern of palliative care, based on experience at a Liverpool hospice is being rolled out into hospitals and nursing homes.

“If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death,” they write.

“As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.”

A Department of Health spokesman said they are investing £286 million over the two years to help improve end of life care.

He added: “The Liverpool Care Pathway is an established and recommended tool that provides clinicians with an evidence-based framework to help delivery of high quality care for people at the end of their lives.

“It has been recommended in the Supportive and Palliative Care Guidance issued by the National Institute for Health and Clinical Excellence.”

For nearly two decades, the medical and legal consensus has been that it is permissable to withdraw life-sustaining artificial hydration and nutrition from adult patients in a persistent vegetative state. But should that standard apply to children, too?

Yes, it should, but only if their parents agree, according to a new position statement issued by the American Academy of Pediatrics’ Committee on Bioethics and published in the August Pediatrics (pediatrics.aappublications.org/cgi/content/abstract/124/2/813/).

There are as many as 35,000 pediatric patients living in a persistent vegetative state, according to the AAP report. The academy’s statement says there are other “limited circumstances” under which it may be morally permissible for physicians to withdraw medically provided nutrition and fluids because those interventions can impose more burden than benefit to pediatric patients.

Cases where putting an end to feeding is ethically appropriate can include children with severe nervous system malformations or prenatal injury such as anencephaly, children with minimal consciousness, pediatric patients with terminal illnesses and infants with total intestinal failure.

The clinical difference between making this ethically difficult call in pediatric cases versus adult patients is that it is often harder to predict how children may fare neurologically, said Douglas S. Diekema, MD, MPH, lead author of the position statement. He said withdrawing artificial hydration and nutrition is especially sensitive when it comes to children.

“It feels different when it’s a child who’s your patient versus a 45-year-old,” said Dr. Diekema, director of the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital. “Also, there is a social significance to feeding in terms of parents taking care of their children, and that sometimes carries over to our thinking and to discussion of medically provided fluids and nutrition.”

Even if a pediatric patient is in a persistent vegetative state, stopping feeding is not “morally required,” the AAP says. Further, doctors and hospitals should not go against parents’ wishes. But when there is disagreement among doctors and family, an ethics consultation should be arranged to help communicate with family and try to reach accord or refer the patient elsewhere, the academy said.

By Kevin B. O’Reilly, AMNews staff. Posted Aug. 20

Although friends who spoke to the British news media said Sir Edward was not known to have been terminally ill, they said he wanted to die with his ailing wife, who had been his partner for more than half a century.

The couple’s children said in an interview with The London Evening Standard that on Tuesday of last week they accompanied their father, 85, and their mother, Joan, 74, on the flight to Zurich, where the Swiss group Dignitas helped arrange the suicides. On Friday, the children said, they watched, weeping, as their parents drank “a small quantity of clear liquid” before lying down on adjacent beds, holding hands.

“Within a couple of minutes they were asleep, and died within 10 minutes,” Caractacus Downes, the couple’s 41-year-old son, said in the interview after his return to Britain. “They wanted to be next to each other when they died.” He added, “It is a very civilized way to end your life, and I don’t understand why the legal position in this country doesn’t allow it.”

Sir Edward, who was described in a statement issued earlier on Tuesday by Mr. Downes and his sister, Boudicca, 39, as “almost blind and increasingly deaf,” was principal conductor of the BBC Philharmonic Orchestra from 1980 to 1991. He was also a conductor of the Royal Opera House at Covent Garden in London, where he led 950 performances over more than 50 years.

Lady Downes, who British newspapers said was in the final stages of terminal cancer, was a former ballet dancer, choreographer and television producer who devoted her later years to working as her husband’s assistant.

“After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems,” the Downes children said in their statement.

British families who have used the Zurich clinic in the past have said that Dignitas charges about $6,570 for each assisted suicide.

Scotland Yard said in a statement on Tuesday that it had been informed on Monday “that a man and a woman” from London had died in Switzerland, and that it was “looking into the circumstances.” The information that prompted the police inquiry appeared to have been given voluntarily by the Downes family, which, Caractacus Downes said, “didn’t want to be untruthful about what had happened.”

“Even if they arrest us and send us to prison, it would have made no difference because it is what our parents wanted,” he said.

Attempting suicide has not been a criminal offense in Britain since 1961, but assisting others to kill themselves is. But since the Zurich clinic run by Dignitas was established in 1998 under Swiss laws that allow clinics to provide lethal drugs, British authorities have effectively turned a blind eye to Britons who go there to die.

None of the family members and friends who have accompanied the 117 people living in Britain who have traveled to the Zurich clinic for help in ending their lives have been charged with an offense. Legal experts said it was unlikely that that would change in the Downes case.

But British news reports about the Downeses’ suicides noted one factor that appeared to set the case apart from others involving the Dignitas clinic: Sir Edward appeared not to have been terminally ill. There have been at least three other cases similar to the Downeses’, in which a spouse who was not terminally ill chose to die with the other.

Sir Edward was known for his support for British composers and his passion for Prokofievand Verdi. After studying at the Royal College of Music in London, he joined the Royal Opera House in 1952. His first assignment was prompting the soprano Maria Callas. He traveled widely as a conductor and became music director of the Australian Opera in the 1970s.

Friends of Sir Edward said that his decision to die with his wife did not surprise them. “Ted was completely rational,” said Richard Wigley, the general manager of the BBC Philharmonic. “So I can well imagine him, being so rational, saying, ‘It’s been great, so let’s end our lives together.’ ”

Jonathan Groves, Sir Edward’s manager, called their decision “typically brave and courageous.”

But even among those who support decriminalizing assisted suicide, Sir Edward’s death raised troubling questions. Sarah Wootton, chief executive of Dignity in Dying, said in a BBC interview that the growing numbers of Britons going abroad to die, and the manner of their deaths, made it more urgent to amend Britain’s laws. There are “no safeguards, no brakes on the process at all,” she said.

The British Medical Association voted this month against legalizing assisted suicide, or lifting the threat of prosecution from “friends and relatives who accompany loved ones to die abroad.” Last week, the House of Lords defeated a bill that would have allowed people, subject to safeguards, to travel abroad to help people choosing to die.

-John Burns

The state of Montana has asked the court to reverse a lower-court ruling that Montanans have a constitutional right to physician-assisted suicide.

Before a Tuesday deadline, at least 14 motions to participate in the case had been filed with the Supreme Court, which is likely to hear oral arguments later this year.

“Usually we get a couple of briefs, but this is going to be a big case,” said Birgit Stipich, an appellate case manager in the office of the Supreme Court clerk.

District Judge Dorothy McCarter ruled Dec. 5 that mentally sound, terminally ill Montanans have a right to choose to end their lives using medication prescribed by doctors – putting the state on a path to become the nation’s third allowing assisted suicide.

The ruling came in the case of Robert Baxter, a Billings man with terminal cancer, who was joined in the lawsuit by four physicians and a nonprofit patients’ rights group.

“Montana has a strong constitution that is among the most protective if not the most protective of all the 50 states in protecting individual privacy and dignity,” said Kathryn Tucker, attorney for Compassion & Choices, the patients’ rights group.

In particular, Tucker points to a section in the state constitution that proclaims human dignity is inviolable – a legal protection that she says is unique to Montana.

The state attorney’s office has said in its brief, however, that the constitution does not provide for a specific right of dignity that is separate from a right to equal protection under the law.

“The terminally ill possess the same dignity held by all Montanans,” reads the brief from Attorney General Steve Bullock. “However, even if dignity were a tractable legal rule, it should not lower the standard of care for this especially vulnerable population.”

A group of 28 state legislators also is urging the court to reject the ruling, claiming that any decision about assisted suicide should fall to the legislative branch of government.

“The District Court decision endangers our citizens – and our most vulnerable citizens at that – without so much as even contemplating the potential abuses and social harms that may result,” reads the legislators’ brief. “That is truly an analysis that should be left for the Legislature.”

On the other side, at least 24 legislators are filing with the court to support a right to suicide for the terminally ill.

“I believe the Legislature has an important role in making sure this right is both recognized and not abused in any way and that role will be to draft legislation that protects that right and ensures it’s not abused,” said Sen. Christine Kaufmann, D-Helena.

Montana would join Oregon and Washington in allowing physician-assisted suicide. But Montana would be the first state where a court has approved writing prescriptions for fatal drugs.

McCarter refused to issue a stay on her ruling pending appeal, and Montana doctors can legally prescribe drugs to end the lives of terminally ill patients. But patients seeking assistance to die have complained they cannot find physicians willing to help them.

After the ruling, the Montana Medical Association issued a policy stating it “does not condone the deliberate act of precipitating the death of patient.”

-Associated Press

Their fears were raised after the Guardian obtained a list drawn up by Dignitas which reveals the medical conditions which have driven 114 Britons to end their lives at the clinic.

The document shows that while many had terminal illnesses such as cancer and motor neurone disease, others had non-fatal conditions which doctors say some people can live with for decades.

It covers the medical history of all but one of the 115 Britons who have died with Dignitas’s help since the first did so in 2002. It identifies 22 conditions in all. Thirty-six of the 114 unnamed Britons had various forms of cancer, 27 had motor neurone disease and 17 had multiple sclerosis.

But two had Crohn’s disease, an inflammatory bowel disease; two were tetraplegics; three had kidney disease, which can be usually treated by dialysis or a transplant; and one had rheumatoid arthritis – all conditions which doctors say are not terminal.

The details have prompted deep concern among senior doctors, calls for the NHS to provide much better end-of-life care and a renewed debate over demands for a new legal right of assisted death to render the growing British use of Dignitas unnecessary.

Professor Steve Field, chairman of the Royal College of General Practitioners, said: “I’m horrified by this list. While I appreciate that some patients with conditions like these experience great suffering and misery, I’m concerned because I know that many of the conditions outlined are conditions patients live with and can live with for many years and continue to have productive and meaningful lives.”

While most of the conditions could contribute to a patient’s death, equally people with many of them – such as Aids, cancer and tetraplegia – could, with the right treatment, lead fulfilling lives, added Field. NHS palliative care was too often “rather patchy”, said Field, who was “worried” that not all the 114 patients may have been aware of treatments that could have prolonged their lives. Dr John Saunders, chair of the Royal College of Physicians’ ethics committee, said: “The conditions are so varied that it suggests that Dignitas is not undertaking the adequate medical assessment [of patients seeking its help] that might be expected. The list does suggest that Dignitas is cavalier in arranging for people to end their lives.”

Dr Tony Calland, chairman of the ethics committee at the British Medical Association, the doctors’ union, said: “This list raises considerable concern. There are some conditions such as Crohn’s disease and rheumatoid arthritis that, whilst extremely unpleasant, are eminently treatable and many of the symptoms can be relieved. To go off and commit suicide simply on the basis of these conditions would be premature and unreasonable.”

Their fears were echoed by Edward Turner, whose mother Anne, a retired doctor who had the incurable degenerative condition supranuclear palsy, became a focus of the right to die debate when she killed herself at Dignitas in January 2006. “The principle should be that if somebody is terminally ill and has started the process of dying, it’s not unreasonable for them to have an assisted death. When people have non-terminal conditions, that’s more troubling”, said Turner.

“I don’t want to see assisted suicide legalised for people who are disabled but not dying because morally that’s a different thing. With the right care and support someone with tetraplegia, for example, can find quality and meaning in life.”

Research published last year in the Journal of Medical Ethics showed that 21.2% of all those of various nationalities ending their lives at Dignitas had a non-fatal illness. The suicide at Dignitas last September of Daniel James, 23, from Worcester who was left paralysed from the chest down in a rugby accident, sparked a debate about the morality of it assisting the non-terminally ill to die.

Sarah Wootton of Dignity in Dying, which campaigns for terminally ill, mentally competent adults to be able to end their lives, said: “This information is a wake-up call.

“We face three choices: we can ignore the problem, we can seek the prosecutions of those that accompany a loved one abroad to die, or we can safeguard the process.

“The only logical way forward is to clarify the law so that it clearly distinguishes between assisted suicide, which should be prevented, and assisted dying, which should be regulated.”

Next week’s annual conference of the BMA will debate calls to end the threat of imprisonment hanging over those who go with loved ones travelling abroad to commit suicide, and a right of assisted dying in the UK for the terminally ill.

Conditions of first 114 Britons to die, starting in late 2002; no details are yet available of a recent 115th

Aids 1

Cancer 36

Cauda equina syndrome 1

Cerebellar ataxia 2

Huntington’s chorea 2

Chronic obstructive lung disease 1

Friedreich’s ataxia 1

Heart problems 1

Inclusion body myositis 1

Kidney disease 3

Motor neurone disease 27

Crohn’s disease 2

Multiple sclerosis 17

Multiple diseases 3

Multiple luxation 1

Multiple system atrophy 3

Non-treatable epilepsy 1

Parkinson’s 3

Pick’s disease 1

Progressive supranuclear palsy 4

Rheumatoid arthritis 1

Tetraplegia 2

-Denis Campbell