Euthanasia: Whose death is it anyway?

Canada’s highest court ruled that euthanasia is illegal, but that won’t stop some doctors from helping terminally ill patients die.

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      Stephen Gardiner’s real name or where he lives cannot be divulged because well-intentioned friends might try to stop him from killing himself. And he doesn’t want them implicated. Wolf Obgielo’s name can be made known because the details of the assistance he’ll get when he decides to die will not be revealed here. Both men are terminally ill with cancer and both want to choose—without the interference of authorities—the time and circumstances of their death.

      The story of Vancouver’s 66-year-old Ken James can also be disclosed. James’s chronic back pain and heart condition are so debilitating, so unrelieved by daily morphine tablets, that he says, half laughing: “If I were a horse, they’d shoot me.” To avoid officials who could lay murder charges against anyone who helps him, he’s been researching the best methods for killing himself with minimal evidence left behind.

      None of these B.C. men can access the prescription drug pentobarbital, which is the lethal drug of choice for most of the 38 or so people in Oregon who annually find release under that state’s so-called Death With Dignity law, its physician-assisted-suicide initiative passed in 1994. And Nembutal, a common trade name for the pentobarbital that Exit International’s Dr. Philip Nitschke recommends, isn’t as simple to acquire as it once was.

      But there is helium inhalation. It’s a quick and easy-to-use option that New Westminster’s Russel Ogden, Canada’s leading researcher on right-to-die issues, knows is currently filling the assisted-suicide gap—until this country joins the growing number of jurisdictions where dying people can legally get help ending their lives.

      In the decades ahead, no issue will be more contentious—as boomers age and medical costs go ballistic—than the fundamental right-to-die question: Whose life is it?

      That was articulated by Sue Rodriguez in the early 1990s. Rodriguez was dying of amyotrophic lateral sclerosis and—incapable of any movements because of the paralytic effect of the disease—had decided to mount a legal challenge to the law, seeking permission to receive medical assistance for when she finally chose to die. “Who should decide when I die?” she asked. She lost the case in a famous Supreme Court of Canada 5-4 decision in September 1993. The court said no one—despite terminal disease, intractable pain, prolonged suffering, or an expressed desire for relief—could legally have help to die.

      So the issue remains the proverbial elephant in the room: big, looming, and—because of the profound ethical questions involved—dangerous. Few politicians are brave enough to say, to paraphrase Pierre Trudeau, that the state has no place at the deathbeds of the nation. Few doctors, nurses, or those involved with hospice care are prepared to risk careers saying aloud what everyone knows: assisted suicide happens—discreetly—all the time in Canada. But were it made visible by admitting that, the police might intervene. So, instead, fear and silence reign. (As one of Vancouver’s leading palliative-care authorities said, requesting anonymity: “Everyone told me not to talk to you. I could lose my job. Talking about assisted suicide is taboo.”)

      And yet, according to a February 2010 Angus Reid poll, a majority of Canadians (67 percent; 75 percent in B.C.) favour the establishment of a medically regulated system of euthanasia; a slightly smaller percentage favours the decriminalization of assisted suicide.

      In January 2007, Wolf Obgielo, then 53 and newly unemployed after working for decades in forestry management, left his Pritchard, B.C., home east of Kamloops to find out why his persistent flu wasn’t going away. When the medical assessments were done, an oncologist informed him he had aggressive Stage IV cancer in his lungs and lymph nodes and had six to 12 weeks to live. It hit him, he says, “like a sledgehammer”. He’d watched his uncle dying, slowly suffocated by lung cancer. His father had hung himself in a closet in the face of prolonged chemotherapy. But for three years, Obgielo fought the disease. This past spring, however, wasted by the cancer drugs’ effects, he decided to give up and began looking at how he would end his life.

      As he sits amid dozens of equestrian knickknacks and scores of wall-mounted photos of himself, his wife, and their two sons—many of them showing the family on horseback, riding the sagebrush-covered rangeland above Pritchard—his breathing is laboured, his words slow. He still rides, he says. His wife helps him. He’s a cowboy at heart. It’s his last real pleasure. But it’s getting harder now. The cancer is in his bones. His lower back. His left hip. Left ribs. His lungs and lymph nodes.

      Is it painful?

      “Oh, yeah!” he replies emphatically. “I’ve got a horror vision of me gasping like a fish in the bottom of a boat. Just flipping around, you know. People who are against assisted suicide don’t know the pain of dying, the mental torture. You could live longer, drugged up. But what the hell do you live for? It’s not the quantity of time but quality of life that matters.

      “When I can’t ride my horse anymore”¦I’ll get the help I need,” he says. “The SPCA could have you charged for cruelty to animals if you have a dying animal and you don’t put it down.”

      Few people in Canada know more about the practicalities of suicide and euthanasia than Russel Ogden, 47, an instructor of criminology and sociology at Kwantlen Polytechnic University. If you Google “How to kill yourself”, his name is among the first dozen or so out of tens of millions of entries. On February 12, 1994, the Vancouver Sun ran a front-page story on Ogden that reported he’d found 34 Canadian cases of illegal assisted suicide while researching his master’s thesis. It was, by coincidence, the same day that Rodriguez, accompanied by a still unknown physician and B.C. MLA Svend Robinson, defied the 1993 Supreme Court of Canada ruling against her wish for assisted suicide by having a doctor help her die. This was international news. Ogden instantly became an authority on the dilemma that society faces when terminally ill or chronically pained individuals wish to end their lives and governments prohibit it.

      In Ogden’s thinking today, there are several central issues concerning assisted suicide that will, in the coming decades, force politicians and the public to resolve the ambiguities that now govern how a sane and terminally ill person who wishes to die can do so. One is the question of civil rights. Over the past 50 years, laws against everything from abortion to gay equality have fallen. The last great taboo, to Ogden, is the right to die under the circumstances of one’s own choosing. “The right to be—or not to be—is the ultimate civil liberty,” he says while sitting in his neat New Westminster home with the tools of assisted suicide—for demonstration purposes only—in the basement below. “Suicide used to be a crime,” he says. “But we no longer bury suicides at the crossroads. Suicide’s legal. The quarrel now is getting assistance to die. I can’t think of a single place in criminal law where helping someone do something is unlawful although it’s otherwise lawful to do it yourself.”

      Along with these steps toward the expansion of civil rights within Canada, there has been, Ogden points out, a dramatic shift in public opinion toward approving right-to-die legislation. Polls show almost twice as many Canadians favour legalizing assisted suicide and/or euthanasia—permitted now in three U.S. states and a half-dozen countries—today as when Rodriguez raised the issue 18 years ago. It’s not simply that Canada’s 9.8 million boomers are getting their first whiff of Eau d’Eternity. It’s that boomers have lived with choices. They’ve grown used to being in control. And, Ogden says, they’re unlikely to accept quietly the dictates of medical professionals who remind them that assisted suicide is illegal.

      Furthermore, Ogden argues, the boomers realize—as do those in generations X and Y—the cost of providing a whole generation of aging Canadians with end-of-life health care will be staggering: tens of billions of dollars annually. In fact, 50 percent of an average person’s lifetime health-care costs in Canada is incurred in the last year of life. This is because physicians, by and large, are fixated on prolonging life—even among the most elderly and the dying—through myriad Hail Mary medical procedures that stand very little chance of providing long-term benefit.

      It’s ironic, Ogden believes, that despite most Canadian doctors’ public reluctance to support right-to-die legislation, the courts have taken a different approach to the illegality of assisted suicide. In almost every case in B.C. where there have been allegations of assisted suicide among the terminally ill, Crown prosecutors have recommended—following a lenient in-house protocol, says Ogden—that no charges be laid. And in the 49 assisted-suicide legal cases in Canada between 1934 and 2010 where Ogden has found charges were laid, 13 people have been jailed, including Dr. Ramesh Sharma of Vernon, B.C., handed a two-year term for prescribing lethal medication to an elderly patient in 2007.

      In Stephen Gardiner’s thinking—he requested a pseudonym so he could tell his story—the prohibition against assisting a suicide and the possibility of court action have created for him, as for many others, a terrible lottery. He cannot seek help in ending his life—he has terminal cancer—without jeopardizing his friends. So, at age 62, a year after he got the bad news, he sits in his La-Z-Boy recliner in an Okanagan town, listing the friends who’ll be invited and recording the music that will be played, and talking about the self-activated device that will gently kill him, at the death ceremony he will soon attend—seated in the very chair he now occupies.

      He’d seen firsthand the problems of dying in his father’s failed efforts to kill himself after a stroke. He knew he’d find a route to elude the struggle his father had faced. “There are a lot of messy ways to kill yourself,” he tells me of those months last fall searching the Internet. “But if you want to kill yourself in a way that’s”¦ well, graceful, it usually requires help.” He knew he didn’t want to die, oblivious to friends, in a hospital-administered morphine coma. Unmarried, self-sufficient, a computer technician before his illness and a man with practical, problem-solving inclinations, he’d searched the Web for spiritual advice, the legal ramifications of assisted suicide, and the various options available to him if, as he came to realize, he would be forced by law to kill himself unaided.

      There was Nembutal, recommended by the Australian founder of Exit International, one of 44 organizations worldwide fighting for right-to-die legislation. The problem was that this veterinary drug—used for putting down animals—is only publicly available in Mexico, and even there with great difficulty. And whoever got it for him could be charged with abetting murder. There was, as well, the fatal inhalation of an inert gas like helium or argon. This method has been explored by the Swiss-based right-to-die group Dignitas. Helium is, of course, readily available at party-balloon stores, and argon can be obtained at welding shops. But the apparatus needed—the same equipment Ogden has in his New Westminster basement—means you die with a plastic bag on your head and a pressurized tank at your side and tubes and valves in between. And that didn’t fit Gardiner’s idea of a “graceful” death.

      Gardiner gets up from his chair and returns from his bedroom with a black neoprene air-purifying facemask, the kind used by workers when sandblasting. It’s the first time, he says, that he’s shown his suicide invention. Because the frightening feeling of suffocation comes from a facemasked person rebreathing carbon dioxide, he explains, the attachment of a carbon-dioxide absorber to the exhalation valve and a closed-circuit air loop means that—with the mask on—he’ll fall unconscious from oxygen deprivation within two to three minutes and be dead 10 minutes later.

      He says he’s thinking of getting a patent, marketing it as a “debreather”, and making a million dollars. At this, he laughs ruefully. “As long as my quality of life is good,” he says, “I want to stay alive. It’s up to the individual to decide when they go. Not the police. Not the medical profession. Not the law. A huge public debate is needed. But when I finally want to die, I’ll die.” And he holds the mask to his face and inhales.

      There are, of course, many people who argue that right-to-die advocates are proposing something abhorrent. There are pro-life Christians whose opposition to euthanasia and assisted suicide is based on the same principle as their opposition to abortion: life is as sacred at the end as it is at the beginning. No person should play God. John Hof, a spokesperson for the Campaign Life Coalition, says assisted suicide is “inherently against life” and would lead to “social degradation”. Members of Canada’s Euthanasia Prevention Coalition, which has hosted Margaret Somerville, director of McGill University’s Centre of Medicine, Ethics, and Law in Montreal, take comfort in her well-documented opposition to assisted suicide and euthanasia. Somerville fears that the movement that began in Holland 30 years ago will, without resistance, lead to the unacceptable—and frighteningly secular—idea that the individual has the right to choose death.

      Organizations for the disabled point to Robert Latimer’s 1993 killing of his severely handicapped, 13-year-old daughter as proof that no latitude should be given for any form of mercy killing. And the Canadian medical profession (with the recent exception of many Quebec doctors) opposes altering prohibitions against euthanasia and assisted suicide. These doctors claim—as do many opponents—that, once it’s approved, there’s a “slippery slope” leading to an unstoppable expansion of euthanasia, resulting in people being legally dispatched against their wishes. This is the kind of supposition that has led to fanciful American talk of health-care “death panels”.

      There is no factual evidence to support the “slippery slope” contention. But its lineage is as old as the bogeyman. Ninety years ago, Christian crusaders said alcohol was the devil’s drink and its use led inevitably to “social degradation”. Thus came Prohibition. Similar arguments have been voiced almost every decade since then by those opposed to such things as the expansion of civil rights and social freedoms. The argument was used in Canada against granting voting rights to Asian citizens in the 1940s, against explicit literary works in the ’50s, against the distribution of birth-control information in the ’60s, against women in the ’70s and gays in the ’80s, and against harm-reduction drug policies in the 1990s. Calamity looms, doomsayers proclaim, if you open the door to alternatives. Decriminalize marijuana and, ipso facto, you’re on the way to a nation of heroin addicts.

      It ain’t so. Today, there are three American states—Oregon, Washington, and, just recently, Montana—where assisted suicide is sanctioned. (Vermont is likely to join this group next year.) There are three countries—Holland, Switzerland, and Belgium—where it’s legal and strictly regulated. There are also a half-dozen other countries—Luxembourg, Estonia, Uruguay, and three in Scandinavia—where no prohibitions exist against providing aid when a terminally ill person requests help to die; death happens discreetly, beyond legal interference.

      The Swiss have recently had to look, in fact, at restricting foreign access to their Dignitas assisted-suicide program in the face of its growing international popularity. They don’t want their country to become a “suicide tourism” destination. Since 1998, almost 1,000 terminally ill people, including at least 10 Canadians, have left homelands where assisted suicide is illegal to be provided with a means to end their lives. After strict medical protocols, the person is eventually handed a lethal barbiturate that is consumed amid family and goodbyes. No hospital-supplied morphine coma at the end. And there is no evidence of abuse within the Swiss system. The same applies to Belgium’s euthanasia program. And in the 12 years since Oregon initiated its physician-assisted-suicide program, 460 people have ingested the prescribed lethal medications. The program is heavily monitored, and there’s not an iota of evidence of abuse. (Washington’s 2008-launched program is too new to assess, and Montana’s Supreme Court only overturned that state’s law against assisted suicide in May 2010.)

      In Holland, the euthanasia law mandates that people who are in unbearable terminal pain, and who can convince two doctors of the legitimacy of their wishes, can receive stringently regulated medical help to die. Last year, 2,636 Dutch people died through euthanasia, a 13-percent jump over the previous year. This increase, say opponents, is proof of the slippery slope. Not so, say advocates. Instead, it shows the growing willingness of the pragmatic Dutch, facing death, to end their lives—and without the prolonged medical interventions, family anguish, and suffering that often mark terminal illnesses elsewhere. In fact, the Dutch right-to-die advocacy group Horizon submitted a 117,000-name petition to Holland’s parliament seven months ago requesting that euthanasia options be extended to those over 70 who feel their lives are complete.

      So, while the B.C. Catholic newspaper rails against “the stench of death” drifting up the I-5 highway from the two pro-euthanasia states to the province’s south, the fact is that it’s neither their current right-to-die legislation nor allegations of abuse that really worry those claiming that a slippery slope is underfoot. From the moralists’ perspective, the situation is far worse. A large segment of Canadian society (67 percent) has come to believe that having a choice about the circumstances of one’s final hours is the same as having a choice about abortion or the sex of one’s marital partner or whether having a martini or two marks the highway to hell.

      Biomedical ethicist Eike Kluge, a professor at the University of Victoria, has confronted the big questions around dying and assisted suicide for decades. He has investigated the cultural and religious history of euthanasia worldwide and has acted as a consultant to dozens of terminally ill people, including Rodriguez. It’s Kluge’s contention that the central ethical issue for the coming decades, as millions of boomers age, is how society deals with assisted suicide. And he’s clear, he tells me, that it’s the medical profession, first and foremost, that is failing those who, at life’s end, desire death. By lobbying against the establishment of legal protocols—like those in place in Oregon and Holland—most Canadian doctors, Kluge believes, are on the wrong side of history and ethics. Without legal assisted-suicide and euthanasia guidelines (which they oppose), most doctors fall back on medicalized efforts to extend life—at great emotional cost to people seeking expedited death.

      “It’s not life that’s being prolonged,” Kluge says. “It’s dying.” Where once death was considered normal and pneumonia was called “the old man’s friend”, Kluge says that doctors today are held hostage by the Canadian Medical Protective Association (CMPA) and its lawyers who argue physicians must never be seen to be hastening dying. It could prompt lawsuits. So, instead, death is delayed. Hospitals’ costly intensive-care units are full, and palliative-care units are overwhelmed.

      But the almost unmentionable truth, Kluge says, is that B.C. physicians assist in the suicide of terminally ill people all the time. But they can’t admit that. Not if they want to remain under the legal protection of the CMPA. Kluge explains the medical charade: “You give a large enough dose of a narcotic—like morphine—ostensibly for pain relief. But the patient’s breathing and heart stops. It’s called ”˜the double effect’. Of course, the doctor knows the dosage is going to kill the patient! But he can’t say that. He can say: ”˜I didn’t intend to kill. The morphine was for pain.’ So it’s not officially called ”˜euthanasia’. It’s called ”˜terminal palliation’. It’s semantics. It’s finessing the system. The CMPA is happy.” Kluge laughs aloud at the duplicity.

      “The fundamental ethical question is: ”˜Are you or are you not prepared to go to the line and face the consequences of your actions?’ ” Kluge says of his belief in the morality of euthanasia. He’s waiting, he says, for some brave B.C. doctors—like their counterparts in Quebec—to take a stand against the medical profession’s self-interested opposition to legal assisted suicide. “You’re pretending,” he says to doctors, “if you say you’re for choice but do nothing. Your values are hot air unless you do something. It’s when the chips are down and the stakes big—that’s when you find out if you’re ethical.” Kluge says that one of his uncles was hung in Nazi Germany for being part of the famous 1944 attempt to assassinate Hitler.

      At a time when most doctors are silenced by their fears and professional association and when politicians see little benefit in leading an ethical crusade, people who support legalizing euthanasia will have to look to the Supreme Court of Canada to overturn Section 241(b) of the Criminal Code. It’s this law against assisted suicide that the court refused to set aside for Rodriguez 17 years ago, and it’s this law that well-known Vancouver constitutional and civil-rights lawyer Joe Arvay, while watching his best friend die of ALS, told himself needed a new legal challenge. He knows it won’t be easy. The Supreme Court, he explains, isn’t inclined to revisit issues that it has ruled on fairly recently. Precedent usually trumps a challenge. But a lot has changed. Only one of the nine current justices was involved in the close 5-4 decision against Rodriguez in 1993. Three European countries and Oregon have amassed a mountain of evidence demonstrating the value and safety of euthanasia programs. Quebec doctors are lobbying for new legislation. And public opinion has swung heavily in favour of permitting assisted suicide.

      “I get calls from individuals and organizations about relitigating the Rodriguez issue,” Arvay says. “But I’d argue it differently than in ’93. There’s a much richer evidentiary basis today. I could see a coalition of petitioners: right-to-die organizations, terminally ill individuals, doctors in favour of physician-assisted suicide like in Oregon, civil-liberty advocates, people familiar with palliative care. It wouldn’t be based on a single individual like Sue Rodriguez but on a range of views.”

      But by then it will likely be too late for people like Ken James, Stephen Gardiner, Wolf Obgielo, and hundreds of others in Canada who will be forced, in the months and years ahead, to act surreptitiously to end their lives. Vancouver’s James carries on today, hoping the strokes that rendered both his grandfathers almost comatose will not also strike him, leaving him incapable of making a helium-assisted escape. The Okanagan Valley’s Gardiner is worried today by his increasing shortness of breath and the results of a new CT scan. He has assembled all the segments of his “debreather” suicide mask and tested it in mid-September in expectation it may soon have to be used. Obgielo of Pritchard was recently informed by doctors that his lung cancer is worsening and he has about two months. He can’t ride his horse, Kitty, anymore, nor even walk outside, because he’s attached to a portable oxygen tank.

      A cowboy to the end, Obgielo says he’s determined to get back on his horse one day and ride up into the bunch grass and ponderosa on Martin Mountain, high above the South Thompson River, and forget for a while the death he has arranged when he finally decides to cross the great divide.

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      Nov 18, 2010 at 9:41am

      If someone wants to die they will find a way. It's a shame we can't ensure that it's the most peaceful and respectful way possible with our current laws.

      I'd hope it will one day be legal with the proper safeguards around such laws. Allowing those who want an end to their suffering to have a dignified exit from this life with those they love and hold dear in their presence and allow all those touched by such an act time to say their goodbyes.

      how bout a right to air?

      Nov 18, 2010 at 11:54am

      Here is a euthanasia TV ad (0:45) that was recently banned by the Television Bureau of Canada.

      There is nothing wrong with the ad according to the Canadian Criminal Code (s. 241). There is obviously someone at the is 'bureau' who made an executive decision made on some other precept, most likely one of religious nature.

      <object width="300" height="193"><param name="movie" value=";hl=en_US"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src=";hl=en_US" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="300" height="193"></embed></object>

      Carl Gullet

      Nov 18, 2010 at 12:50pm

      The level of sophistry involved on this topic from the anti-euthanasia side is absurd. The main thing holding Self Deliverance back is most certainly religion. The superstitious notions of hellfire, brimstone and whatnot scare people shitless. And one of the big reasons that the terror instilled in something like suicide was because the church needed fierce crusading proselytizing marauders for their empire of persuasion and control ever since the days of Constantine.

      People like the Cathars or even Martin of Tours who rejected violence in any form and would rather die themselves rather than kill another posed a huge threat to the church. Needless to say suicide and non-violence became anathema and it has stuck ever since.

      This can be witnessed by the fact that essentially everyone who is arguing against another person's right to choose euthanasia, will be the same crowd screaming for capital punishment and the need for more troops in the middle east...or any other heathen's lands.

      I understand that some doctors might be afraid of lawsuits that could possibly arise. But, I know for a fact that many doctors have been brought up in religious families and that therein lies their inhibitions alone. As witnessed during the passing of my own father in a Victoria Hospice last winter.

      And i'll reiterate now what I said to the palliative elves last winter. Whatever the reason for your fears, understand that death is not to be feared. Needless suffering is.

      Regardless, I had the fortune of watching dad rot for a week and then finally die from dehydration.


      Nov 18, 2010 at 9:33pm

      Thank you to the Georgia Straight, thank you so very much for going public with this topic. Just who else will - certainly no politician. I much favour euthanasia, and not just for the terminally ill, but like in the Dutch proposal, for whoever over 70 has "lived" life and wants to leave. One can write to public "leaders" in this country; never an acknowledgment, never a reply. It appears we are subjected to the inhumanity of being kept alive beyond our wish to live to feed the exponentially expanding health care industry and appease religions.


      Nov 18, 2010 at 11:01pm

      What safe guards can possibly be in place to ensure that an unethical relative doesn't pull the plug before the person is ready to die?

      I got a call from family in Ontario stating that my mother was dying and for me to come ASAP. I had just spoken to her 1 week prior she said she was fine and sounded fine. I was told she was taken to hospital to get fluid drained, as she's been doing for the past few years, and the hospital wanted to keep her over-night. The hospital I was told put her in a codeine induced coma! I was not told this until after she died! My brother had authority over her should she be unable to make decisions for herself. He said he didn't ok the induced coma. When I got to hospital, she was not hooked up to anything, no fluids, food, nothing, they were starving and dehydrating her! She was dead within 3 days, and yes the estate was left in my brothers name, he owed her allot of money from his business! I didn't challenge the estate, because I didn't think I could handle the court battle in regards to what took place.
      Just make sure you have at least three trusted people make your death decision when the time is right, and have your wishes on video. Mother rest in peace.


      Nov 19, 2010 at 8:47am

      One of the BIG problems is creepos tryying to convince old Aunt Mary that her life is OVER ANYWAY. You know the Aunt Mary who has all kinds of stocks/bonds/property.

      Mike Grant

      Nov 19, 2010 at 9:50am

      If a person can state clearly to an independent council their wish and the reasons for wishing to die and no alternative is available beyond painful death or soul searing loneliness in a body become prison who are we to deny them?

      Sorry to hear..

      Nov 19, 2010 at 9:57am

      ...that your brother is a dick. The worst part is that your mother had to basically starve and dehydrate to death. This method is barbaric. That's one of the points of this article. We can change these methods and let the patient decide for themselves in advance if they would like to end their lives in a more peaceful method rather than leave it until it is too late and let shady family members decide for them. In that case I am sure that you would have definitely been informed much farther in advance and you wouldn't have had to go through the psychological torment that your brother ended up putting you through. This is something that Canadians need to start discussing, opposed to procrastinating, as we always do when the subject of death come up, and implement a more humane civilized way of crossing the void.

      Rod Hebner

      Nov 19, 2010 at 9:59am

      I honestly believe the laws in Holland are based on common sense when it comes to the terminally ill. Euthenasia is a difficult issue for the living but not for the terminally ill who are left with no way out of a situation they alone are left to deal with. For Euthenasia to be granted in Holland, it must first come as a request from a terminally ill patient. The patient's doctor must submit an application and all medical records to a medical board of governors who consider the request based on the medical records provided. A decision is reached by the board and if the application is approved, the doctor must follow the stict guidelines given by the board. The doctor must inform the patient of those guidelines and the patient must ask three separate times with a given time period between each time. The doctor is not to influence the patient's decision in any way, at any time. Once the final request is given, the prescribed time period is given and the doctor informs the patient that his request for euthenasian has been approved, a date for it is set and a final question is put to the patient before witnesses who are required to sign as witnesses to the final request. A prescribed lethal cocktail of drugs is given to the patient who drifts off to sleep and death without pain or discomfort. It's ironic that we, as humans, have more compassion for our beloved pets than we do for our terminally ill family members. I truly hope in the event that I become terminally ill that the law changes so it allows me a choice in my final days on this earth