Monday, February 28, 2011


Since the 1970s, when organ transplantation was still in its infancy, a spirit of altruism was promoted in organ procurement programs, and at least initially successfully implemented. However, voluntary organ donation fell far short of the need for human organs. Only 28% of the potential UK donor base has joined the Organ Donor Register. The most recent statistics available at the time of writing; ((February 28, 2011) in the last 11 months, 
• 2,383 people have received transplants 
• 7,735 people are still waiting for transplants.
Of these, approximately 10%  will die while waiting as there are not enough organs available. 

The debate about acceptable approaches to human organ acquisition focus on the four main methods of acquiring human body parts: 
• donation (expressed and presumed) 
• abandonment 
• sale 
• societal appropriation 

Today, four decades since the debate ensued, all four methods are generally deemed culturally acceptable although two ethical concerns remain; is selling one's organ a justifiable means to fight poverty and the right to decide what to do with one's corpse. 

Another more recent ethical concern is assisting in the expedient departure of those existing at less than acceptable living conditions. Do Christian ethical standards clash with those espoused by humanists and secular society? 

Transplant surgery is saving lives, and concurrently has created a ‘lively’ trade in human body parts spurred in large part due our innate desire for longevity. The supply-and-demand is feeding the frenzied booming international black market of body parts and brings together the rich recipients and the destitute, and sometimes helpless donors. Surprisingly, the biggest participant in the trade are unscrupulous Western pharmaceutical companies seeking to profit from marketing their latest products that have derived from the procurement of human body parts. 

Two differing views are commonly heard in the debate on euthanasia: 
1. That it is wrong to take someone else's life or to urge someone else (eg a doctor) to do so to alleviate suffering 
2. That humans should have the freedom to ask others to give them help to end their lives to alleviate their suffering 

Euthanasia (Grk = good death) implies that there is a benefit to the person involved. However, there is a great difference between reality and what they are supposed to be. Therefore, prior to deciding on which side to come down about euthanasia we need to be clear about what constitutes euthanasia and how it is to be executed. 

Active or voluntary euthanasia 
Generally this describes a decision by a patient, with the support of others, to end his/her life, because a terminal or degenerative illness has led to a painful existence with a very poor quality of life. 

The following views on euthanasia appear to be shared by most Christians. Any positive action to speed up the demise of a person that will lead to (painless-good) death should not be encouraged or legalized. Conversely, withdrawal of treatment - particularly the life support system of intensive care units - should be legalized, when the patient desires it. This system is already in wide use.

Christians base their beliefs mainly on the Bible, where, they believe, they can find God's teachings for all people of all cultures and at all times.

Can we dismiss the Old Testament words where
 God’s key instructions were given to the Hebrew people:
1.     ‘Let us make man in our image, in our likeness.' - Genesis 1:26

2.     You shall not kill (one of the Ten Commandments) - Exodus 20:13

3.     The life of every creature and breath of all people are in God's hand - Job 12:10 
We find the same importance placed on human life in the New Testament in these words:

1.     Look at the birds of the air.....are you not more valuable than they? - Matthew 6:26

2.     Even the very hairs of your head are numbered (by God, that is). - Matthew 10:30 

Can the Nazarene healer’s words, ‘no greater love than that a man lay down his life for his friends’ be translated as encouragement to us in offering our lives to save the physical life others? He is the founder of our faith and example in holy living, and cared for people who had a poor quality of life and for those who were regarded as vulnerable, living on the edge in his society. Each person mattered to him. Life is God-given and therefore has intrinsic sanctity, significance and worth. In a near to death scenario with two of God’s children struggle to live, but with only one having even a remote chance of life, should the other die and his body parts transplanted, ought we to approve of euthanasia? Or ought the Christian watch both die? Would it make a difference if the person being ‘saved’ was a loved one? When asked if they would support speeding up death through withdrawal of treatment in order to harvest organs for restoring one’s own or a family member’s quality of living most Christian would express a willingness based on the ‘greater good’ argument. 

Christians are called to a relationship with all God’s children characterized by such words as respect, responsibility and duty. Human beings, as moral agents were assigned the highest value above all other creatures in that we have the capacity to make free and responsible choices. Our reason for being is found in our relationship with God, in the exercise of freedom and in our relationships with one another and the wider community. 

We know that one day the 'sting of death' (1 Corinthians 15:55) will be removed forever. Until then we have a God appointed mandate to care for the weak and needy, to visit those who are sick and in prison, to clothe and warm the naked and to provide dignity for the dying. 

We need to ask ourselves if our actions are helpful or harmful; to ask, is this what a Christian should be doing. Just because sinful things are being practiced more and more, it doesn’t make them less sinful, and we need to stop and think about how we are being affected by this negative influence. We need to remain unaffected recognizing that sin is sin no matter how popular our society says it is, and even though it may be practiced legally. No amount of legislation will ever make wrong into right. 

While serving in Moscow, Russia in the 1990s I asked a newly arrived senior Dutch Salvation Army officer during a coffee break at the CIS HQ about his early impression of Moscow. The topic was the new ‘openess’ evident in Moscow society as reflected by the open cannabis smoking, prostitution, and practiced gay lifestyles. He replied, “for someone who has spent their life in the Netherlands nothing is ever surprising or shocking”. He was then asked, “do you think Holland is too liberal and have things been allowed to go too extreme?” His response? “We’re not liberal, we like to think that we are instead among the most tolerant of all Western nations…” 
Tolerance is a word that has become increasingly fashionable in the last few decades. Tolerance is most often the result of another factor, compromise. The word tolerance is never used in relation to the things that we deem good and pleasing. Rather, the aspects of life that we tolerate are things that annoy us or that we do not like. And, accepting them results from lessening our resolve, compromising our values, our standards. . If we choose to tolerate something it’s generally in the form of some tradeoff; we do so because we perceive that there is some greater good that we wish to attain/maintain or some greater evil that we wish to avoid. Often, for tolerance to succeed it requires stages of acceptance and in those stages controversial issues are passed through the process of compromises. 

Yet, there is more to tolerance when it comes to looking at it through the lens of one’s faith. There is tolerance that endangers one’s faith, and there is tolerance that lends to and enhances it. Tolerance and compromise are attributes that are not always synonymous with virtuous characteristics or actions. Too often they signal a compromise achieved at by giving up too quickly; not having a solid enough argument pro or con. Often, it’s nothing more than a cloak for cowardice. We lack the conviction that our faith and causes can be communicated effectively and convincingly. 

A simple definition of tolerance is that it is, "a fair, objective, and permissive attitude toward opinions and practices that differ from one's own.". Being tolerant, according to this definition, is to be non-judgemental. The Bible tells us in Matthew 7:1, "Do not judge or you too will be judged" (NIV). Christians need to demonstrate love and avoid putting conditions on that love, yet recognizing that a neutral perception of the limits of tolerance is nigh impossible.

 For the time will come when people will not put up with sound doctrine.
Instead, to suit their own desires, they will gather around them
 a great number of teachers to say what their itching ears want to hear.
They will turn their ears away from the truth…    2 Timothy 4:3-4 (NIV) 

Does Christian tolerance require us to be active? In view of the many modern media concepts and processes ought we to exercise a more active tolerance? Tolerance has a fine line, one that blurs both the humanists’ and Christians’ sense of fairness when seeking the other’s viewpoints. None should argue or negotiate from false or an undefined position with the intent to proffer false compromises; we should be tolerant of one another enough to listen and love one another despite our difference. 

John Stuart Millís On Liberty (1859) is unanimously considered as the milestone of modern liberal tolerance. Tolerance is a fair, objective, and permissive attitude toward those whose beliefs or personal characteristics (race, religion, nationality, etc.), differ from one's own. Further, tolerant means not harming the other. This harm can be emotional, mental, physical or economic, and can be caused by condemning the other, insulting him, making him feel uncomfortable, avoiding his presence, discriminating against him and so forth. 

Surely this is what we are all supporting and working for in our journey as a risen community.

In view of our responsibility as witnesses of the Gospel, recognizing that the present day western European culture dismisses the Bible’s validity in defining human values we must know our own, the bible’s, and the receptors culture. 

We must explore and establish proper channels of communication by which we can share our Biblically mandated principles. 

We must begin at the felt need of the receptors and we must initiate communication immediately because the receptors base values continue to shift and erode. 

Christians need to enter a covenant solidarity to battle the cultural collective solidarity of a people. Insensitivity to a cultural evil is often the consequence of denying its existence in one’s own society or the distance from its current threat. Covenant solidarity ultimately reflects a people’s commitment to the Gospel and the ability to have that understanding impact on other fellowships. It means communicating; points of effective contact to points of effective attack. 

In the New Testament the verb epistrepho translates as the verb shub. It means to turn, bring back or return. It is used in relation to the turning of unbelievers and erring believers into a right relationship with God. Another term used in the New Testament is metanoeo which means to change one's mind or to regret. Both these experiences can lead to repentance. However, in this instance the emphasis is on the conversion to a new set of thinking, accepting a new form of values. 

Is there a lesson to be taught here? Is there still sufficient time to make a difference?

Dr. Sven Ljungholm
Govan Citadel Corps

Friday, February 25, 2011


Conclusion B

As virtuous men pass mildly away,  

And whisper to their souls to go,  

Whilst some of their sad friends do say, 

"Now his breath goes," and some say, "No."
John Donne

There exists great ambiguity of the transition between life and death, and for practical and ethical reasons we, as a society, have had to define life and death, and we do it in various ways. The definition turns on various philosophical and theological issues focusing primarily about using people for the benefit of others, prior to their death. Many argue that the definition be adapted to facilitate doctors’ need to get human organs before they become unusable; dead.

Most organ donors on reading the phrase ‘after my death’ assume all life is absent. What it really means is that the person is comatose and apneic but in fact all other organs are working fine and that the removal of organs can begin with my heart spontaneously beating and blood circulating.

The  rationale for equating “brain death” with death remains controversial. Thus, information highly relevant for the potential donor’s moral decision making is systematically withheld. According to Dr Robert D. Truog, Professor of Child Anaesthesiology at Harvard University and director of ICU at Children’s Hospital, Harvard Medical School, Boston “ ‘brain death’ remains incoherent in theory and confused in practice.” He suggests that the only purpose served by the concept is to facilitate the procurement of transplantation organs

Assistant Professor of Neurology at the Ohio State University, Dr Robert M. Taylor, defines death as “the event that separates the process of dying from the process of disintegration” and emphasizes that “the proper criterion of death in human beings is ‘permanent cessation of the circulation of blood’. Dr Emmanuel Panagopoulos, assistant director of the 2nd Surgery Clinic at “Agios Savvas” Hospital in Athens  and Professor of Surgery at the University of Athens, explicitly states  that  “ ‘brain death’ is a process of death but not death”. Biological death is not a continuous process but an instantaneous event.

A person is dead if he shows:

·      irreversible cessation of circulation and breathing
·      irreversible loss of all the functions of the entire brain, including the brainstem.

Nonetheless, the  ‘brain death’ criteria is not universally accepted. The difficulties in diagnosing ‘brain death’ were shown in a 1989 study concerning doctors and nurses involved in the harvesting of organs for transplantation. The study proved that “only 42% of the doctors and 25% of the nurses correctly identified the legal and medical criteria for the definition of death, which revealed the confusion around the issue.” Furthermore,  a more recent study in 1999 presented to the Society of Critical Care Medicine demonstrated that “only 39% of pediatric attending physicians correctly defined brain death…

Defining Death for the Purpose of Effecting Organ Transplantation:
Religious and Humanist Ethical Considerations

The concept of ‘brain death’ has come to be considered as a state of relative neurological inactivity and as an approximate diagnosis. Professor Shewmon writes that the diagnosis of death is not something that we can discover by any scientific method, but rather something we must choose, based upon our religious and philosophical values”. For the Christian human death is not a process but an instantaneous event during which the ‘logical soul’ leaves the human body.
The conclusion which follows the presentations of the above data is that the concept of ‘brain death’ is a construct which was basically invented for social reasons. Nonetheless could it not serve the Christian community well: ‘brain death’ would signal that one is no longer able to continue in a state of communication with God and all worship, adoration and honor will have ceased.

The Harvard criteria listed two reasons for trying to sort out brain function criteria for certification of death: (in determining an appropriate time for organ removal)

·      The burden of futile treatment.
·      The facilitation of organ donation.

According to Jim Hughes, a bio-ethicist at Trinity College in the United States, the idea of brain death has distinctly cultural, utilitarian origins.

Under the law and our general moral revulsion to the idea, killing somebody to take their organs out wasn’t acceptable until a person was declared dead. As a result a kind of a social compromise was constructed to serve the needs of the living.

There has been a small but growing collection of voices questioning whether the brain dead are really dead at all. One of those dissenters is Alan Shewmon, Professor of Neurology and Pediatrics at UCLA Medical School in the United States;
”Well, the term itself is kind of ambiguous from the start, because in one sense it could simply mean death of the brain as an organ, just like you can have necrosis or death of a finger, if you cut off the blood supply to it

It is clear that hearts can beat independently without brain function, and many other organs continue on their own, even without life in the remainder of the body. But what we’re talking about here is not just the functioning of individual organs or tissues, but a more unified holistic functioning. Many patients in the state of brain death… these patients are deeply comatose, permanently comatose but they’re still living human beings.

Those practices which hasten death or bring about the direct termination of life, in order to harvest organs for transplantation trivialize the human person and lead society down a slippery slope. Most of us would happily donate one of our organs after death, for the sake of another human being. But are we prepared to have our organs removed while the heart is beating and blood circulating; to be removed at the time of the so-called ‘brain death’? How was the term ‘brain death’ coined? Why all this controversy in the Greek and international medical community? Why do some doctors deny that ‘brain death’ is equated with the definitive biological death?

Since the concept of ‘brain death’ is not unanimously accepted by the national or international medical community many suggest that the equation of ‘brain death’ with death should be re-examined. And, that such reexamination be removed from any and all interests whatsoever.

The issue of organ harvesting for transplantation is important and calls for profound philosophical and theological reflection. Any intervention to remove a donor's organs before his/her definite death is unacceptable because it means taking the donor's life, even when this is done for the sake of curing another patient. Or does the end justify the means. Is there no longer any mystery of death?

By all means our life is the field of exercising our free will. In order for change to be meaningful for the Christian, indeed society, it must be definable and sustainable and making a positive difference. Dare we say it must be Spirit-led, yet in some circumstances radical, pushing us beyond our comfort zone, the status quo. Can we see the Lord’s leading in having us reanalyze our life moving along horizontal axis of man-to-man relations and agree with those whose motives are plainly humanist driven?

Can we Christians see as the goal, one of obtaining organs for transplantation only after a declared ‘brain death’ and where the heart may yet be living and the donors’ giving of an organ is as an expression of Christian love or simple altruism. Or is the proper criterion of death in human beings the permanent cessation of the circulation of blood, even if  adopting this criteria life saving organs can not be harvested causing death to waiting recipients?

"Life is a gift of God, but not one that belongs to the donor only. It also belongs to its receiver. Life is ours as well. It is the paramount field of exercising our free will. Life is not donated to us in order to live in selfishness and possessiveness, but is rather offered to us so that it can be so much our life that we can even offer it. This is the reason why we love and take care of our life more than anything else. This is done both with great caution, because it is God'’s gift, and in our free will, because it is our life. The best way to return it to God is by offering it to our neighbour." (Saint Macarius the Egyptian).

Dr. Sven Ljungholm
PhD Ethics; Human Values

Wednesday, February 23, 2011


Everything in the universe is subject to change
and everything is on schedule! (Canadian bumper sticker)



Active Euthanasia: to be involved with, or to participate in bringing about the death of another person.
Passive Euthanasia: To deliberately withhold or withdraw medication, which would help a patient to live longer (thus resulting in the patient's death taking place sooner).

For consideration; both of the above actions are performed with the same intention - to end the life of a human being. Views on whether our life-spans should be in the hands of other human beings differ; we should be entitled to live all the life we've been assigned.

Voluntary Euthanasia:  Euthanasia at the request of someone.

Non-voluntary Euthanasia: Ending the life of someone no longer capable of communicating; performed believing this person would not want to continue living

For consideration; is administering medication to someone, intended to relieve their suffering but will have the side-effect of causing them to die, a form of active or passive euthanasia?

Other choices for those seeking early termination of their life are:
Oregon (USA) (since l997, physician-assisted suicide only).
Switzerland (1941, physician and non-physician assisted suicide only).
Belgium (2002, permits 'euthanasia' but does not define the method.
In many countries there is no specific law dealing with the matter of assisted dying, and often cases are tried based on other established laws.

Some common arguments in favor of legalizing euthanasia:
·      Do not want to be an emotional and financial burden to their relatives, or society.
·      Not all pain can be controlled by drugs.
Some arguments against legalising euthanasia
·      We do not know if someone will never recover from a 'terminal' illness.
·      People should be looked after, cared for, and helped through their last days, rather than be 'got rid of'.
·      Doctors are meant to do all in their power to preserve life, not end it!
·      Legalising euthanasia is giving people a license to murder.

There are countless people who have end-stage organ disease and could be saved by transplantation. Do we as a society have a responsibility to explore every possible ethical means for increasing the rate of recovery of acceptable organs?  Should we accept the view that people can sometimes be required to act for the greater good and consequently accept a ‘routine recovery’? Ought we to endorse the intended legislation being introduced on many fronts that while alive, people’s organs should be considered their personal property, but after death their “organs [should be considered] a societal resource.” Or does adopting organ procurement using this practice leads to an unnecessary loss of life?

The shortage of organs for transplantation has worsened forcing clinicians to review alternative approaches to organ procurement. Organ procurement has relied on the altruism and goodwill of donors, a 40-year-old policy. However, in that not a sufficient number of people want to donate, Henri Kreis of the Faculty of Medicine Paris-Descartes, Department of Transplantation shared; “in order to increase the availability of suitable organs and allow cadaver organ trans-plantation to continue, it is time to consider new strategies other than donation.” 

In Europe, the euthanasia lobby is becoming bolder and more extreme. They have let go of their traditional anthems of voluntary euthanasia for the competent and suffering to that of language that would lead to euthanasia as a human right. This serves as a useful reminder that the issue of euthanasia is not about terminal illness, compassion for the dying or ending suffering. Recently, there have been fewer restrictions on euthanasia and assisted suicide. Pressures also are appearing to establish a “right” to be killed.

Is hastening the death of a person to save the life of others not the greatest sign of love? No greater love…

The shortage of organs for transplantation has worsened forcing clinicians to review alternative approaches to organ procurement. Organ procurement has relied on the altruism and goodwill of donors, a 40-year-old policy. However, in that not a sufficient number of people want to donate, Henri Kreis of the Faculty of Medicine Paris-Descartes, Department of Transplantation shared; “in order to increase the availability of suitable organs and allow cadaver organ trans-plantation to continue, it is time to consider new strategies other than donation.” 

The “passive" form of euthanasia is allowed, with proponents stressing that this differs from the practice now permitted in some other European countries.  Unlike the situation in the Netherlands and Belgium, where doctors are not prosecuted for actively ending the life of a patient, the French legislation deals mainly with acts of omission. (see The NL and Belgium heading)

Described as a "patient's rights" bill, it will allow doctors, acting at the request of patients and their families, to end medical treatment that is seen to be maintaining life artificially. Doctors will furthermore not be penalized for administering - at the request of patients suffering from extreme pain - higher-than-normal doses of medication, even if the drugs have a secondary and subsequent effect of hastening death. A third aspect of the law will allow a gravely or a terminally-ill patient to refuse life-sustaining medical treatment. "This legislation is one that allows dying but does not allow killing. That is how it is different from euthanasia.  

Euthanasia in the UK
Although it is illegal to actively end the life of another person, in reality doctors in the UK regularly practice a form of 'passive euthanasia' when they turn off life-support machines in cases where there is 'nothing more they can do'.

Cost-effectiveness of transplantation 
In addition to saving lives, transplantation is highly cost-effective, and represents incredible savings to the NHS budget and is the treatment of choice for many patients, particularly those with end-stage renal failure. 

There are over 37,800 patients with end-stage renal failure in the UK. Nearly 21,000 are on dialysis, whilst the remainder have a transplant.
The indicative cost of a kidney transplant (including induction therapy but excluding NHSBT costs) is £17,000 per patient per transplant. 
The immuno-suppression required by a patient with a transplant costs £5,000 per patient per year. Kidney transplantation leads to a cost benefit in the second and subsequent years of £25,800 pa. 

The cost benefit of kidney transplantation compared to dialysis over a period of ten years (the median transplant survival time) is £241,000 or £24,100 per year for each year that the patient has a functioning transplanted kidney.  At the end of March 2009, the UK Transplant Registry had records of over 23,000 people in the United Kingdom with a functioning kidney transplant. On 1 April 2009 there were 6,920 patients waiting for a transplant of which the majority were on dialysis, costing around £193m per year. If all of these patients received a transplant, the approximate cost would be £41m per year, which represents a saving to the NHS of £152m per year. 

(USA) Some physicians have advocated a policy of "presumed consent," which allows physicians to retrieve organs unless the deceased opted out by specifically stating an opposition to organ donation prior to death. It was suggested that drivers’ licenses could be used for this purpose.
A countered argument is that presumed consent is fraught with legal and ethical traps. "It will only take one case in which someone’s decision not to donate is overlooked or ignored to put an end to presumed consent for good."
More popular with both physicians and ethicists is the policy of "required request," mandating that hospitals ask families about organ donation in every case of brain death. Many hospitals across the country have voluntarily adopted such a policy, and several states have enacted or have pending required-request legislation.
Many people support the right of a terminally ill patient to die - but what if the act becomes an obligation? And what of the potential for abuse by those might profit through the death of another? And for the purpose of this paper, should the death of a terminally ill patient be sacrificed to harvest life saving organs?

·      Should dying patients have the right to order their doctors not to start or continue medical treatment?
·      Should doctors be protected from prosecution if they shorten a patient's life expectancy with pain-killing drugs

The NL and Belgium
Euthanasia and assisted suicide were legalized in the Netherlands and Belgium in 2002. The Netherlands had effectively legalized euthanasia and assisted suicide by the decree of the courts in 1985, with the 2002 legalization simply codifying accepted practice into law.

The Netherlands are often hailed as a model when arguing for the legalization of euthanasia, where it is allowed if:
·      The patient is in unbearable pain, with no improvement in sight
·      The patient has voluntarily requested euthanasia on more than one occasion
·      The patient is aware of their condition and options
·      At least two doctors agree that these conditions are present
·      That euthanasia is carried out in a medically appropriate manner
·      That the patient is at least 12 years old.

The Netherlands
Cost containment is one of the main aims of the health care policy in Holland and Belgium. In an effort to contain costs and increase speedy procurement of body parts euthanasia training has been part of both medical and nursing school curricula since the early 1990s. The expense of the training is quickly recouped when those trained get their hands on patients.  Euthanasia has been administered to people with diabetes, rheumatism, multiple sclerosis, AIDS, bronchitis, and accident victims.

Holland is widely regarded as one of the world's most civilized countries. Active euthanasia is legal there, but for the past decade the government has not prosecuted doctors who report having assisted their patients to commit suicide. A Dutch government investigation of euthanasia revealed some disturbing findings . In one year in the early 1990s, 1,030 Dutch patients were killed without their consent. And of 22,500 deaths due to withdrawal of life support, 63% (14,175 patients) were denied medical treatment without their consent. Twelve per-cent (1,701 patients) were mentally competent but were not consulted

The Dutch experience seems to demonstrate that the "right to die" can soon turn into an obligation. We need to contemplate the potential reality for abuse if mercy killing becomes legal. What if someone stands to gain by the expedient death of another? 
Right-to-die advocates often point to Holland as the model for how well physician-assisted, voluntary euthanasia for terminally-ill, competent patients can work without abuse.

The main argument in favor of euthanasia in Holland has always been the need for more patient autonomy -- that patients have the right to make their own end-of-life decisions. Yet, over the past 20 years, Dutch euthanasia practice has ultimately given doctors, not patients, more and more power.  The question of whether a patient should live or die is often decided exclusively by a doctor or a team of physicians.

In the 1990s in  Holland:
·      52% were killed by doctors (active, voluntary euthanasia). 
·      12% died as a result of doctors providing them with the means to kill themselves (physician-assisted suicide). 
·      48% died from involuntary euthanasia, meaning that doctors actively killed these patients without the patients' knowledge or consent.
·      14% of these patients were fully competent.
·      72% had never given any indication that they would want their lives terminated.
·      In 8% of the cases, doctors performed involuntary euthanasia despite the fact that they believed alternative options were still possible.

8,100 patients died as a result of doctors deliberately giving them overdoses of pain medication, not for the primary purpose of controlling pain, but to hasten the patient's death. In 61% of these cases (4,941 patients), the intentional overdose was given without the patient's consent. According to the Remmelink Report, Dutch physicians deliberately and intentionally ended the lives of 11,840 people by lethal overdoses or injections--a figure which accounts for 9.1% of the annual overall death rate of 130,000 per year.

The majority of all euthanasia deaths in Holland are involuntary deaths. The most frequently cited reasons given for ending the lives of patients without their knowledge or consent were: "low quality of life," "no prospect for improvement," and "the family couldn't take it anymore." 

In 45% of cases involving hospitalized patients who were involuntarily euthanized, the patients' families had no knowledge that their loved ones' lives were deliberately terminated by doctors.

Critics have claimed that the Dutch initiative for euthanasia will trigger a wave of "euthanasia tourism", and this potential boom has begun through the establishing of death clinics in Cambodia and Mexico. 

In 2003, a group of “ethicists” at the Groningen University Hospital began looking at the question of infant euthanasia in the Netherlands. The 2002 law allowed the euthanasia of consenting persons over the age of 12. The problem that the committee at Groningen University was attempting to solve was: what should be done with newborns that are born with anomalies? The Groningen Protocol allows euthanasia of infants when the parents give consent and when the child is considered to lack an “acceptable” quality of life.

In the Netherlands, the goal is the legalization of the “last-will pill.” This is a prescription that would be given to healthy individuals (usually the elderly or people with disabilities) who were tired of living.
Switzerland has tolerated assisted suicide for many years. Suicide groups have been assisting suicide within Switzerland based on a legal interpretation of their 1918 suicide law. In other words, Switzerland never legalized assisted suicide, but tolerates the practice based on a legal interpretation. The Dignitas Suicide clinic is probably the best known of these groups.
The Dignitas clinic has now changed its suicide technique from the use of a prescription to that of the plastic bag with helium (an exit bag). Using the plastic bag with helium method to eliminate the need for a physician to agree to assisting the death, because even many physicians who support assisted suicide would often refuse to write lethal prescriptions for people who weren’t dying or suffering. The clinic is known for its encouragement of suicide tourists from countries around the world where euthanasia is not permitted or tolerated, who go to Switzerland to die. It is estimated that two out of three people who die at their suicide clinic are suicide tourists.
The Dignitas assisted suicide groups in Switzerland, has some 2,000 members and welcomes foreigners. Dignitas must be fully informed in advance of a person’s wishes, circumstances, and agree to help. It is not (yet) a ‘walk-in’ clinic.  The most serious question facing Dignitas concerns welcoming and assisting the the mentally ill or depressed as much as those suffering a physical illness and pain. Dignitas members argue that mentally ill people have the same right to take their own lives as others: "You can't say and you shouldn't say that mentally ill people should not have human rights." "A lot of people feel lonely, lonesome at that stage and they say, 'Well, I have nothing more. I have no relatives, I have no friends, no life ... Why am I still living anymore,'" says Eichenburger. "That's when I say that the dying has begun." 

Although the Dignitas market is largely German, by late 2008, approximately 100 British citizens had travelled to Switzerland from the UK to die at one of Dignitas' rented apartments in Zurich. Just a month later the number of British members of Dignitas had risen to 725. Assisted suicide is not a criminal act under Swiss law if it is motivated by altruistic considerations.

Dignitas launched an effort to gain legal permission for healthy foreigners, including married couples committed to suicide pacts, to end their lives in Switzerland.  Dignitas has found
If voluntary euthanasia is made legal for "persons of sound mind" there will inevitably be tremendous pressure to provide it for those who "would request it if they were able to" - the mentally ill or handicapped, the senile, the unattached or non-productive elderly, etc. One can easily argue too to link euthanasia and health care costs in the same breath; financial pressures will multiply in the coming years as our population ages. 

Sven Ljungholm
Govan Corps