Originally Posted - April 25, 2006

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The practice of euthanasia was easily established and advanced in the United States under the pretense of end of life wishes, choices, compassion, dignity, and self rights to the public through introductions by various means.

Among those heavily involved in pushing euthanasia via legislative and public policy change in the U.S. is Myra Christopher, along with billionaire donors to fund the cause. Myra has been instrumental in the push towards legalizing assisted suicide and euthanasia on many fronts, largely through educational programs directed toward healthcare givers and healthcare systems, government, and the clergy, which leads to public policy changes. She has spent more than 20 years in achieving that goal through her connections to Last Acts, now defunct, which spun off the Hemlock Society. http://www.northcountrygazette.org/articles/041606HealthcareConnection.html

Community-State Partnerships to Improve End-of-Life Care (C-SP)

One of the most pervasive governmental programs tied to the Robert Wood Johnson Foundation (RWJF) and Myra Christopher in advancing euthanasia was conceptualized to include all states in the United States. In 1997, the Robert Wood Johnson Foundation (RWJF) granted $11.25 million in funding for a national program called Community-State Partnerships to Improve End-of-Life Care, in concert with the Last Acts Campaign, which promoted change in public policies and practices for end of life care. The C-SP program arose out of the SUPPORT Study, also funded by the RWJF that claimed most Americans died in hospitals, most often alone, and in pain, and were simply uncared for at the end of their lives.

Again, Last Acts is no longer operational. Last Acts evolved from the Hemlock Society. The Hemlock Society has always advocated euthanasia. http://www.northcountrygazette.org/articles/032906AssistedSuicide.html

Myra was involved in the C-SP project in various capacities. An example of the Community-State Partnerships to Improve End of Life Care is Oregon's State Initiative, "Oregon Health Decisions: Lighting the Way to Common Ground," which was the second in a series profiling new policies and practices for end of life care, and was then published in 1998 by the National Program Office (NPO) within Myra's Center. Myra also served as Executive Editor of the Oregon series. http://www.rwjf.org/files/publications/other/State_Initiatives_EOL2.pdf

The target audience consisted of health care professionals and others who care for the dying, health care institutions, regulatory agencies, professionals to improve end of life care, and the public.

RWJF wanted autonomous, state enacted plans, instead of programs that needed continual funding. Their hope was that the state programs would network existing organizations such as hospitals and their associations, physicians, nurses, medical societies, clergy, hospice organizations, AARP, councils of churches, medical and nursing schools, public officials, consumer organizations, state agencies, universities, professional associations, ethics institutes, euthanasia and assisted suicide organizations, and other groups to work together in implementing and institutionalizing governmental and legal reform, along with sustaining programs that would continue long after RWJF funding ended.

Organizational involvement varied among states' projects, but included health care providers, hospice organizations, health and medical professional schools, state medical associations, state licensing boards and state agencies, community coalitions, advocacy organizations, professional associations, research organizations, religious organizations, insurers and others.

A total of 24 applicants (U.S. states) received grants. The program ran from February 1999 through January 2003.

As of June 2003, participants in the CSP program included Alabamians for Better Care, California Coalition for Compassionate Care, Florida Partnership for End-of-Life Care, Connecticut Coalition to Improve End-of-Life Care: Better Endings, District of Columbia Partnership to Improve End-of-Life Care, Hawaii: Kokua Mau, Improving End-of-Life Care in Iowa, Kansas: Living Initiatives for End-of-Life Care (LIFE), Kentucky: Journey's End, Maine Center for End-of-Life Care, Michigan Partnership for the Advancement of End-of-Life Care, Minnesota Partnership to Improve End-of-Life Care, Nevada Center for Ethics and Health Policy, New Hampshire Partnership for End-of-Life Care, New Jersey Comfort Care Coalition, North Carolina: The Carolinas Center for Hospice and End-of- Life Care, Matters of Life and Death Project: North Dakota, Oklahoma Alliance for Better Care of the Dying, Rhode Island: Improving Quality of Care for Our Most Vulnerable Population, Partnership to Improve End-of- Life Care in Utah, and The West Virginia Initiative to Improve End-of-Life Care.

Myra served as Director of the Community-State Partnerships project. Myra's Bioethical Center served as the National Program Office (NPO) tasked with providing guidance, technical assistance, resources and education about ethical issues to professionals, policymakers and the public.

Initially, 12 applicants or states received planning grants; 23 received implementation grants. Two grantee organizations received only planning grants (Indiana and Texas), and one implementation grantee terminated their statewide project early (New York). Grantees received an average of $440,000. In all, 24 applicants received grants totaling $9,834,509 between January 1999 and June 2003.
($75,000 = planning grant)
($375,000 = implementation grant)
Additionally, Myra's Midwest Bioethics Center received $3,377,951 from February 1998 to January 2003 From RWJF for the project. Touchstone Consulting in North Bay Village, Florida, received $734,960 from February 2000 to January 2002 for surveys and services rendered on the project, from RWJF.

In 2002, the "evaluator" noted that the objectives of the individual states encompassed comprehensive, long term change in cultural or social norms and in professional standards and behavior. Obviously, societal shifts and professional policies and behavior were proving more difficult to change and standardize than they initially anticipated.

Even where statewide projects appeared to have met their goals, the full influence of their work might not be discernible for several more years, they reported. Oregon was easy when legalizing assisted suicide. Rapid succession of other states legalizing assisted suicide and euthanasia simply did not occur as they had hoped. If the evaluator is correct, we shall see their changes and results within the next couple of years. Hopefully, these changes will not occur in the form of legalization of assisted suicide and euthanasia.

Findings and Evaluation of C-SP: 1) On the issue of Hospitals and Nursing Homes, program results concluded, "Provided some form of training to hospital staffs and administrators in addressing needs of dying patients and improving the quality of their treatment."

Our evaluation---The goal: education of healthcare professionals to the bioethical changes occurring within medicine. An example is that feeding tubes may be removed on patients such as Terri Schiavo. But, does removing a feeding tube on a non dying patient improve the quality of their treatment? We know that act hastens their death and does so in the name of self rights, privacy rights, choices and compassion with the claim that this is what improves the quality of end of life patient care. According to Ron Cranford and other right to die activists, a severely brain injured patient, the demented, and terminal patients have no quality of life, and therefore, their life should be terminated due to the drain on resources.

2) On the issue of Education on palliative care to professionals in training and practice, program results concluded, "Sponsored training for physicians, nurses and pharmacists using a nationally recognized end of life care curriculum. Beginning in 2001, the DC Partnership to Improve End-of-Life Care facilitated the training of 16 physicians in the American Medical Association's Educating Physicians on End-of-Life Care (EPEC) project."

Our evaluation---When the end of life curriculum entails withholding treatments, procedures, and care to select categories of patients, we are then practicing assisted suicide and euthanasia.

We are also rationing healthcare to conserve resources.

The public is thus lured into justifying and accepting the concepts of assisted suicide and euthanasia so that we have no remorse (this barrier is removed) when terminally sedating a patient to death with medications, hastening their death by withholding food and fluids, or withholding treatments which hastens their death as in not treating an infectious process, not providing oxygen, or not performing a surgical procedure. There is no remorse because the above actions or inactions have been replaced by teachings and assurances that this is standard, accepted public and legislative policy.

3) On the issue of Demand for and access to quality end of life care such as palliative care and advance care planning, program results concluded, "Legislatures enacted laws in 6 states requiring new or increased reimbursement for hospice care under Medicaid (Florida, Hawaii, Maine, Nevada, New Jersey and West Virginia)." In Maine and New York, lawmakers passed legislation that required all insurers cover hospice.

Our evaluation---Instead of utilizing long term care facilities, hospice is now well equipped to take Alzheimer's, AIDS, the brain injured, and comatose patients, while Medicare and Medicaid pays. We must ask whether these hospice facilities advocate hastening death, terminal sedation, or offer no treatment at all. Hospice originally provided basic care to those with less than 6 months to live. When hospice converts to care facilities that provide bare, existential needs, the public has a right to know. The public also has a right to know whether these changes within hospice include futile care policies, hastening death, and terminal sedation.

If one lives in Oregon, the government will even pay to suicide you, if that is your wish, or their relative can have you euthanized, if you are demented or brain injured and unable to speak for yourself.

The glaring fact is that abuse, neglect and exploitation of the elderly and disabled has always occurred, and is now a burgeoning problem for all by the push to legalize euthanasia and assisted suicide by advocates who agree with the practice of ridding society of these burdensome classes of people. Sadly, virtually no states took up legislation this session to protect these vulnerable classes of people.

4) On the issue of Improve advance care planning, program results concluded, "Statewide projects led education efforts for the need for advance care planning and provided advance directive forms (to be included in medical records) and assistance to patients in filling them out." Also, "Statewide projects helped legislators as they developed policy changes to simplify and remove conflicting provisions from legislation and regulations governing advance directive completion."

Our evaluation---In Florida, legislators enacted legislation defining Persistent Vegetative State (PVS) as a terminal illness. One could argue Alzheimer's is a terminal illness. One could argue AIDS is a terminal illness. Legislators enacted legislation claiming feeding tubes were a life prolonging procedure. They also enacted an egregiously flawed piece of legislation defining life prolonging procedures as "any medical procedure, treatment, or intervention, including artificially provided sustenance and hydration, which sustains, restores, or supplants a spontaneous vital function. The term does not include the administration of medication or performance of medical procedure, when such medication or procedure is deemed necessary to provide comfort care or to alleviate pain."

These specific factors in these laws sealed Terri Schiavo's fate, as she was grandfathered into these laws by Judge George Greer many years after her sudden collapse. These laws also allow any guardian to halt sustenance via a feeding tube, under the pretense the feeding tube is a life prolonging treatment or procedure. This law can also be applied to any and all treatments; oxygen, intravenous fluids or medications via an IV line, dialysis, everything, except medication administration. The only assurance you are guaranteed is that you will be provided comfort care measures and pain relief. Comfort care, as in clean, unsoiled clothes and bed linen, positioning changes, medication for your vomiting and pain, and other measures that ease discomforts. Pain relief is administration of narcotic and sedative medications that not only alleviates your pain, but can hasten your death and kill you.

The choice lies with your guardian or health care proxy in many cases. To be sure, check with your individual states' laws.

Can food and fluids be a life prolonging treatment? If eating and hydration is as necessary as the air we breathe to sustain life, is it ethical to remove a necessity of life that sustains life? Oxygen provided to patients with emphysema is now considered a treatment, procedure, or intervention which sustains, restores, or supplants a spontaneous vital function in Florida. In fact, all medical treatment can be discontinued, either by a guardian or a physician, in the state of Florida, except medication administration due to the laws above.

Any change to these laws or a new law to protect the mentally incapacitated and disabled was decried as a violation of a person's rights and governmental interference. But governmental interference, by enacting these laws in Florida, is what brought us to the doorstep of assisted suicide and euthanasia, cloaked under privacy rights in the state, along with Myra's Community-State Partnerships to Improve End of Life Care, and in concert with Myra's National Conference of State Legislatures manuals provided to each states' legislators and their staff.

During legislative sessions for the calendar year of 2006, there is very little activity in terms of bills at the state level to protect the elderly, brain injured and those with disabilities. The lack of care, compassion, and empathy towards the disabled, elderly, and brain injured in this country is completely contradictive to what these end of life organizations boast within their missions' statements, which is providing quality care to the dying who are alone and in pain.

For instance, although there is a law prohibiting euthanasia in Florida, the act can still be carried out based on the specific Florida laws above. Simply stated, Florida has two laws which negate each other. How they function concurrently depends on the judge. Terri Schiavo is a perfect example of the sloppy laws in the state which offer no protection to the elderly and disabled and that allow euthanasia under false pretenses.

Myra's Bioethics Center, philanthropists, right to die groups, and those misinformed about the euthanasia push have accomplished changes within our governmental and legal systems which allow assisted suicide by theie influence and money on such projects as the CSP.

5) On the issue of "Aided those in public policy to encourage physicians to prescribe needed pain medication, program results concluded, "Educated legislators of the importance of requiring professional education in pain control." Also, "Projects worked with state licensing boards to craft new standards for pain management. State boards of medicine, nursing, pharmacy and osteopathy developed a joint policy statement with the goal of promoting better pain management at the end of life, which the legislature later enacted in the state of West Virginia. The West Virginia law now provides protection from legal prosecution to health care professionals who practice according to this policy statement; and (3) encourages adequate pain relief for dying patients."

Our evaluation---For instance, if you want to be killed by a nurse or physician in West Virginia, (or if you don't) they can kill you by assisted suicide and will not face prosecution for your death due to a law enacted for their protection.

Obviously, governmental intrusion into medicine is here to stay. Myra Christopher was one of many catalysts inserting government into the medical field and changing the ethical milieu within many disciplines; clergy, medicine, state law, federal law, and even areas of research. Government influences and changes our public policies more now than ever before, without even factoring in the legal challenges which become policies.

Some interesting lessons they learned from the project;
"Statewide projects that achieved policy changes focused on linking public policy to the concerns of private lives." (Evaluator)

"To reach significant numbers of health care professionals, it is better to offer continuing education for them in small doses and at venues already attended by target audiences than to try and hold separate meetings devoted only to end-of-life care issues." (Evaluator)

"The educational efforts of project staffs, particularly those aimed at a community audience, should be targeted to those who are "primed" to receive it." (Evaluator)

Our lessons learned from the project;
These analyses are an indication as to how deeply the right to die groups and their movement encroached into the public domain using religion and clerics, and how those clerics further evolved into "experts" on end of life issues, which affected public view in accepting practices of discontinuing basic care. Pushing the self rights and Self Determination Act in government was paramount in setting the stage by euthanasia advocates as well. The "rights" issue was also structured to include privacy rights.

Healthcare professionals are more likely to attend the shorter educational meetings offered due to time constraints. Gradually introducing a morally repugnant act in "small doses" is more palatable to digest. They may go even further by enticing and rewarding those medical professionals in attendance with continuing education contact hours.

C-SP also provided the media with a toolkit in 2000 containing public service announcement ads, newspaper print ads, posters, brochures and template press releases on end of life care. Four articles were written by NPO staff (Myra's Center). Individual grantees wrote articles describing their projects, and three were accepted by the Journal of Palliative Medicine. Timothy Quill and Ira Byock serve on the Editorial Board of the Journal. Myra's Center also distributed an 85 page Community Engagement Guide and a Media Tactics newsletter series. http://www.liebertonline.com/doi/abs/10.1089/10966210252784971

The public relations blitz encouraged end of life ideology under the pretense of assisted suicide and euthanasia as problems within our society that needed resolutions. Instructions to the media and how these programs were subsequently reported to the public had an extreme influence on the public's comprehension and views towards what constituted end of life care, just as involvement of the clergy in the Compassion Sabbath project had a roll over influence on public views. Religious leaders, government, and medicine are telling us we have the right to decide how and when we die, even if that includes physician assisted suicide that inevitably leads to euthanasia.

We also learned that using a physician or any healthcare giver to assist in suicide, aid in dying, and the right to die, lends credibility to the process, and gives the process a more aesthetic overtone. After all, the medical fields are respected in the public domain. Further, the public must accept the idea in order to advance a morally repugnant concept as normal, and so it is presented under false pretenses at many levels of society; medical, theological and state governmental policies.

As of 2004, 19 states and DC had active coalitions and/or guidance manuals on end of life care. Most had web sites, as well. Brown University in Providence, RI had an end of life care program. The Albany based project in NY was operational from January 1999 to February 2001, before closing. The University of Texas Medical Branch in Galveston, TX had a planning grant. Indiana University in Bloomington, IN had a planning grant. The George Washington University and Myra's Bioethics Center collaborated to produce the Governor's guidebook, "State Iniatives in End of Life Care: Policy Guide for State Legislatures". http://www.rwjf.org/reports/grr/032334s.htm

According to the RWJF, Community-State Partnerships to Improve End-of-Life Care was established at a time when state officials, advocates, and citizens were grappling with the issue of legalizing physician assisted suicide. RWJF states, "Much of the program's work - done through local coalitions or partnerships - sought to improve care for the dying so that physician-assisted suicide would not be necessary. However, these statewide projects ran into several challenges externally and internally, some raised by this broader political context, as well as other factors. For example, project staff and partners in Maine found themselves in the midst of a contentious referendum vote on the issue of physician-assisted suicide in November 2000, which threatened to overshadow their work on improving palliative care. The project's work also competed with substance abuse headlines."

The success of the Community-State Partnerships program under Myra's direction is truly measured by the states who were actively involved in this project and whether those states refrained or will refrain from legalizing assisted suicide and euthanasia. When assisted suicide is up for debate in state legislatures across this country, we fully expect to hear Myra testify and oppose the action. Otherwise, the money spent on these programs is under false pretenses. The education, guidance, and other activities offered by Myra's Bioethics Center to improve care for the dying so that physician assisted suicide would not be necessary may well prove to be a farce.
4-25-06