When Not Awkward Becomes …

On January 8, 2024, I had the pleasure of appearing on the “Making it Awkward” podcast hosted by Jessica Wilson, MS, RD, and Whitney Trotter, DNP.

As I stated in a prior article, there is no doubt that on some issues, our views are very different… at times even opposite. However on that day, I thought there was a feeling of respect, of professionalism, of courtesy. I certainly extended those qualities to the two hosts. However, it would appear that those feelings of respect and professionalism on the part of the esteemed hosts may have ended that day, if they existed at all.

After my appearance on the podcast and before it was disseminated, I contacted Ms. Wilson and Ms. Trotter, thanked them for the opportunity and on two occasions discussed iaedp’s certification process and how the BIPOC community could get involved at the earliest level. The exact language I used was:

(The First email)

“Also, I will be sending to you in the next few days an email talking about iaedp’s certification process. The BIPOC Committee at iaedp, and the BIPOC community as a whole, have an incredible opportunity to be on the ground floor in helping come up with new certification guidelines. More to follow.”

(The Second email)

“Regarding the “certification program,” we are facing a unique challenge. In one of two ways, the eating disorder certification program is going to change, to grow, to evolve in the next few years.  First, the Court may very well take away the certification program from iaedp and assign it to an established board specializing in overseeing certification programs.  Or two, Ms. Harken will decide she has had enough and will step away. These are inevitabilities.”

“And the BIPOC Committee of iaedp as well as BIPOC advocates have the opportunity to have their voices heard, to be part of the process which changes certification, to have the certification program become much more fair and available to all. However, this requires that the BIPOC community come together, to reach agreement on how best the certification process can be changed to meet the needs of the BIPOC community and to speak with one, mighty, united voice.”

“But, that voice has to be clear. That voice has to provide real life, workable, reasonable solutions which can be implemented.

I believe you two are in a place where you can be the harbingers of this change, this voice. But, this must be organized expeditiously and wisely. I also have no doubt that the obstacles are many and the way forward is difficult. Then again, what great thing was ever accomplished without hardship?”

So, what was their response?

Ms. Trotter responded with:

“Thanks so much for the feedback. We’ve heard positive reviews as well- which has been encouraging. There are several folks on the IADEP BIPOC subcommittee who I’m sure would be interested in helping with the certification process. It’s not a task that I can undertake but I appreciate you reaching out and asking.” 

Ms. Wilson responded with:

“I cannot take on the full task of improving the certification, but I’m happy to provide paid consultation to those who are interested in my experience.”

Interesting. It appears as if their collective response was tantamount to, “We cannot be bothered to undertake such a momentous task knowing that progress and obtaining results which could help the BIPOC community is beyond us. And in Ms. Wilson’s case, “unless of course, you pay me to participate.”

To be on the ground floor of building a foundation that would inevitably help the BIPOC community. What an incredible opportunity. But Ms. Wilson and Ms. Trotter chose to not participate. To not be influencers. To not engage in bettering the community in this manner.

Ms. Wilson and Ms. Trotter then conducted Part 2 of the discussion and invited Meghan Cichy to appear. A majority of that podcast was dedicated to, “Steven Dunn is a loon, he has it all wrong, let’s run down him and his views, read his mind and epitomize the name of their podcast, ‘Making it Awkward.’”

After listening to Part 2 of the Podcast, and its many inherent flaws, it would have been so very easy to go on the attack, pick apart Part 2 of the Podcast, pointing out the many inaccuracies, inconsistencies and false narratives. But, to what end? What would be accomplished other than causing a few more rifts in the community? Of hurting others for their views no matter how misguided.

Instead, I reached out to Ms. Wilson and Ms. Trotter.  My email stated the following:

“I had the chance to listen to your Litigation Podcast 2. I can tell you I do enjoy the different points of views you bring out from different guests. And what a learning experience it is hearing other’s opinions. So, thank you!

There were a number of points that could use clarification but, it is what it is.

Again, I appreciate the opportunity to be on the podcast and would welcome any future interaction.

Oh… and I am SOOOO sending you both Christmas cards!”

To date, Ms. Trotter and Ms. Wilson have not responded to that email.

There comes a point where the hand we extend in friendship cannot be turned into a fist. A point where we continue to seek understanding and compassion even if those around us do not. Someone must show compassion and understanding for those who are in such internal turmoil and pain.

In this matter, damage was done and opportunities lost. Why compound it? An opportunity to collaborate, to bring together people of divergent viewpoints and opinions for the betterment of those suffering from eating disorders was not recognized and was lost. Perhaps grace, acceptance of other people’s viewpoints, respecting them even if you disagree with them are foreign concepts to some.

As I reflect upon my interaction with Ms. Trotter and Ms. Wilson, I have no doubt I gained some insight especially on sensitive issues and topics which have the potential to be incredibly awkward. Respecting the person, treating them with courtesy, with respect, with civility is the best weapon to diffuse awkward topics and issues. To turn awkward issues into issues upon which we can work together even as we maintain divergent points of view. That is a special gift. That is the essence of making awkward not awkward.

Because undoubtedly, our end goal is the same. That is, saving as many lives as humanly possible. Helping as many people in pain and suffering as we possibly can. Aren’t we all working toward that same, end goal?

The Power of the Message CANNOT be lost because of the false narrative that the Image of the Messenger is far more important. When the focus is on the messenger and not the message, the message is lost, the end goal is pushed further away and we as a community suffer.

Which results in more pain, more harm, more loss endured by families suffering from eating disorders. And when that happens … we all lose.

Ohhhhhhhh Colorado

A few weeks ago, I wrote of Canada’s decision to delay until 2027, implementation of Physician Assisted Suicide (“PAS”) for people whose primary diagnosis is a mental illness.

Reasons given included: Canada’s healthcare system was not ready to handle the increase in requests for PAS from patients with mental health issues; the expansion of PAS could undermine efforts to prevent suicide; politicians casting blame on the opposing party; and the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on Canada’s health care system.

And so reasonable, hopefully rational studies will be funded addressing the issue of PAS for patients with mental health issues.

Brava Canada!

In opposition to this reasoned, rational, logical approach, we have ‘Murica … specifically the State of Colorado.

In 2006, the movie, “Idiocracy” had a limited release in the U.S. It was directed by Mike Judge and co-written by Mr. Judge and Etan Cohen. Mr. Judge was the creator (or co-creator) of Beavis and Butthead, King of the Hill and Office Space.

The plot of Idiocracy follows U.S. Army librarian Joe Bauers, (played by Luke Wilson) who wakes up five hundred years in the future after a botched government hibernation experiment. He finds himself in a dystopian society run by corporations, where evolution has made humanity stupid because the benefits of technology made it unnecessary for people to be intelligent and physically fit to survive. Idiocracy serves as social satire that touches on issues including anti-intellectualism, commercialism, consumerism, dysgenics and overpopulation.

Colorado already has in place an overly liberal (or accommodating depending on your viewpoint) law on PAS. But then, certain Colorado politicians embraced some of the over the top aspects of the Idiocracy movie and are seeking to expand Colorado’s PAS law.

This is the proposed bill:

Click to access 2024a_068_01.pdf

The Colorado bill could have been drafted by Mike Judge as a script for an Idiocracy sequel entitled, “Idiocracy: How to Die in Colorado Without Really Trying.”  And yet, to date, there is no registered opposition to the bill in Colorado’s lobbying database.

So, let’s review some of the key provisions of this Idiocracy bill.

First, we know how busy Colorado medical doctors are. Overworked. Underpai.. well, overworked. So, let’s take some of the burden off them by allowing “Advanced Practice Registered Nurses” to make the determination that a patient qualifies for PAS. We also want to take even more burden off physicians so let’s allow Advanced Practice Registered Nurses to also serve as “consulting providers.”

Of course, this “consulting provider” must be qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness. [emphasis added] Qualified by experience? That certainly gives an entirely new meaning to the phrase, “Expert by Experience.”

Naturally, with Colorado being an enlightened, beneficent land of opportunity, they surely cannot restrict their expanded PAS to residents of Colorado alone. When the bill is passed, ANY ADULT is eligible to apply for PAS. Even those who reside outside the State of Colorado. The bill does not restrict its implementation and activities to the State of Colorado. Which brings up a number of intriguing and troubling issues.

With the expansion and proliferation of the Interstate Medical Licensure Compact Act and the use of tele-health, the bill does not address whether a provider can make his/her diagnosis via telehealth and whether the opinion of the consulting provider may be provided via telehealth. If the attending provider has the requisite DEA certificate and complies with any applicable administrative rules, that provider can send the poison cocktail medications directly to the patient.

Then there is the current mandatory waiting period for PAS in Colorado which is 15 days. Presumably, that is far too long to consider and contemplate the end of one’s existence. So, let’s shorten that puppy up to 48 hours! After all, one can squeeze a lot of living in 48 hours … champagne, five-star dining, complaining about the latest Taylor Swift conspiracy. What more does one need? However, if the attending provider believes that death will come within that 48-hour window, even that waiting period can be waived.

But, what to do about those pesky life insurance companies which have exclusions in their policies for insureds who commit suicide? The Colorado bill thought of that too. The bill provides that a life insurance company doing business in Colorado cannot deny nor alter benefits otherwise available to its insured who chooses to undergo the Colorado PAS process.

At this point, we should also ask if this is merely a tempest in a teapot.  How prevalent is PAS in Colorado?

Since 2017, [when Colorado’s medical-aid-in-dying law went into effect] and 2022, according to data gathered by state health officials more than 1,090 patients were prescribed life-ending medication. Of those, 838 picked up the medication. [This information can be read by clicking on the link underlined in the prior sentence.] It’s unknown how many people used the medication to end their lives.

Over that six-year period, aid-in-dying prescriptions were provided by 219 Colorado doctors.

Interestingly, a survey was published in January 2022 of 583 physicians in Colorado carrying for potential medical-aid-in-dying patients. This survey can be found here:

https://link.springer.com/article/10.1007/s11606-021-07300-8

This survey provides some fascinating insight into those providers who are involved in medical-aid-in-dying for their patients.

The survey’s general conclusions were, “Many physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation.”

The survey was transparent about the ethical concerns which included: “Ethical concerns include, but are not limited to, issues of equity and justice, patient autonomy, the nature of human suffering, slippery slope arguments, the proper roles of physicians, and the potential for devaluing human life. Religious beliefs have led some religiously affiliated hospitals to prohibit employed physicians from providing MAiD.”

For diseases like cancer, the availability and applicability of MAiD is much more compelling. Medical knowledge has shown the human body constantly produces new cells. Normal cells follow a typical cycle: They grow, divide and die. Cancer cells, on the other hand, don’t follow this cycle. Instead of dying, they multiply out of control and continue to reproduce other abnormal cells. These cells invade body parts, such as the breast, liver, lungs and pancreas. They may also flow through the blood and lymphatic system and spread to other parts of the body. Within a reasonable medical likelihood, death can be estimated.

But PAS for mental illnesses? For Anorexia Nervosa? Without having any objective medical criteria to determine a person’s capacity to make a life-or-death decision? Not even requiring a licensed psychiatrist or physician to be involved? Our wisdom and knowledge have not expanded to address mental health issues and PAS. To believe otherwise is clearly Idiocracy material.

One day, will our understanding of the human body, the brain, the complexities of our psyche reach a level which turns Physician Assisted Suicide into Medical-Aid-in-Dying for mental health issues? Perhaps so. But that day is certainly not today. Today, we are subjected to Idiocracy bills like Colorado’s law, short on wisdom and long on pedantic naivete.

Without the need of a physician to oversee the process, opening the process to everyone, and shortening the mandatory wait period to 48 hours, Colorado could become a mecca for PAS tourism.

Imagine Colorado’s new state slogan:

QUESTIONS AND WEBS OF SUBTERFUGE

The iaedp Annual Symposium is about four weeks away. All the while, iaedp finds itself in an expanding web of trouble, legal issues, and membership rebellion. And learning the hard way that subterfuge and non-transparency is a pathway to failure.

Dark, lightning-laced storm clouds on the horizon evince a tempestuous future which may very well spell doom for iaedp, the certification process and Bonnie Harken. And not because of the lawsuit.

Alarming issues have been raised regarding iaedp and Bonnie Harken. One can’t help but wonder whether iaedp members and corporate chapters are receiving direct, honest answers to questions which should be asked. Or instead, are they receiving subterfuge in the guise of finger pointing and failed attempts to blame the messenger in a vainglorious attempt to play the misdirection game, the shell game … the con game?

With the belief that iaedp members and chapters may not be receiving direct answers about questions and issues regarding iaedp, let’s attempt to address them here. Let us put out those questions in an open, free forum. Then, it will be up to iaedp members and chapters to demand open, transparent, honest answers … if that is what they choose.

Petition

The online petition calling for the resignation of Ms. Harken is only two (2) months old.  And yet, it already has 258 signatures!

258 persons who demand to see the eating disorder field improve and evolve.

258 people who believe that iaedp is not serving this mission.

For those interested in this petition, some of your questions may be:

Q:       Ms. Harken, have you met with the people who started the petition, respectfully listened to their concerns, and then brought these concerns to the iaedp Board of Directors?  If not, why not?

Q:       At the upcoming Annual Symposium, will you commit to having an open forum about this petition and iaedp in general and open that forum to all interested persons? Again, if not, why not?

Q:       What do you plan to do about the very alarming issues raised in the Petition?

Corporate Chapters

We know at least six (6) chapters who wish to dissolve/disband. They are Baltimore, St. Louis, Phoenix, Denver, Los Angeles and Central Coast. The reasons given by the Baltimore chapter are very alarming.

For those interested in this topic, some of your questions may be:

Q:       Why aren’t iaedp and its Board of Directors concerned about chapters closing and what are iaedp and its Board doing to talk to those chapters trying to keep them in the fold?

Q:       Is it true that Ms. Harken is intentionally dragging her feet and not dissolving those chapters hoping she can find other people in that area who will agree to take over those chapters?

Q:       Is it true that the iaedp national Board of Directors supports that conduct? What discussion was had about that topic? [And be very careful … there may be documents which prove the facts in that question.]

Q:       Is it true that Ms. Harken is demanding that any money left over in those dissolving chapters be paid over to iaedp national? That even though those funds were raised by local people from people in their community who intended their donations to be used in the local community, Ms. Harken is making demand for those amounts? [And be very careful … there may be documents which prove the facts in that question.]

But those are not the only issues surrounding the corporate chapters. According to the Illinois Secretary of State website, the following thirteen (13) chapter are listed as being, “Not in Good Standing:”

Alabama

Baltimore

Central Coast

Denver

Greater Philadelphia

Hawaii

Lubbock

New Haven

Orange County

San Diego

South Florida

St. Louis

West Philadelphia

Additional questions may be:

Q:       Ms. Harken had the duty to maintain the records for those chapters. How could she let so many chapters go into the status of being “Not in Good Standing.”

Q:       When a chapter is listed as not being in good standing, what does that mean in terms of the ability to raise funds … and possible liability?

Ms. Harken’s Employment Status with iaedp

Ms. Harken has been adamant that she, and/or her dissolved (since 2016) corporation, Crossroads Programs, have always been “independent contractors” of iaedp. Her reasons for this flight of fantasy are obvious.

When workers are classified as independent contractors, organizations avoid paying the benefits that most employees are entitled to such as health insurance, paid time off, and the employer’s side of payroll taxes. In some instances, employers deliberately misclassify employees to avoid paying those employee benefits and taxes.

When an employee is misclassified, federal and local government lose out on tax and payroll revenue. Employers may be responsible for paying state and federal payroll taxes as well as Social Security and Medicare taxes for all employees found to be classified incorrectly. Penalties can also be imposed for failing to timely deposit payroll taxes.

If the IRS believes an organization has intentionally misclassified workers, there is also the possibility of criminal and civil penalties and sanctions. Additional penalties and fines can be applied depending on the severity of the misclassification.

So, what is an independent contractor? In essence, you hire independent contractors for very specific jobs. A plumber. An electrician. Your bookkeeper. Your accountant. Your attorney. Your PR person.

But the only person who oversees all aspects of your organization’s operations, including financial matters? The only person on a full-time basis? That person is clearly an employee.

Regarding Ms. Harken and iaedp, she recently filed an affidavit in federal court in Dallas, Texas. In this affidavit, Ms. Harken admitted the following:

  1. She is “very actively involved in the iaedp, particularly with regard to its annual symposium”;
  2. “My duties have included, among other things …”
  3. “to lead the organizations according to the decisions made and strategies developed with the board of directors” [not BY the board of directors];
  4. “protect and grow the organization’s financial health”;
  5. “plan for upcoming initiatives and leadership of the initiatives”;
  6. “mentor new leadership”;
  7. “create policies that ensure new strategies align with the organization’s mission are put into action.”

In that affidavit, Ms. Harken also admitted that she supervises people under her, that “she operates iaedp from my home in Pekin, Illinois;” that she has custody and control over all physical and electronic records of iaedp.

We also know she is not only on the Board of Directors of iaedp national but is Chairman of the Board of Directors for all corporate chapters.

This overwhelming Mt. Everest sized stack of evidence establishes one inescapable conclusion … Ms. Harken is more a Dictator than an independent contractor.

I am confident the IRS, the Department of Labor and the California Franchise Tax Board will agree.  And those three (3) agencies have now been informed of the iaedp situation and evidence forwarded to them.

As such, the questions which could be asked of Ms. Harken could include:

Q:       From 2017 – 2021, why did you falsely state that Crossroad Programs, Inc. was an active corporation on iaedp’s Form 990 tax filings and that iaedp had a contractual relationship with this non-existent entity?

Q:       Couldn’t that be tax fraud?

Q:       Do you plan to plead the Fifth Amendment to any questions asked about your leadership of iaedp?

Q:       Despite the overwhelming amount of evidence, why do you still believe you are an independent contractor?

Q:       If any of those agencies find back taxes, interest and penalties are due, how will iaedp pay those?

Q:       Have you asked for, or received any legal opinions evidencing that you are NOT an independent contractor? If so, why did you ignore them?

Q:       Do you understand that if iaedp financially collapses because of your malfeasance, the certification process could also collapse and that could result in families being hurt?

Final Questions

Lawsuits are filed for different reasons. Uncovering the fundamental truth ranks at the top of the list.

They can also be filed to uncover evidence, evidence that state and federal agencies can utilize to prosecute administrative actions and lawsuits against people and organizations who run afoul of the law.

Evidence like … sworn affidavits. Affidavits which contain crucial information. Information which can be utilized in administrative actions against those people.

Perhaps a few final questions should be …

Q:       How has it come to this?

Q:       How did an entire community fail to come together and replace so called leadership who demonstrates the qualities of narcissism, ego and avarice?

For those who have shown the courage to stand up and be counted, you inspire us all. You dared to be mighty. You are facing slings and arrows but you know, you absolutely know, that through your deeds, you are making a positive difference. You are in the arena. You are the light of hope in a dark room.

And finally, one last question I have …

Q:       For those treatment providers who refuse to ask those questions of iaedp and Ms. Harken, for those treatment providers who have no interest in discovering the truth, for those treatment providers who stand on naïve, blind loyalty instead of pushing for the truth, for those treatment providers who do not dedicate themselves to improving the care and treatment of eating disorders but instead, choose to bury their heads in the sand …

Why should any family trust you to care for their beloved children?

Medical Aid in Dying or Physician Assisted Suicide?

Words matter. Words are one of the strongest ways in which we communicate. We use words to express every human emotion. When words are used passionately and honestly, they can inspire us to greatness. Motivate us to dare mighty deeds. To, in the name of humankind, be open to exploring the greatest mystery facing us, that is, our very existence.

Close your eyes. Now, embrace the rapture you feel when the most special person in your life holds you in his/her arms, looks you in your eyes and says, “I love you.” Revel not just in those words, but the feelings and emotions they evoke.

Contrarily, words can also be used to inflict the deepest, darkest scars on a person’s soul. Words can cause such pain, such rage … such defeat, that they can push us prematurely closer to our graves.

Again, close your eyes. And try to imagine how you may feel when the most special person in your life looks you in the eyes and says, “I do NOT love you.” One word. One small word. One word changes everything. It changes feelings, emotions. That one small word changes … life.

Recently, end of life issues in the mental health community have come to the public’s attention, not just domestically, but internationally. Are physicians in the Netherlands prescribing death-inducing medications for autism? Is the UK government allowing life support measures to be removed from a child against a parent’s and their doctor’s wishes? Canada’s recent decision to delay until 2027, end of life measures for persons whose primary diagnosis is a mental health issue. And of course, here in the U.S., end of life options for persons suffering from severe and enduring anorexia.

And yet for these great emotional debates and issues, we cannot even agree which term of art to use … Medical-Aid-in-Dying (MAiD) or Physician Assisted Suicide (PAS). Each phrase engenders very different thoughts and feelings. Granted, this was not much of a debate when MAiD was first being considered for biologically based diseases for which the medical community did not have viable cures. It is now.

Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities, states: “There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway.”

As Lee Corso, a college football pundit and legend is fond of saying, “Not so fast my friend!”

Now, a once relatively clear line is being blurred.

In the United States, ten states and the District of Columbia allow patients to receive life ending medication. However, among these states, I could locate no provision specifically including, or excluding mental health issues. 

Instead, the statutory language focuses on the requirement of a “competent, terminally ill patient.” A vague, ambiguous term. When a person’s life hangs in the balance, there are few things as egregious as including terms which are vague, subjective to numerous interpretations and which are not readily definable.

So, what is the difference, if any, between MAiD and PAS?

Some health advocates and medical professionals insist that a terminally ill patient with a recognized, biologically based, somatic disease taking medication to hasten the end of their life is doing something fundamentally different than suicide. The term “medical aid in dying,” they say, is meant to emphasize that someone with a terminal diagnosis is not choosing whether to die, but how to die. Their death is immediate and inevitable.

Anita Hannig, an anthropologist at Brandeis University and author of the book, “The Day I Die: The Untold Story of Assisted Dying in America,” stated, “A phrase like “medical aid in dying” would reassure patients that they were taking part in a process that was regulated and medically sanctioned. Medicine has that legitimating power, like it or not, that really removes a lot of the stigma.”

Now, look at the language used by Ms. Hannig.

A process that was regulated.

A process that was medically sanctioned.

I would add, a process focused on a biologically based, somatic diseases, thoroughly researched and studied. Diseases in which relatively objective findings, treatment regiments and outcomes had been thoroughly vetted and are considered reliable. A disease, which in an advanced state, medical science cannot effectively combat nor cure.

For this, yes, Medical Aid in Dying may very well be accurate, understandable and compassionate.

But for circumstances in which a mental health issue is the primary diagnosis? Particularly, Severe and Enduring Anorexia? A legion of questions abound.

When did Anorexia become terminal? Does the medical community even have a remotely accurate understanding of the manner in which eating disorders impact the brain? And if so, why haven’t effective, biologically based treatments been researched, studied and implemented?

For that matter, regarding eating disorders, we also know the following:

There are no generally accepted standards of care. The “experts” in the community cannot even agree about the most effective medical and mental health interventions to treat this deadly mental health illness. For that matter, should anorexia even be classified primarily as a mental health illness?

There is no effective collaboration with any other medical or mental health community.

Private equity companies have been allowed to dictate residential “standards of care” and the way this mental health illness is treated. Emphasizing profits over patient safety. Even a former CEO of a residential treatment center is now admitting to this reality.

There are no pharmaceutical drugs which have been specifically researched, trialed and then approved to treat eating disorders. The drugs being used today were all designed to be used for other mental health and medical issues.

If the statistics can be believed, the mortality rate for eating disorders is worsening.

It is with this background, despite these harsh facts, that some people are attempting to legitimize end of life options for Severe and Enduring Anorexia.

Seriously. What criteria and protocol would be utilized to establish that which constitutes the highest level of treatment care before patients are welcomed into the warm embrace of death? Some pro PAS professionals may even look upon death as not being a failure or even a bad outcome.

How many years would a patient have to be afflicted with Severe and Enduring Anorexia before a death protocol is appropriate for them?

What objective testing exists to determine brain atrophy? Testing which would give more objective evidence showing that a patient either has or does not have the capacity to make life and death decisions?

As it is, no state has set forth any minimum, objective biological standards which must be met before a death protocol is made available for patients suffering from mental health issues.

With many biological based, somatic diseases such as cancer, objective testing and decades of research support a medical finding that death is inevitable. And as a compassionate society, Medical Aid in Dying, with effective oversight and clear protocols, very well may be in humanity’s best interest.

However, with Physician Assisted Suicide for mental health issues, because of the dearth of medically objective criteria, the diagnosis of “terminal” is based not so much on whether a patient will die, but how they will die.  

That patient’s death may not be pending, may not occur soon and may not be inevitable. That is the heart of Physician Assisted Suicide. Besides subjective criteria experienced by some mental health providers, there appears to be no medically recognized protocols or standards supporting those person’s views.  That is not and should not be acceptable.

For the treatment of Severe and Enduring Anorexia, the brightest and the best medical and mental health doctors cannot collaborate and come up with treatment standards utilizing the latest technological and science-based knowledge and innovation. There are no protocols to preserve life.

When the community cannot come up with and implement a legitimate, generally accepted protocol for life, how can anyone seriously consider a protocol for death?

OHHHHHHHHH Canada …

A number of countries set aside March 17 as a celebration of St. Patrick’s Day.

The first St. Patrick’s Day parade in Ireland was held in Waterford in 1903. Strangely enough, this came hundreds of years after the first parade in North America. 

One of the longest-running and largest Saint Patrick’s Day parades in North America occurs each year in Montreal whose city flag includes a shamrock in its lower-right quadrant. This yearly celebration has been organized by the United Irish Societies of Montreal since 1929.

The parade has been held yearly without interruption since 1824. St. Patrick’s Day itself, however, has been celebrated in Montreal since as far back as 1759 by Irish soldiers in the Montreal Garrison following the British conquest of New France.

But this year’s St. Patrick Day promised a much darker, very somber day of international concern. This was the day Canada was prepared to implement medically assisted suicide for people whose primary health issue was a mental health disorder.

In 2015, Canada introduced medically assisted dying after its Supreme Court ruled that requiring people to cope with intolerable suffering infringed on fundamental rights to liberty and security. In 2021, the Canadian law was expanded after the Superior Court of Quebec struck down the government’s original assisted death law on constitutional grounds because it only applied to people whose deaths were “reasonably foreseeable.”

The 2021 law then expanded eligibility to people experiencing “grievous and irremediable” conditions. It included a separate provision for people suffering from mental illnesses. This provision was added to the law by Canada’s unelected Senate.

Perhaps understanding that the mental health aspect of the law was not just controversial but beyond the pale of the act of a compassionate, informed society, the implementation of this aspect of the law was postponed until 2023. It was then again postponed until March 17, 2024.

In the last two weeks, Canada announced it was postponing implementation of the mental health aspect of the law until 2027.

The reasons given were varied. The official, governmental explanation was, “… a special parliamentary committee studying the law concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so.” A committee spokesperson stated, “The system needs to be ready, and we need to get it right … It’s clear from the conversations we’ve had that the system is not ready, and we need more time.”  

 Many other reasons for this delay have been speculated. These reasons include:

It is a consequence of the inability of Canada’s public health care system to offer adequate psychiatric care, which is chronically underfunded and facing demand that outstrips its availability.

Many psychiatrists say the plan would undermine efforts to prevent suicide, and they have expressed fear that patients with complex problems will abandon treatments that can take years to achieve results in favor of a medically assisted death.

Not wanting to be left out, political viewpoints have entered the fray. The opposition Conservative Party charged that the liberal government of Prime Minister Justin Trudeau is promoting a “culture of death.” Some on the left oppose the expansion for mental illnesses and have said they want to focus on further expanding psychiatric care. At least one conservative member in Parliament favors an indefinite extension stating, “I don’t see any indication that the fundamental issues that are at the heart — or should be at the heart — of putting a pause on this expansion will be resolved.”

There are still other speculations. Canada has a socialized health care system. One analysis conducted in 2020 estimated a potential annual health care cost savings of $66 million. Certainly, the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on the health care system is alarming.

Then, there are religious aspects being taken into consideration. In Canada, in every province but one, the government exempts taxpayer-funded religious institutions from providing services deemed contrary to their beliefs. In 2016, these exemptions were extended to specifically cover assisted suicide. Last week, a Catholic archbishop filed a challenge to Canada’s law on physician-assisted death, which includes both medically assisted suicide and euthanasia.

Lack of access to quality care has been a baseline, foundational issue for as long as there has been a health care system. If you are wealthy or have health insurance coverage, you have the keys to unlock the door of the healthcare system. If you do not have that key, you are confronted with a “No Trespassing” sign. Shouldn’t a compassionate enlightened society be known not for how it treats the elite in its society, but the downtrodden?

In addition, readily being presented with assisted dying services—instead of treatments or alternatives—can create a sense of being undervalued or marginalized. It implies that end-of-life choices should be prioritized over efforts to provide care, support, or treatments that could improve one’s quality of life or extend their lifespan.

I have the good fortune of being included in a small group of professionals studying eating disorders and end of life options. The issues are many and daunting. Any real progress is problematic, albeit not impossible, at best.

And then, I read a question which so eloquently encapsulated a fundamental concern about physician assisted suicide. That is …

“Why is their suffering acknowledged enough for euthanasia but not enough to fund clinical research?”

Why indeed.

Diamonds in the Undertow

One definition of undertow is “a strong current flowing underwater in a different direction from the way the water on the surface is moving.” This is mostly experienced on a beach where the undertow strongly flows away or sideways in a different direction from the waves breaking on that beach.

There are so many factors regarding undertows. They are a natural phenomenon caused by various factors.  They can also be much stronger than what they appear. They can rapidly change directions and even strong swimmers can be pulled out to sea. Swimming or fighting against an undertow can exhaust a person until they lose all strength to keep fighting.

They vary in strength and the signs of them are not always obvious. The undertow can be deadly. They serve as a reminder of the immense power and unpredictability of nature.

Of course, another definition for undertow is: “an implicit quality, emotion, or influence underlying the superficial aspects of something and leaving a particular or lasting impression.”

An implicit quality underlying surface impression.

Implicit quality such as the grief experienced by a parent after their beloved child dies. No matter how much time passes, that unthinkable grief remains within us, under the surface, swirling, changing, varying in strength, inexorably trying to pull us away from ever feeling a sense of “home.” It never leaves us. But it is there. And the undertow of grief can be brought to the surface in unexpected ways at unexpected times by unexpected events.

Yesterday, I was about to walk into a grocery store. [I do most of the cooking.] As I was about to turn off the car, “This American Life,” a program on NPR (Yes, yes… I listen to NPR and not infrequently!) began to talk about an event experienced by a grieving couple suffering the loss of a child. This couple attended a comedy show in Los Angeles and sat in the front row. The warm-up act, a comedian named Adam Ray, began a bit about children and how kids are a pain in the neck! He then involved the audience and eventually addressed the couple.

The comic asked the father how many kids they had.  He said two. The comic asked their ages.  The father hesitated. Not immediately answering. The comic took this as a sign that he did not know so he started in on his wife with what he believed was good natured ribbing. He even asked which of the children they loved more. The mom then stopped down the show by saying in a clear voice, “our son is dead.”

Naturally, at that point after hearing groans from all, shock and awkwardness permeated the crowd and the performers. Where do you go from that? The comic was stammering a bit at that point and did not know how to end his set with anything resembling grace or humor. But then from somewhere in that incredible mom’s heart, she said:

“But … my dead son would have loved this!”

The crowd erupted in cheers and after that mom said his name, the performers and crowd repeatedly called out Max’s name.

This interaction can be found here:

And I found myself in the car with tears coming down my cheeks.

What incredible grace this mother had. What strength. What inspiration to turn an awkward situation into one filled with laughter and love.

But now, for the rest of the story.

Today, Sunday, I went to NPR’s website to listen to that episode again. Here is the link:

https://www.thisamericanlife.org/823/the-question-trap

I am publishing this article on the afternoon of Sunday, February 3, 2024. On NPR’s website it reports this episode, “The Question Trap,” is not being aired until 7:00 p.m. … on Sunday, February 3 ,2024!

What I listened to was not a teaser-trailer. It was not a portion of that segment. At the end of what I listened to there was no promo, “For the rest of the stories tune into Socialist Radio… [I mean NPR] Sunday night, February 3, 2024, at 7:00 p.m.”

How was I able to listen to something that deeply moved me, that moved me to tears, on NPR before the episode was even released?

Sometimes salvation or enlightenment come from the most unexpected places in the most unexpected ways.

The interaction with those parents and the strength shown by that mom came on the heels of a very significant event for me … and Morgan. When Morgan passed, her bodily remains were cremated. I have given small vials of her to family, to trusted friends to be spread where they believe she would have traveled or loved to see.

And so, parts of Morgan are in Venice, Tahiti, Key West, Cabo, and even the Texas end zone in the venerable old, Cotton Bowl in Dallas, Texas. And now … Barbados.

We were there last week. Deep sea fishing. (A shark ate one of the black fin tunas up to its head while it was on the line. The shark left me alone … professional courtesy and all that). Relaxing and recalibrating. And then, snorkeling.

Barbados beaches offer crystal clear water and shipwrecks just offshore. Wrecks which have begun to turn into coral reefs. Fish life galore. Sea turtles. A different aspect of our world. And one small, precious vial of Morgan made this journey.

As I was hovering over one of those shipwrecks, the top of the ship was as close as 10 feet to the surface. It was time.

So, I pulled her vial out, said a brief prayer and opened the stopper.

When salt water initially interacts with ashes in a confined space, the initial result looks like a thickish, white smoke. By now, tears were beginning to flow. [Try snorkeling and crying at the same time.] I gently tapped what was her temporary glass home … and she was liberated.

Many fish, probably believing it was feeding time, rapidly closed on us. Too many to count.  In various colors, shapes and sizes. Swimming around us. Perhaps a few tried to ingest her. But then.

One of those moments in life you will always remember happened. Perhaps it was the manner in which the bright sun shone in the water. Perhaps it was something else.

But as the fish swam around and through Morgan, her ashes were spread out by their activity (and perhaps the gentle undertow?) and then began to slowly drop directly over the shipwreck. Through tearful eyes, I saw, I experienced, each particle of Morgan began to shine brightly, like very small diamonds. Incredibly bright. Thousands of small diamonds slowly descending. Shining. Glittering. Iridescent.

The fish continuing to swim through her, around her, spreading her further. Then those glittering diamonds began to slowly drop onto the shipwreck. To become one with it. Her new home.

I could only shake my head hoping that would clear my eyes. But the imagery remained.  Or was it the reality? I was caught in an incredible moment of love, but also of heartache. Caught up in the divine mysteries of our very existence.

Those precious, little diamonds flowing away from me as surely they must. And becoming part of something far greater. I lingered for quite some time just watching, taking in the environment, taking in one of Morgan’s last resting places. And I grieved.  But I also loved.

And once again, I was reminded of what the eating disorder community should be fighting for. A reminder of what the eating disorder community should be united behind. A reminder of what the eating disorder community should be emphasizing above all else. 

A parents love of their child. The lives of our children.

The lives of our children.

Obstacles, Self-Awareness and our Humanity

When people, organizations, and yes, even nations have strong disagreements, it seems to be human nature to focus on the need to be right. We look at existing problems myopically. It has become ingrained that we must be correct. We listen to reply … not to learn. And somewhere along the way, we lose our humanity.

Our humanity.

The essence of who we are, who we complex, yet fragile people are, becomes secondary if not lost altogether.

Our humanity.

This reality was recently brought home in an unexpected way. While on vacation, I was bobbing around in the Atlantic Ocean on the eastern most island in the Caribbean. I got this feeling of being a speck really, at the mercy of a force far greater than me. The ocean, its deep mysteries, its majestic nature, its unique characteristics, was made manifest as wave after wave pressed its might against me. Unstoppable. Unrelenting. I was in the presence of an overwhelming force, filled with its own living organisms and truth be told, I was helpless and at its mercy.

One individual. One human. Overwhelmed by the reality that the forces around me could take a life, any life, my life, without hesitation or delay. There was no humanity that I could see.

And yet, it is humanity about which we must be keenly aware. Especially in times of conflict, strife and crisis.

By now, most people know or have heard about the lawsuit involving Bonnie Harken, iaedp and the three (3) directors overseeing all of the corporate chapters. People may know the lawsuit alleges and illegal tying agreement involving certification and iaedp membership and mandatory attendance at iaedp’s symposium. This by itself would be a large obstacle.

But that is not the only huge obstacle being faced.  Complaints have also been directed against iaedp regarding BIPOC membership and lack of BIPOC leadership. The petition involving those topics (and certification) and calling for Ms. Harken’s resignation, is now up to 208 signatures. This number is incredibly significant when considering the size of the eating disorder community.

Then there is the issue pertaining to the demands for dissolution from iaedp corporate chapters. Baltimore. New Haven. St. Louis. Denver. Central Coast. Baltimore. Phoenix. All wishing to disassociate from the national chapter.

Any person facing these significant obstacles alone would surely question their own motivations and conduct. Your membership and chapters demanding disassociation and your resignation. The heartache knowing that an organization for whom you toiled for 22 years no longer wants you is shattering to the ego of any person.

And now, the stakes have escalated and exposure is far greater. With this added reality, the pressure must be nearly inconceivable. These added stakes now include complaints and requests for investigation being made to:

The Internal Revenue Service

The U.S. Department of Labor

The California Franchise Tax Board

California Senator Dan Cortese

The same Senator Cortese, the Chair of California’s Senate Labor, Public Employment and Retirement Committee who stated, “An independent contractor is a specific designation for self-employed people or businesses engaged in contract work. It’s not a gimmick for organizations to avoid paying for employee healthcare and other benefits or reducing their tax liability. Any company found breaking the law will be brought to justice, and they would certainly have no business advising other companies on labor law.”

If my reading of the law and its interpretation is correct, the tax issues facing not just Bonnie Harken and iaedp, but iaedp’s national board of directors could be momentous.  And result in draconian measures against one and all.

Ms. Harken believed she could run all operations of iaedp and remain outside the purview of state and federal administrative agencies. Most tax-exempt organizations, such as iaedp, are required to withhold and pay federal income tax with respect to wages of their employees in the same manner as for-profit organizations. These organizations are also required to withhold and pay these taxes, also known as Federal Insurance Contributions Act taxes, in the same manner as for-profit organizations.

California requires employers to withhold state income tax from wages paid to employees. There are also three other state payroll taxes.

Presumably, Ms. Harken believed she could get avoid these taxes by classifying herself as an independent contractor and utilizing her dissolved corporation as a “go between” entity.  If she is wrong, the consequences for not just her but iaedp’s board of directors could be financially, mentally, and emotionally catastrophic.

With all of these issues, I cannot begin to fathom the pain, the fear, the uncertainty, the anguish experienced every day by a person facing those insurmountable objects. As the twilight of our existence on this plain overtakes us, most of us hope to be able to look back upon a life well lived and filled with happiness, purpose and love. To be thrust into numerous battles against state and federal agencies would test the resolve and strength of any person. In the twilight of our life and career though? Devastation.

We are all but specks of living tissue. Fragile bodies. Throughout our lives, we face forces so much greater than us. What we are left with as we fight our on-going and dying battles is our humanity.

Humanity.

And grace that must be extended to those in such pain. For in extending grace, we embrace our own humanity. Accountability? Yes, absolutely. But that should never color or diminish extending grace and embracing our humanity.

And the humanity of others.

When Awkward Becomes … Not Awkward

On January 8, 2024, I had the pleasure of appearing on the “Making it Awkward” podcast.  This podcast is hosted by Jessica Wilson, MS, RD, and Whitney Trotter, DNP.

Some of their past topics included: Feeling Aligned in Queer Fashion, BMI and Transcare, Things Got Awkward at the Trans Health Summit, The Research on BMI and Gender Affirming Care, Is Non-Binary Identity a 3rd Gender Category, and other important topics. At first glance, the lens utilized by the hosts on these and other topics would be very different than mine. Or is it?

When asked to appear, I did not hesitate for a second.

And so, the day arrived. Right out of the gate, the questions were hard hitting. And yet, they were fair. Potentially sensitive issues, issues which many would consider awkward, were addressed.  

There is no doubt that on many issues, our views were very different… at times maybe even polar opposite. However, at all times, as we discussed these topics, there was a feeling of respect, of professionalism, of courtesy.

If asked back, I would agree in a heartbeat.

As I reflected back upon our interaction, perhaps I gained a bit of insight. And that is, on sensitive issues, issues and topics which have the potential to be incredibly awkward, perhaps respecting the person, of treating each other with courtesy, with respect, with civility is the best weapon to diffuse these awkward topics and issues. To turn awkward issues into issues upon which we can work together even if we maintain divergent points of view. That is a special gift.

So, Whitney and Jessica, thank you for that gift.

I look forward to future interactions with you both!

Dateline iaedp … and Mixing Metaphors

I am reminded of the old saying, “If an iaedp Symposium falls in the forest and no one is there to hear it, does it make a sound?”

Bonnie Harken a/k/a iaedp is in some ways, and unlike Jules in the movie Pulp Fiction, beset on all sides by the equities of the just and the goodness of those seeking integrity. However, Ms. Harken does not see that and instead is determined to bring to reality her belief that she will, “fight to the bitter end.”

In doing so, Ms. Harken bastardizes the maritime tradition summed up by the phrase, “A captain goes down with the ship.” What that statement really represents is a captain’s sworn duty to forego their own departure from the ship and in some instances, sacrificing their own life in order to try to save as many souls as possible on board. Saving lives. Placing others before you. Selflessness. It does not mean punching holes in the hull of your own ship/organization to speed along its demise.

The iaedp ship has hit the iceberg. So, let’s examine the evidence and information supporting this inevitability.

First, some of the “independent” corporate chapters of iaedp, each of which were organized by Ms. Harken and each of which has Ms. Harken as the Chair of their Board of Directors are beginning to see the handwriting on the wall and are quickly manning the lifeboats.

The St. Louis Chapter.

The New Haven Chapter.

The Los Angeles Chapter.

Purportedly, the Phoenix Chapter is in discussions to dissolve.

And finally, the Baltimore Chapter.

However, the Baltimore Chapter opted to issue a public statement. A statement eviscerating iaedp.  That statement is here:

These are not insignificant chapters. Ms. Harken and her co-defendants have the fiduciary duty to file the Articles of Dissolution. To date, that apparently has not been done.

There are other issues of grave concern indicating the Visigoths are at the gates of iaedp.

On December 17, 2023, a petition was started calling for the ouster of Ms. Harken and the certification process being removed from iaedp. To make it clear, I did not draft the petition. I did not edit it. I did not see it. I was not asked about the petition.  IF I had been asked, I would have counseled against the petition.

Since this was one week before Christmas, to presume anyone would read, let alone sign this petition was naïve.  That time of the year we are focused on our loved ones. Our families. Our children. To believe that people would spend time in studied contemplation of a seismic change in an eating disorder organization would simply not happen. And yet.

Here we are one month after the petition started and there are now ONE HUNDRED NINETY (190) signatures. Considering the size of iaedp (and its now shrinking nature) and the small size of the eating disorder community, this number of signatures is incredibly significant.

That petition can be found here:

https://www.change.org/p/remove-bonnie-harken-as-managing-director-of-iaedp-change-certification-policy-ae99d4fe-d465-478b-85f7-9c714397fb5e

These 190 people have flooded the lifeboats. Their voices are loud.

There also seems to be an overall lack of planning, vision and collaboration in the eating disorder community.

Ms. Harken and iaedp epitomize these qualities. This is evidenced by the timing of the 2024 Symposium. The 2024 Symposium takes place one week after the International Conference of Eating Disorders (ICED) hosted by the Academy for Eating Disorders (“AED”). ICED 2024 takes place in New York City. To believe that the brightest and best clinicians, medical and mental health practitioners can take two consecutive weeks away from their patients is not possible. And this year some of the most controversial topics will be discussed and explored at ICED.

Purportedly, sponsorships and registration for iaedp’s 2024 Symposium is dramatically down this year. If attendance remains historically low, this will have a dramatic financial impact on Ms. Harken.

Then, there is the pending litigation. Facts and information are crucially important when allegations of the type asserted in the lawsuit against iaedp and Ms. Harken are made. In order to provide facts and information to the “independent” corporate chapters, I have on a number of occasions, communicated in writing with most of the chapters. I sent to them the following:

  1. Information on my background and advocacy;
  2. Information showing that iaedp has never had a separate, independent audited financial statement prepared;
  3. Information showing that Ms. Harken’s corporation, Crossroads Programs Inc. did not exist, and was being misrepresented on iaedp’s Form 990 tax filings as being in existence [This was admitted by Ms. Harken’s prior attorneys and on the latest Form 990, the corporate status of Crossroads has been removed];
  4. Information showing that according to the California Secretary of State’s records, iaedp was not authorized to operate or solicit for charitable purposes in the State of California since February 15, 2019 [That has since been corrected];
  5. Information showing that in the past, I had reached out to Ms. Harken asking her to provide resources that I could forward to Apple for their employees to have access when I gave a presentation to Apple’s employees;
  6. Information emphasizing that the corporate chapters were not targets for litigation and I gave them resources for them to possibly obtain very low cost attorney’s assistance;
  7. Information showing that the certification process may violate antitrust laws and information regarding the recent case in New Jersey;
  8. Information about the “Remove Bonnie” petition including the link to the petition;
  9. Illinois resources were given regarding how to dissolve a non-profit organization in Illinois.

This information was in writing and where possible, supported by documents or links to sites on the internet. I repeatedly emphasized that I was open for any questions and assured everyone they would be treated with professionalism and respect. Some people did contact me. Our communications were very cordial.

Until recently, my understanding is that instead of discussing these many concerns and issues with iaedp, Ms. Harken chose instead to attack the messenger. In the legal community, we have an old saying. “When you don’t have the facts, argue the law. When you don’t have the law, argue the facts. When you don’t have either, bang your shoe on the table and yell very loudly.” Iaedp is banging and yelling. The community deserves better than that.

There is the issue of where does the lawsuit go. The attorneys appointed by the Officers and Directors Insurance Company have signed “waivers of service” which means the defendants will file their first responses in federal court in the next few weeks. The first response will undoubtedly be a Rule 12(b)(6) Motion to Dismiss.

This motion requests the Court to dismiss the case at this very early stage and asserts that sufficient facts have not been set forth to support the pleadings. We are allowed to respond. The defendants will reply. And sometime later, the Court will decide.

Ms. Harken’s attorneys will file a Motion to Transfer the case to the district in which Ms. Harken lives. For the ease of all parties and because the parties and witnesses are spread throughout the United States, we believe it more economical for the case to remain in Texas. Again, the Court will decide this matter.

The Court may decide, “Dunn, you and your clients are loons. Case dismissed.” I respectfully submit that it is much more likely the case will not be dismissed at this stage. And when the case is not dismissed, the likelihood that certification will be taken from iaedp increases dramatically. And whatever is left of iaedp at that time, undoubtedly will do its Humpty Dumpty imitation.

Opportunities for resolution were presented to Ms. Harken before litigation was filed. They were not responded to.

Now, people in the community must ask themselves … who has the greater credibility?  The person who has been providing information, and facts, and documents (none of which has been publicly refuted by the other person) and has reached out and is open to questions and communications. Or the person who has not provided information and who instead has cast aspersions and who is insisting on absolute power and control?

This all should make any reasonable person wonder, where is iaedp’s Board of Directors? So many facts and issues have already been uncovered that one can presume any informed, involved Board of Directors would take notice and would have taken strong steps to thoroughly investigate and then take action in this matter. However, in standing with Ms. Harken, those people on the board need to understand that sometimes the light at the end of the tunnel is on oncoming freight train. And they too, could become, or are already, legitimate responsible parties.

Sometimes, the questions presented to us are very simple. And Occam’s Razor applies. Do you trust the person who repeatedly reaches out a helping hand to assist those in the water to get into a lifeboat? Or do you trust the person who is supposed to be the captain but instead, is only looking out for her own lifeboat?

DOUBLE EFFECT AND PHYSICIAN ASSISTED SUICIDE

With the approaching legalization of Physician Assisted Suicide (“PAS”) for mental disorders set to take effect in Canada on March 17, 2024, both proponents and opponents are making last ditch efforts to forestall or support implementation.

The statutory law is complex, extensive and awash in legalese.  So, I am embedding a link to this law:

https://www.parl.ca/documentviewer/en/44-1/AMAD/report-2/page-ToC

A Reader’s Digest version of this law, as it pertains to “mental disorders,” and presuming the “mental disorder” does not result in a natural death that is reasonably foreseeable is as follows:

Safeguards for persons whose natural death is not reasonably foreseeable.

The following procedural safeguards apply to persons’ whose natural death is not reasonably foreseeable (*indicates safeguards specific to those requests):

  • request for MAID must be made in writing: a written request must be signed by one independent witness, and it must be made after the person is informed that they have a “grievous and irremediable medical condition” (a paid professional personal or health care worker can be an independent witness);
  • two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met;
    • *if neither of the two practitioners who assesses eligibility has expertise in the medical condition that is causing the person’s suffering, they must consult with a practitioner who has such expertise;
  • the person must be informed that they can withdraw their request at any time, in any manner;
  • *the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and must be offered consultations with professionals who provide those services;
  • *the person and the practitioners must have discussed reasonable and available means to relieve the person’s suffering, and agree that the person has seriously considered those means;
  • *the eligibility assessments must take at least 90 days, but this period can be shortened if the person is about to lose the capacity to make health care decisions, as long as both assessments have been completed;
  • immediately before MAID is provided, the practitioner must give the person an opportunity to withdraw their request and ensure that they give express consent.

To provide greater insight, I am embedding testimony taken in May 2022 before the Special Joint Commission on Medical Assistance in Dying:

https://www.parl.ca/DocumentViewer/en/44-1/AMAD/meeting-9/evidence

This site contains much of the evidence and testimony elicited when the Canadian law was being vetted. And of course, there are a number of matters and issues of concern contained within the Report and testimony.

For example, with regard to the crucially important, “Balancing Individual Autonomy and the Protection of the Vulnerable,” the Committee’s findings constituted only four (4), short paragraphs and ended with the following conclusion: “The committee recognizes that a delicate balance must be struck between promoting individual autonomy and protecting against socio-economic vulnerabilities.”

We have an adequate grasp of the painfully obvious. Perhaps the Committee should have focused on the merely obvious conclusion.

Under the Canadian law, the Committee stated, “To be eligible for MAID, a person must have a ‘grievous and irremediable medical condition.’ As Jennifer Chandler explained, “irremediable” is not a medical or scientific term. Rather, as noted above, “grievous and irremediable” is defined in the law as incurability, being in an advanced state of irreversible decline, and “enduring physical or psychological suffering that is intolerable to [the person] and that cannot be relieved under conditions that [the person] consider[s] acceptable.”

Because of this wording, eligibility must meet ALL of these criteria. Further, if we are to use that definition, doesn’t that necessarily exclude all instances of anorexia nervosa? Incurability? Anorexia?

With regard to Minors, the Committee stated, “In Canada, a person must be at least 18 years old to access MAID. However, minors with the requisite capacity are generally entitled to make their own healthcare decisions. The exact parameters of minor consent to healthcare vary by province.” The Committee then held, “The term ‘mature minor’ refers to a common law doctrine according to which “an adolescent’s treatment wishes should be granted a degree of deference that is reflective of his or her evolving maturity.”

Minors. Our teenagers. Our children.  The Committee also found, “In the Netherlands, MAID is allowed for minors aged 12 and over, and may soon be expanded to include younger children. In Belgium, there is no minimum age, so long as the minor has the requisite capacity.”

So, are we to allow young people, our children, whose brain is not biologically developed let alone mature to make life or death decisions? Where is the morality in that?

Principle of Double Effect

Which brings us to the issue of a just society and the morality not only of medical professionals making this life or death call, but whether the very act in question is morally right. To this, we turn to the Principle of Double Effect. (Principle)

The Principle has its historical roots in the medieval natural law tradition, especially in the thought of St. Thomas Aquinas (1225-1274). It has been refined both in its general formulation and in its application by generations of Catholic moral theologians[1].

Although there has been significant disagreement about the precise formulation of this principle, it generally states that, in cases where a contemplated action has both good effects and bad effects, the action is permissible only if it is not wrong in itself and if it does not require that one directly intend the evil result.

Classical formulations of the Principle of Double Effect require that four conditions be met if the action in question is to be morally permissible:

  1. First, that the action contemplated be, in itself either morally good or morally indifferent;
  2. Second, that the bad result not be directly intended;
  3. Third, that the good result not be a direct causal result of the bad result, and;
  4. Fourth, that the good result be “proportionate to” the bad result.

Supporters of the Principle argue that, in situations of “double effect” where all these conditions are met, the action under consideration is morally permissible despite the bad result[2].

The Principle is regularly invoked in ethical discussions about palliative sedation, terminal extubation and other clinical acts that may be viewed as hastening death for imminently dying patients. Unfortunately, the literature tends to employ this useful principle in a fashion suggesting that it offers the final word on the moral acceptability of such medical procedures. In fact, the rule cannot be applied appropriately without invoking moral theories that are not explicit in the rule itself. Four tenets of the rule each require their own ethical justification. For example, the third condition must necessarily invoke the Pauline Principle which states, “One should never do evil so that good may come.” 

Some ethicists believe that if a suffering, terminally ill patient dies because of intentionally receiving pain-relieving medications, it makes a difference whether the death itself was intended or merely anticipated.  If the death was intended it is wrong but if the death was anticipated it might be morally acceptable[3]. 

Philosophers and medical ethicists have speculated that, “According to this Principle, euthanasia and physician-assisted suicide are always illicit acts, while the same is not said for other actions that bring about patient’s death as a foreseen effect, namely, palliative treatments that hasten death or failure or interruption of life support. The reason for this difference is that, in the first two cases, the patient’s death is intended as a means of pain relief; whereas, in the latter two, death is only a side effect of a medical act, an act justifiable if it is necessary to achieve a proportionate good.”

We also need to question whether the moral objection to an action is the same as the physical performance of that action. Dr. Paulina Taboada addressed this question accordingly, “But the physical performance of an action (actus hominis) does not necessarily coincide with a moral act. Only an action in which human freedom is exercised (actus humanus) can be morally qualified. A moral act is essentially an act in which human freedom is exercised. This means that the moral act itself is marked by an ‘intrinsic intentionality’; it tends towards an object (called moral object).”

Dr. Taboada then stated, “Hence, the moral act cannot be properly characterized by describing a mere physical performance. In order to find out which is the kind of moral act we are performing (i.e., the ‘moral species’ of the act), the key question is: What are you doing? And an answer like “injecting morphine to this patient” would not do it. The proper answer to this question – relieving pain – reveals the ‘intrinsic intentionality’ of the moral act. An analysis of the lived ethical experience shows that the moral character of our free acts is basically determined by this ‘intrinsic intentionality’ of the act, i.e., by the kind (‘species’) of act we perform.”

Dr. Taboada then concluded, “A careful analysis of our most basic human moral experience shows that the ethical character of human acts does not primarily depend on the motivation or intention of the agent, but on the moral species of the action to be performed. Hence, the common saying ‘the end does not justify the means’.[4]”

The Canadian law, at best, paid lip service to this incredibly complex issue. An issue which not only touches our existence, but the very heart of our humanity. Faith. The Soul. Life. Death.

Our society seems to be in such a rush to show all others that we are capable of performing a certain act better than it has ever been done … and thus, show our individual wisdom and humanity. However, in doing so, we have lost sight of the question we need to be exploring, that is, “Should we do this act?”

A question that our medical and mental health providers certainly cannot answer. Perhaps there is no answer. And yet, if we do not keep exploring the boundaries of our being, our imagination, our very lives, we will continue to fail. We will fail on a generational level.

We cannot, and do not have the luxury of taking action without seeking wisdom from all interested parties. We must work toward being open to options we never previously considered. We must strive to chart the unknown and unlimited possibilities of existence.

And we can only do that if we take all reasonable and necessary steps to preserve the sanctity of life.

[1] http://sites.saintmarys.edu/~incandel/doubleeffect.html

[2]https://pubmed.ncbi.nlm.nih.gov/3080130/#:~:text=The%20doctrine%20holds%20that%2C%20in,%2C%20and%20(d)%20there%20is

[3] https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia

[4] https://hospicecare.com/policy-and-ethics/ethical-issues/essays-and-articles-on-ethics-in-palliative-care/shaws-criticism-to-the-double-effect-doctrine/