Thursday, July 30, 2020

Egypt The land of Cleopatra The strongest woman of History persecuting poor women


 Egypt The land of Cleopatra The strongest woman of History  persecuting  poor women 

Egypt jails six young women over TikTok videos
The women, who do satirical lip-syncs, comedy skits, dance videos and voice-overs, were all given jail sentences
By ALISON TAHMIZIAN MEUSE
JULY 30, 2020


A woman watches a video of influencer Mowada al-Adham, who was sentenced to two years in prison on charges of violation public morals, on the video-sharing app TikTok in Egypt's capital Cairo on July 28, 2020. Photo: AFP/Khaled Desouki
Egyptian courts have handed down multi-year prison sentences to six young women in the past week over TikTok content, deeming lip-syncing, dancing and explainers for how to monetize social media as “inciting debauchery” and “calls for prostitution.”

In their short videos on the app, the young women appear doing satirical lip-syncs, comedic skits, dance videos and voice-overs, content that is widely popular around the world on the Chinese mobile app.

At least one of the women received a request by investigation to inspect her hymen, a so-called “virginity test,” a practice the World Health Organization says has no scientific merit and may cause long-term psychological damage.

Another of the young women’s mothers told Egyptian media she sold the family’s refrigerator and washing machine to post bail and prevent her daughter from spending a night in an Egyptian prison.

In 2011, Amnesty International discovered that a male Egyptian doctor had forced a group of 18 arrested female protesters to undergo “virginity tests” in full view of other men who were taking pictures.


“We didn’t want them to say we had sexually assaulted or raped them,” an Egyptian general explained as the authorities’ justification at the time.

On Monday, the lawyer for TikTok-er Mawada al-Adham told Egyptian media his client had refused to submit to the controversial procedure.

Why destroy someone?
In the run-up to the arrests, one of the young women posted an emotional video recounting the abuse she had received online over her social media presence.


“How do you benefit from destroying a human being?” demanded Haneen Hossam tearfully, days before being arrested for allegedly encouraging women to engage in prostitution.

Hossam said she had only offered tips to her followers on how to monetize their social media presence and not to engage in any inappropriate behavior. She argued that social media influencers had the right to earn money like any other profession.

“Does anyone agree to work without getting paid?” she asked.

In recent years, big-name influencers such as Kylie Jenner and Bella Hadid have wracked up millions of dollars in endorsements through their ubiquitous social media presence, which they have used to plug brands as well as their own business ventures.

On Monday, five Egyptian female social media influencers including Hossam were found guilty of “harming family values,” each sentenced to two years in prison and fined 300,000 Egyptian pounds (US$18,750).

Then on Wednesday, TikTok-er Manar Samy was handed a three-year sentence on charges of “inciting debauchery, immorality and stirring up instincts” through her online videos.

Samy, in her early-to-mid twenties, dances and lip-syncs to popular music in her videos, something ubiquitous to TikTok the world over. An Egyptian court deemed the content to be “offensive to public decency” and posted with the intent of soliciting sex work, a societal death sentence in a conservative and patriarchal society like Egypt.

Double standards
The court cases centered on protecting “family values” in a country notorious for sexual harassment of women, raising accusations of double standards among civil society activists.

Mohamed Khairat, the founder of the independent English-language website Egyptian Streets, suggested a comparison between the treatment of an Egyptian male soccer star and one of the young women jailed.

“Egyptian football star Amr Warda … sexually harassed several women on social media, often aggressively. Punishment? None,” he tweeted. Next to Warda he posted a photo of Mawada el-Adham. The young woman, he said, “posted ordinary videos on #TikTok.”

Her punishment? “Arrested for ‘violating public moral and family values.'”





Egypt’s most famous soccer player – Mohamad Salah – famously deployed his star power to defend his teammate Warda after the latter’s aggression toward women came to light.

Warda, who had been benched by the Egyptian Football Association last summer, was quickly returned to the field after Salah’s intervention.

Egyptian Streets is now trying to raise awareness and bring justice to a 2014 incident, in which a group of wealthy and connected young men allegedly drugged and gang-raped a young woman in the Fairmont Hotel in Cairo, posting the video online and threatening her against retaliation.

Rights groups say more freedoms have been curtailed in Egypt under President Abdel Fattah al-Sisi, who took office in 2014. Feminist Mona Eltahawy took to Twitter to point out that previous “virginity tests” against demonstrators were carried out when Sisi was head of military intelligence.





Egypt has in recent years enforced strict internet controls through laws allowing authorities to block websites seen as a threat to national security and to monitor personal social media accounts with moe than 5,000 followers.

– With reporting from AFP

Wednesday, July 29, 2020

Obsolete and Outdated- National Guidelines for Stem Cell Research - 2017 INDIA and stem cell therapies

NAC-SCRT, Government of India
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Department of Health Research

Ministry of Health & Family Welfare

Government of India


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“As per the National Guidelines for Stem Cell Research - 2017, at present, there are no approved indications for stem cell therapy other than Haematopoietic Stem Cell Transplantation (HSCT) for haematological disorders. Accordingly, all stem cell therapies other than the above shall be treated as investigational and may be conducted only in the form of clinical trials after obtaining necessary regulatory approvals. Use of stem cells for any other purpose outside the domain of clinical trials will be considered unethical and hence not permissible.”

Tuesday, July 28, 2020

Death of Indian Sandalwood

Ironically, it was a well-intentioned diktat for protecting sandalwood that delivered the knockout punch. In 1996, in an example of the road to hell being paved with good intentions, the central government decided to regulate the export of sandalwood and its oil by imposing export quotas. It set up a system of raw-sandalwood auctions. One could export the oil only if one bought the wood.

That move constricted supply and jacked up the price of Indian sandalwood oil. Today, it costs anywhere between Rs. 65,000 per kg if it is extracted from smuggled wood and Rs 1.5 lakh per kg. of genuine source material. India has out priced itself from the market, while Australia has positioned itself as the dominant supplier of sandalwood and its oil. It has also started growing Indian varieties.

Ironically, India will soon begin buying sandalwood oil of the indigenous variety grown in Australia.

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“Indian sandalwood oil is priced at Rs. 65,000 per kilo which is easily twice the price of sandalwood oil from Australia and three times the price of African sandalwood oil. According to Kapoor selling such a product at a global level is impossible.” On top of that, it takes inordinately long to get an export license. The first set of export licenses were issued in 1998, almost two years after the first auction.

“How could you wait for two years before delivering an export order? No international client will wait that long,” says Moraddhwaj Saini, another erst-while distiller. The bigger problem as a distiller and exporter is the lack of surety about obtaining the next license and thus guaranteeing regular supplies to one’s clients overseas.

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Kapoor finally brought down the curtains on their distillation plant and set up another small unit the by gathering sandalwood dust. Kapoor’s distillery is one of 22 such distilleries in Kannauj was the last to be closed down. An offshoot of a century-old sandal oil distillation business, Indian Fragrances & Chemicals used to make 800 kg of oil a month belongs to Kapoor’s family has been shut down in 1998.

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A Fading Fragrance:

One obvious fallout of the unabated increase in sandalwood prices is that it has totally distorted the character of Kannuaj’s traditional attar industry.

In the 1970s, attar made from top-quality sandalwood oil sold as a personal fragrance; that from inferior quality oil went into making incense and flavoring pan masala.

When oil prices shot up, attar as a personal fragrance became prohibitively expensive. Already, preferences were changing towards modern perfumes; this hastened the process.

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By the start of the 1980s, attar manufacturers turned to the other domestic industry which was coming up in a big way — the pan masala and tobacco industry. But attar producers had to meet the price compulsions of pan masala and tobacco industry, so they began substituting sandalwood oil with liquid paraffin and other similar compounds as the base ‘note’ or layer. “How can a gutkha a mix of pan masala and tobacco sachet continue to be priced at just Re.1 all these years when sandalwood oil prices are shooting through the roof?” asks Saini. “Attar manufacturers had to find some way to substitute sandalwood oil.”

Today, 90-95% of all attar manufactured in Kannauj is used for flavoring pan masala and tobacco. Only around 10-15% of all attars use sandalwood oil primarily because the main consumers of attars are the pan masala industry do not want to increase the retail prices of their products.

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Of the 5 percent attar produced as personal fragrance, almost all is exported to West Asian countries like Saudi Arabia.

“Perhaps it may not be wrong to say that a whole generation has gone by without really knowing what true sandalwood oil-based attar really smells like,” say Pradeep Kapoor with a wry smile.

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He also belongs to the same family which started the first distillation and perfume factory in Kannauj. His family firm, Jagat Aroma, moved out of the sandalwood distillation business and now exports fragrance components to foreign perfume manufacturers like Lancome, Tom Ford and G’ Issey.

Double Whammy:

The story of India’s loss doesn’t end here. In the late 1990s, around the time that India’s grip on the sandalwood oil trade had begun to loosen, Australia spotted an opportunity and started working on a unique project: It started developing plantations of the Indian variety of sandalwood.

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Australia’s indigenous variety of sandalwood, Santalum Spicatum is decidedly inferior to the Indian variety, Santalum Album in terms of oil content. For that reason, Australia was till then a bit player in the sandalwood export market.

This however did not deter the Australian government to put in place the Sandalwood Act of 1929 to ensure the regeneration and sustainability of the most valuable commercial wood in the world. The Act mandates that only a percentage of sandalwood is available for harvest each year and for every tree cut down, a dozen seeds must be planted.

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At present there are about 20,000 hectares of sandalwood plantations of different ages and species in Australia. Most of these plantations are in Western Australia. The Forest Products Commission (FPC) which governs the state-owned sandalwood resources of Western Australia claims to be the largest supplier of sandalwood resources in the world.

As per the information sources there is about 15 to 17 ton of sandalwood oil produced a year in Australia with expectations of this increasing as the plantations mature. The majority of the oil goes overseas with little consumption in Australia and in a roundabout way, India might end up with about 20% of the exports says Tim Coakley, executive chairman of the Wescorp Group of Companies. Wescorp Sandalwood Pty Ltd is the sole processor, marketer and exporter of Santalum Spicatum for FPC. It is expected that Australia would start exporting the Indian variety of sandalwood oil to India in the course of the next three to seven years.

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“It’s really a shame how we have managed to ruin a sector where we enjoyed undisputed dominance. It is the result of over regulation” says Pradeep Kapoor.

Western Australia claims to be the only region in the world that can guarantee harvest of approximately 2,000 tons of sandalwood each year on a sustainable basis. In India exporters like K.N. Kapoor have to shut shop because they are not sure about the availability of sandalwood or the availability of export license.

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Sandalwood Legislation in Australia:

Licensing for the harvesting of sandalwood is managed by the Department of Parks and Wildlife under the Biodiversity Conservation Act 2016. It replaces the Wildlife Conservation Act 1950 and the Sandalwood Act 1929. The new legislation will enforce tougher penalties for illegal activities including unlicensed harvesting as well as improving trading and processing accountability.

The commercial harvesting of sandalwood on Crown land is controlled under the Forest Products Act 2000 and the Biodiversity Conservation Act 2016. The Forest Products Commission (FPC) is responsible for the commercial harvesting, regeneration, marketing and sale of wild Western Australian sandalwood from Crown land including land subject to pastoral leases.

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The sandalwood harvest limit is prescribed in the Sandalwood (Limitation of Removal of Sandalwood) Order 1996 (the Sandalwood Order) and is set on advice from the Minister for the Environment and approved by the Governor in Executive Council.

The Sandalwood Order took effect on 1 July 2016 and set the annual quota at 2,500 tons with a maximum 1,250 tons of green wood.

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The new volume will be processed to service our current international markets over the next 10 years and will support the ongoing sustainability of the industry.

The illegal harvesting and theft of sandalwood is a significant issue and is currently being addressed with the introduction of new legislation. The FPC is also working with the Department of Parks and Wildlife and the Commonwealth Department of Agriculture, who have regulatory responsibility under the Illegal Logging Prohibition Act 2012 (Commonwealth) to implement an assurance system which will assist to demonstrate legality and compliance with relevant legislation.

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The End of the Road?

But not all is lost. If the government wants, it can still work towards developing India’s sandalwood forests, especially by roping in the private sector and we can regain our lost dominance” says Saini.

“Look at how the paper industry thrives in the US, Canada or the Scandinavian countries,” points out Pradeep Kapoor. “They have a proper re-forestation policy. Here the government never involved the private sector who stood to gain the most from sustainable exploitation of the sandalwood forests.”

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In Canada it is a pretty straightforward deal. The forests remain the government’s property but are given to private players on a long-term lease of 100 years or more. This allows private players to plan better. For each tree that is cut, the company must plant two new ones. The state monitors the way the forests are being managed. Apart from the lease money, the government earns through local taxes.

Bangalore based environmentalist Leo Saldanha says, “If we allowed sandalwood to be farmed and there was an excess of supply then automatically it can intervene against thefts taking place and today it is very easy to steal it.”

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But he feels leasing forests to companies is not a solution for India because human densities in our forests are much higher. While travelling for days in the Canadian and North American forests you won’t find anyone he says.

“When you bring in industry just to make sure sandalwood farming takes place, the natural result would be that local people are denied their natural and rightful access to those lands” he adds.

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Saldanha’s solution is to allow tribal and forest dwelling communities to farm these valuable trees. “In reality, it is the local forest dwellers that catch the poachers, not necessarily the forest department officials. By and large protection to sandalwood comes from the local forest communities since it has cultural and religious sanctity for them.”

A very senior Indian Forest Service official, who requested anonymity, says India would have to ban all use of sandalwood for 20 years before we can regenerate that sandal wealth. Pradeep Kapoor says “Waiting would be both good and bad. Bad because no oil distiller can wait for such a long time and good because the move will get us back on track.”

Protect the forest by involving the communities, the birds will carry the seeds and do the job of planting and sandalwood’s regeneration potential will take care of the rest, says Saldanha. “It’s a very healthy tree; you don’t have to do anything.”

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An Evergreen Aroma:

Traditionally, all attars were sandalwood oil based because of the unique ability of sandalwood oil to lose its own mild fragrance and absorb another. The other reason for its use is the remarkable stability it provides to the perfume. It is generally held that well made attar based on sandalwood oil would smell just the same even after 100 years.

However, paraffin-based attar should not be expected to hold the fragrance for even a full year. Moreover, it lacks the medicinal qualities of sandalwood oil. “Sandalwood oil was the best fixating agent. That’s why it was valued. It was the base note over which the pyramid of an attar or perfume is structured” explains Pradeep Kapoor, a former attar maker.

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OSK REDDY
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Monday, July 27, 2020

Death with Dignity Act

The term "euthanasia," or mercy killing, refers to the intentional taking of another's life (with their consent) in order to ease the suffering of a terminally ill individual. Euthanasia is technically illegal in all states, although a few states allow physician-assisted suicide in a manner that gives the patient complete control over his or her demise. This remains a very controversial medical and social policy issue, involving several different aspects of medicine, religion, ethics, and law.


Death. “It’s the big elephant in the room. Everyone’s afraid to talk about it,” said Heather Bitar, D.O., a palliative care physician and assistant clinical professor in the Department of Supportive Care Medicine at City of Hope.
 
But “patients know when they’re not feeling well. They know,” she insisted. And when she is upfront with them about their prognosis, “Many are not surprised.”
 
Many of the dying don’t fear death as much as they fear how they will die, Bitar said. “It’s the in-between part people fear the most. If you can give them insight on what to expect, that can ease a lot of their concerns.”

No One Wants To Talk About It

However, it is as difficult for physicians to talk about death as patients, Bitar said. “Physicians may think it means they’ve failed their patients.” In addition, she said, oncologists can get overly focused on the tumor and tumor markers, “but I think it’s important to redefine the situation and remember a person is more than their disease.” In the face of incurable disease, instead of hoping for a cure, “You can hope for more time to do something special with your grandchild,” for example.
 
“We take cardiac arrest and CPR protocols so seriously, yet there is no protocol for people who are dying,” Bitar continued. “It requires an emphasis on compassion, empathy and learning the individual’s needs and that person’s and that family’s grieving process.”
 
When a person is dying, Bitar said, palliative care physicians  focus on treating symptoms rather than the disease, and they let the patient direct the care.
 
The three main symptoms that need to be managed at end-of-life are pain, delirium and shortness of breath, she said.
 
In addition, she said, “We get focused on the physical things, when a lot of the stuff is spiritual, such as  unresolved family dynamics. It’s amazing how much [physical] pain can be relieved when you address the emotional issues.”

The Dying Process

Since families are often unprepared for the dying process, “They can go into shock when it happens,” Bitar said. But, “no matter how you get there, natural death is similar for everyone.”
 
It begins with a person no longer wanting to eat. This is a natural reaction to the body starting to shut down and no longer being able to process food. Many families make the mistake of urging the patient to keep eating at this point, which will only make them feel ill, Bitar said. “When you’re dying, your body isn’t working in a way where it can naturally process these things, like intravenous fluids, food. It is no longer absorbed in the same way,” Bitar said.
 
Many families fear the patient is dying of starvation. “They’re not starving, they’re dying of their disease,” Bitar said. “When they’re entering the active stage of death, it doesn’t bother them that they don’t have an appetite.”
 
Once the patient has slowed or stopped eating and drinking, they become weaker and weaker, become bedbound and begin to go into kidney failure. When the kidneys stop functioning, toxins build up in the bloodstream. Their level of consciousness goes down at this point, and they go into a “dreamlike state.” The toxins cause their electrolytes to become unbalanced, which causes the heart to go into arrhythmia, and the weakened heart eventually stops.
 
This “active dying” process generally can take up to two weeks, and the focus should be on comfort and pain control, Bitar said. “In the final hours to days the person may not be able to verbalize their needs, so we have to know by their body language and facial expression what’s going on.”
 
The patient’s breath may become labored, and they may make a gurgling sound. “’Agonal’ breath is part of the natural dying process,” Bitar said. “It looks like they’re struggling to breathe, but they’re not. Their body is just shutting down. They are too weak to swallow the saliva, so they gurgle. The patient usually isn’t suffering.” 
 
Even if the person can’t speak or they look unconscious, “Never assume they can’t hear,” Bitar said. “Most people fear dying alone. If they still hear their loved ones, that makes a huge difference.”
 
Many dying patients exhibit delirium, but Bitar emphasized that the patient lacks awareness of their behavior. “It’s possible to be peacefully confused,” she said. “Talk to them and orient them: ‘You’re at home. We’re here.’ Open the blinds and close them at night so they know whether it’s day or night.”
 
When the patients stops making urine, “You know you’re within 24 to 72 hours of death because the kidneys have failed at that point,” Bitar said.

Natural Death Shouldn’t Hurt

Natural death “doesn’t look pretty, especially if it’s prolonged,” Bitar said. “But in theory, medically speaking, it should be a pleasant way to go. The toxins that build up put you in a dreamlike state that is supposed to be euphoric. It’s not supposed to be uncomfortable.”
 
We’re a very cure-focused society. Keep going, keep going, keep going, death,” Bitar added. “Sometimes patients are in denial — unwilling to talk about what’s happening. That’s the hardest of them all. That creates a lot of challenges in caring for them at the end of life, for providers and their loved ones. Both are shooting in the dark because we don’t know what the person wants because it was never discussed. That’s a big barrier and it’s tough to overcome. It creates distress and anxiety for everybody.”
 
Facing a grim prognosis head-on is probably the bravest and most difficult thing a person can do. Bitar said she reminds people that “’Your life is not your disease.’ We try to take a step back and see the whole person. We want to talk about big-picture things, meaningful things. People have to be allowed to be human and talk about what matters most to them at this time.”

There are numerous reasons why someone would want to end their life, ranging from severe depression to terminal illness, and in fact suicide is the tenth leading cause of death in the United States. While there are treatment options available for people with depression, what are the options for those who aren't expected to live much longer, perhaps suffering extraordinary pain? More to the point: is assisting with suicide a crime? If you're not a licensed physician, then assisting someone with suicide is most definitely a crime. But in states that have enacted "right to die" or "death with dignity" laws, eligible patients may request lethal drugs and administer them on their own.

This article lays out the legal parameters for assisted suicide, including what it means to assist someone with ending their life and the policy reasons for its prohibition in most states.

What's Considered Assisted Suicide?

Every state has a slightly different definition of what it means to assist a suicide and some states do not actually define it in their statutes. Generally, someone assists with a suicide when they:

  • Do some act which causes someone else to die, such as administering lethal doses of drugs;
  • Provide the drugs or tools necessary for someone else to commit suicide when they know those tools are likely to be used for suicide;
  • Advise someone else on the way to commit suicide; or
  • Persuade someone else to commit suicide.

Note that it is not considered assisted suicide to fail to resuscitate someone who is already dying. Individuals who do not wish to be kept alive through artificial means (such as feeding tubes and breathing machines) may state their wishes in a legally binding advance directive.

Why is Assisted Suicide Illegal?

There are two major public policy reasons why assisting with suicide, a crime in most states, is generally frowned upon. First, many states consider the preservation of life the highest priority. Consequently, in those states, anything that ends a human life is considered a crime, such as murder or manslaughter. But while the U.S. Supreme Court reached a similar conclusion -- ruling that there is no constitutional right to physician-assisted suicide -- states are free to enact such laws.

The second policy reason against assisted suicide is that it can be difficult in some cases to distinguish it from murder or manslaughter. States have an interest in ensuring that no one is forced to commit suicide through threats or deception. For this reason, the few states that currently allow physician assisted suicide (including WashingtonOregon, and Montana) have strict requirements and procedures that must be followed before any lethal medication is administered, including the following:

  • Patient must be a resident of the state.
  • Patient is mentally competent, terminally ill, and predicted to live only a short while (typically six months).
  • Patient's request was voluntary.
  • Patient is given multiple opportunities to change their mind.

Get Professional Legal Help With Your End-of-Life Concerns

While assisting with suicide is a crime in most states, the list of states allowing physician-assisted suicide continues to grow. But if a family member or loved one with a terminal illness doesn't want to be kept alive through artificial means, they have that choice. Regardless, be sure to consult with a health care law attorney if you have any additional questions about end-of-life care.


The term "euthanasia," or mercy killing, refers to the intentional taking of another's life (with their consent) in order to ease the suffering of a terminally ill individual. Euthanasia is technically illegal in all states, although a few states allow physician-assisted suicide in a manner that gives the patient complete control over his or her demise. This remains a very controversial medical and social policy issue, involving several different aspects of medicine, religion, ethics, and law.

Euthanasia Law and the Oregon Death with Dignity Act

Oregon is one of just a few states where terminally ill patients may legally end their own lives if they choose. The Oregon Death with Dignity Act allows terminally ill patients to receive a prescription for lethal medications, which they administer themselves after completing the consent process. To be eligible, patients must be given six months or less to live, be at least 18 years old, and submit three separate doctor requests (two oral, one written).

The Oregon Health Authority provides the necessary forms on its Website, including the Patient Request Form (PDF) and Consulting Physician Form (PDF). See the following chart for more details of Oregon's physician-assisted suicide statute.

Code Section127.800, et. seq. (The Oregon Death with Dignity Act)
Euthanasia Condoned in Statutes?Physician-assisted suicide is allowed in limited circumstances: Patient must have been diagnosed with a terminal illness in which he/she is expected to die within 6 months; physician may prescribe a lethal dose of drugs to eligible patients who have provided the necessary consent.
Safeguards and Consent

After confirming presence of a terminal illness, the patient requesting lethal drugs to end their life must be informed of alternatives (including hospice and counseling); referred to another physician to confirm the diagnosis and to confirm the patient's decision to end their life; and be informed of their right to rescind the request for lethal drugs.

Effect of Withholding of Life-Sustaining ProceduresWithholding or withdrawal of life-sustaining procedures or artificially administered nutrition and hydration does not constitute suicide, assisted suicide, homicide, or mercy killing.

Note: State laws are always subject to change, usually through new legislation or higher court decisions. You may want to contact an Oregon health care attorney or conduct your own legal research to verify the state law(s) you are researching.


Oregon Revised Statute: Oregon's Death with Dignity Act

Chapter 127

NOTE: This page reflects the changes to the Death with Dignity Act resulting from the passage of Senate Bill 579 by the 2019 Oregon legislative assembly.

Please browse this page or download the statute for printing.

You can also view the statute on the Oregon State Legislature webpage: https://www.oregonlegislature.gov.

127.800 s.1.01. Definitions.

The following words and phrases, whenever used in ORS 127.800 to 127.897, have the following meanings:

(1) "Adult" means an individual who is 18 years of age or older.

(2) "Attending physician" means the physician who has primary responsibility for the care of the patient and treatment of the patient's terminal disease.

(3) "Capable" means that in the opinion of a court or in the opinion of the patient's attending physician or consulting physician, psychiatrist or psychologist, a patient has the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient's manner of communicating if those persons are available.

(4) "Consulting physician" means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's disease.

(5) "Counseling" means one or more consultations as necessary between a state licensed psychiatrist or psychologist and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.

(6) "Health care provider" means a person licensed, certified or otherwise authorized or permitted by the law of this state to administer health care or dispense medication in the ordinary course of business or practice of a profession, and includes a health care facility.

(7) "Informed decision" means a decision by a qualified patient, to request and obtain a prescription to end his or her life in a humane and dignified manner, that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:

(a) His or her medical diagnosis;

(b) His or her prognosis;

(c) The potential risks associated with taking the medication to be prescribed;

(d) The probable result of taking the medication to be prescribed; and

(e) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.

(8) "Medically confirmed" means the medical opinion of the attending physician has been confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.

(9) "Patient" means a person who is under the care of a physician.

(10) "Physician" means a doctor of medicine or osteopathy licensed to practice medicine by the Board of Medical Examiners for the State of Oregon.

(11) "Qualified patient" means a capable adult who is a resident of Oregon and has satisfied the requirements of ORS 127.800 to 127.897 in order to obtain a prescription for medication to end his or her life in a humane and dignified manner.

(12) "Terminal disease" means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months. [1995 c.3 s.1.01; 1999 c.423 s.1]

(Written Request for Medication to End One's Life in a Humane and Dignified Manner)

(Section 2)

127.805 s.2.01. Who may initiate a written request for medication.

(1) An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner in accordance with ORS 127.800 to 127.897.

(2) No person shall qualify under the provisions of ORS 127.800 to 127.897 solely because of age or disability. [1995 c.3 s.2.01; 1999 c.423 s.2]

127.810 s.2.02. Form of the written request.

(1) A valid request for medication under ORS 127.800 to 127.897 shall be in substantially the form described in ORS 127.897, signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request.

(2) One of the witnesses shall be a person who is not:

(a) A relative of the patient by blood, marriage or adoption;

(b) A person who at the time the request is signed would be entitled to any portion of the estate of the qualified patient upon death under any will or by operation of law; or

(c) An owner, operator or employee of a health care facility where the qualified patient is receiving medical treatment or is a resident.

(3) The patient's attending physician at the time the request is signed shall not be a witness.

(4) If the patient is a patient in a long term care facility at the time the written request is made, one of the witnesses shall be an individual designated by the facility and having the qualifications specified by the Oregon Health Authority by rule. [1995 c.3 s.2.02]

(Safeguards)

(Section 3)

127.815 s.3.01.Attending physician responsibilities.

(1) The attending physician shall:

(a) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;

(b) Request that the patient demonstrate Oregon residency pursuant to ORS 127.860;

(c) To ensure that the patient is making an informed decision, inform the patient of:

(A) His or her medical diagnosis;

(B) His or her prognosis;

(C) The potential risks associated with taking the medication to be prescribed;

(D) The probable result of taking the medication to be prescribed; and

(E) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control;

(d) Refer the patient to a consulting physician for medical confirmation of the diagnosis, and for a determination that the patient is capable and acting voluntarily;

(e) Refer the patient for counseling if appropriate pursuant to ORS 127.825;

(f) Recommend that the patient notify next of kin;

(g) Counsel the patient about the importance of having another person present when the patient takes the medication prescribed pursuant to ORS 127.800 to 127.897 and of not taking the medication in a public place;

(h) Inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the time the patient makes the patient’s second oral request pursuant to ORS 127.840;

(i) Verify, immediately prior to writing the prescription for medication under ORS 127.800 to 127.897, that the patient is making an informed decision;

(j) Fulfill the medical record documentation requirements of ORS 127.855;

(k) Ensure that all appropriate steps are carried out in accordance with ORS 127.800 to 127.897 prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner; and

(L)(A) Dispense medications directly, including ancillary medications intended to facilitate the desired effect to minimize the patient's discomfort, provided the attending physician is registered as a dispensing physician with the Board of Medical Examiners, has a current Drug Enforcement Administration certificate and complies with any applicable administrative rule; or

(B) With the patient's written consent:

(i) Contact a pharmacist and inform the pharmacist of the prescription; and

(ii) Deliver the written prescription personally or by mail to the pharmacist, who will dispense the medications to either the patient, the attending physician or an expressly identified agent of the patient.

(2) Notwithstanding any other provision of law, the attending physician may sign the patient's death certificate. [1995 c.3 s.3.01; 1999 c.423 s.3]

127.820 s.3.02. Consulting physician confirmation.

Before a patient is qualified under ORS 127.800 to 127.897, a consulting physician shall examine the patient and his or her relevant medical records and confirm, in writing, the attending physician's diagnosis that the patient is suffering from a terminal disease, and verify that the patient is capable, is acting voluntarily and has made an informed decision. [1995 c.3 s.3.02]

127.825 s.3.03. Counseling referral.

If in the opinion of the attending physician or the consulting physician a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling. No medication to end a patient's life in a humane and dignified manner shall be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment. [1995 c.3 s.3.03; 1999 c.423 s.4]

127.830 s.3.04. Informed decision.

No person shall receive a prescription for medication to end his or her life in a humane and dignified manner unless he or she has made an informed decision as defined in ORS 127.800 (7). Immediately prior to writing a prescription for medication under ORS 127.800 to 127.897, the attending physician shall verify that the patient is making an informed decision. [1995 c.3 s.3.04]

127.835 s.3.05. Family notification.

The attending physician shall recommend that the patient notify the next of kin of his or her request for medication pursuant to ORS 127.800 to 127.897. A patient who declines or is unable to notify next of kin shall not have his or her request denied for that reason. [1995 c.3 s.3.05; 1999 c.423 s.6]

127.840 s.3.06. Written and oral requests.

(1) In order to receive a prescription for medication to end his or her life in a humane and dignified manner, a qualified patient shall have made an oral request and a written request, and reiterate the oral request to his or her attending physician no less than 15 days after making the initial oral request.
(2) Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die within 15 days after making the initial oral request under this section, the qualified patient may reiterate the oral request to his or her attending physician at any time after making the initial oral request.
(3) At the time the qualified patient makes his or her second oral request, the attending physician shall offer the patient an opportunity to rescind the request. [1995 c.3 §3.06]

127.845 s.3.07. Right to rescind request.

A patient may rescind his or her request at any time and in any manner without regard to his or her mental state. No prescription for medication under ORS 127.800 to 127.897 may be written without the attending physician offering the qualified patient an opportunity to rescind the request. [1995 c.3 s.3.07]

127.850 s.3.08. Waiting periods.

(1) No less than 15 days shall elapse between the patient’s initial oral request and the writing of a prescription under ORS 127.800 to 127.897. No less than 48 hours shall elapse between the patient’s written request and the writing of a prescription under ORS 127.800 to 127.897. [1995 c.3 §3.08]
(2) Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die before the expiration of at least one of the waiting periods described in subsection (1) of this section, the prescription for medication under ORS 127.800 to 127.897 may be written at any time following the later of the qualified patient’s written request or second oral request under ORS 127.840. 

127.855 s.3.09. Medical record documentation requirements.

The following shall be documented or filed in the patient's medical record:

(1) All oral requests by a patient for medication to end his or her life in a humane and dignified manner;

(2) All written requests by a patient for medication to end his or her life in a humane and dignified manner;

(3) The attending physician's diagnosis and prognosis, determination that the patient is capable, acting voluntarily and has made an informed decision;

(4) The consulting physician's diagnosis and prognosis, and verification that the patient is capable, acting voluntarily and has made an informed decision;

(5) A report of the outcome and determinations made during counseling, if performed;

(6) Any medically confirmed certification of the imminence of the patient’s death;

(7) The attending physician's offer to the patient to rescind his or her request at the time of the patient's second oral request pursuant to ORS 127.840; and

(8) A note by the attending physician indicating that all requirements under ORS 127.800 to 127.897 have been met and indicating the steps taken to carry out the request, including a notation of the medication prescribed. [1995 c.3 s.3.09]

127.860 s.3.10. Residency requirement.

Only requests made by Oregon residents under ORS 127.800 to 127.897 shall be granted. Factors demonstrating Oregon residency include but are not limited to:

(1) Possession of an Oregon driver license;

(2) Registration to vote in Oregon;

(3) Evidence that the person owns or leases property in Oregon; or

(4) Filing of an Oregon tax return for the most recent tax year. [1995 c.3 s.3.10; 1999 c.423 s.8]

127.865 s.3.11. Reporting requirements.

(1)(a) The Health Services shall annually review a sample of records maintained pursuant to ORS 127.800 to 127.897.

(b) The division shall require any health care provider upon dispensing medication pursuant to ORS 127.800 to 127.897 to file a copy of the dispensing record with the division.

(2) The Health Services shall make rules to facilitate the collection of information regarding compliance with ORS 127.800 to 127.897. Except as otherwise required by law, the information collected shall not be a public record and may not be made available for inspection by the public.

(3) The division shall generate and make available to the public an annual statistical report of information collected under subsection (2) of this section. [1995 c.3 s.3.11; 1999 c.423 s.9]

127.870 s.3.12. Effect on construction of wills, contracts and statutes.

(1) No provision in a contract, will or other agreement, whether written or oral, to the extent the provision would affect whether a person may make or rescind a request for medication to end his or her life in a humane and dignified manner, shall be valid.

(2) No obligation owing under any currently existing contract shall be conditioned or affected by the making or rescinding of a request, by a person, for medication to end his or her life in a humane and dignified manner. [1995 c.3 s.3.12]

127.875 s.3.13. Insurance or annuity policies.

The sale, procurement, or issuance of any life, health, or accident insurance or annuity policy or the rate charged for any policy shall not be conditioned upon or affected by the making or rescinding of a request, by a person, for medication to end his or her life in a humane and dignified manner. Neither shall a qualified patient's act of ingesting medication to end his or her life in a humane and dignified manner have an effect upon a life, health, or accident insurance or annuity policy. [1995 c.3 s.3.13]

127.880 s.3.14. Construction of Act.

Nothing in ORS 127.800 to 127.897 shall be construed to authorize a physician or any other person to end a patient's life by lethal injection, mercy killing or active euthanasia. Actions taken in accordance with ORS 127.800 to 127.897 shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law. [1995 c.3 s.3.14]

(Immunities and Liabilities)

(Section 4)

127.885 s.4.01. Immunities; basis for prohibiting health care provider from participation; notification; permissible sanctions.

Except as provided in ORS 127.890:

(1) No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with ORS 127.800 to 127.897. This includes being present when a qualified patient takes the prescribed medication to end his or her life in a humane and dignified manner.

(2) No professional organization or association, or health care provider, may subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership or other penalty for participating or refusing to participate in good faith compliance with ORS 127.800 to 127.897.

(3) No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of ORS 127.800 to 127.897 shall constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.

(4) No health care provider shall be under any duty, whether by contract, by statute or by any other legal requirement to participate in the provision to a qualified patient of medication to end his or her life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient's request under ORS 127.800 to 127.897, and the patient transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient's relevant medical records to the new health care provider.

(5)(a) Notwithstanding any other provision of law, a health care provider may prohibit another health care provider from participating in ORS 127.800 to 127.897 on the premises of the prohibiting provider if the prohibiting provider has notified the health care provider of the prohibiting provider's policy regarding participating in ORS 127.800 to 127.897. Nothing in this paragraph prevents a health care provider from providing health care services to a patient that do not constitute participation in ORS 127.800 to 127.897.

(b) Notwithstanding the provisions of subsections (1) to (4) of this section, a health care provider may subject another health care provider to the sanctions stated in this paragraph if the sanctioning health care provider has notified the sanctioned provider prior to participation in ORS 127.800 to 127.897 that it prohibits participation in ORS 127.800 to 127.897:

(A) Loss of privileges, loss of membership or other sanction provided pursuant to the medical staff bylaws, policies and procedures of the sanctioning health care provider if the sanctioned provider is a member of the sanctioning provider's medical staff and participates in ORS 127.800 to 127.897 while on the health care facility premises, as defined in ORS 442.015, of the sanctioning health care provider, but not including the private medical office of a physician or other provider;

(B) Termination of lease or other property contract or other nonmonetary remedies provided by lease contract, not including loss or restriction of medical staff privileges or exclusion from a provider panel, if the sanctioned provider participates in ORS 127.800 to 127.897 while on the premises of the sanctioning health care provider or on property that is owned by or under the direct control of the sanctioning health care provider; or

(C) Termination of contract or other nonmonetary remedies provided by contract if the sanctioned provider participates in ORS 127.800 to 127.897 while acting in the course and scope of the sanctioned provider's capacity as an employee or independent contractor of the sanctioning health care provider. Nothing in this subparagraph shall be construed to prevent:

(i) A health care provider from participating in ORS 127.800 to 127.897 while acting outside the course and scope of the provider's capacity as an employee or independent contractor; or

(ii) A patient from contracting with his or her attending physician and consulting physician to act outside the course and scope of the provider's capacity as an employee or independent contractor of the sanctioning health care provider.

(c) A health care provider that imposes sanctions pursuant to paragraph (b) of this subsection must follow all due process and other procedures the sanctioning health care provider may have that are related to the imposition of sanctions on another health care provider.

(d) For purposes of this subsection:

(A) "Notify" means a separate statement in writing to the health care provider specifically informing the health care provider prior to the provider's participation in ORS 127.800 to 127.897 of the sanctioning health care provider's policy about participation in activities covered by ORS 127.800 to 127.897.

(B) "Participate in ORS 127.800 to 127.897" means to perform the duties of an attending physician pursuant to ORS 127.815, the consulting physician function pursuant to ORS 127.820 or the counseling function pursuant to ORS 127.825. "Participate in ORS 127.800 to 127.897" does not include:

(i) Making an initial determination that a patient has a terminal disease and informing the patient of the medical prognosis;

(ii) Providing information about the Oregon Death with Dignity Act to a patient upon the request of the patient;

(iii) Providing a patient, upon the request of the patient, with a referral to another physician; or

(iv) A patient contracting with his or her attending physician and consulting physician to act outside of the course and scope of the provider's capacity as an employee or independent contractor of the sanctioning health care provider.

(6) Suspension or termination of staff membership or privileges under subsection (5) of this section is not reportable under ORS 441.820. Action taken pursuant to ORS 127.810, 127.815, 127.820 or 127.825 shall not be the sole basis for a report of unprofessional or dishonorable conduct under ORS 677.415 (2) or (3).

(7) No provision of ORS 127.800 to 127.897 shall be construed to allow a lower standard of care for patients in the community where the patient is treated or a similar community. [1995 c.3 s.4.01; 1999 c.423 s.10]

Note: As originally enacted by the people, the leadline to section 4.01 read "Immunities." The remainder of the leadline was added by editorial action.

127.890 s.4.02. Liabilities.

(1) A person who without authorization of the patient willfully alters or forges a request for medication or conceals or destroys a rescission of that request with the intent or effect of causing the patient's death shall be guilty of a Class A felony.

(2) A person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient's life, or to destroy a rescission of such a request, shall be guilty of a Class A felony.

(3) Nothing in ORS 127.800 to 127.897 limits further liability for civil damages resulting from other negligent conduct or intentional misconduct by any person.

(4) The penalties in ORS 127.800 to 127.897 do not preclude criminal penalties applicable under other law for conduct which is inconsistent with the provisions of ORS 127.800 to 127.897. [1995 c.3 s.4.02]

127.892 Claims by governmental entity for costs incurred.

Any governmental entity that incurs costs resulting from a person terminating his or her life pursuant to the provisions of ORS 127.800 to 127.897 in a public place shall have a claim against the estate of the person to recover such costs and reasonable attorney fees related to enforcing the claim. [1999 c.423 s.5a]

(Severability)

(Section 5)

127.895 s.5.01. Severability.

Any section of ORS 127.800 to 127.897 being held invalid as to any person or circumstance shall not affect the application of any other section of ORS 127.800 to 127.897 which can be given full effect without the invalid section or application. [1995 c.3 s.5.01]

(Form of the Request)

(Section 6)

127.897 s.6.01. Form of the request.

A request for a medication as authorized by ORS 127.800 to 127.897 shall be in substantially the following form:

REQUEST FOR MEDICATION

TO END MY LIFE IN A HUMANE

AND DIGNIFIED MANNER


I, ________________, am an adult of sound mind.

I am suffering from _______, which my attending physician has determined is a terminal disease and which has been medically confirmed by a consulting physician.

I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care and pain control.

I request that my attending physician prescribe medication that will end my life in a humane and dignified manner.

INITIAL ONE:

_____ I have informed my family of my decision and taken their opinions into consideration.

_____ I have decided not to inform my family of my decision.

_____ I have no family to inform of my decision.

I understand that I have the right to rescind this request at any time.

I understand the full import of this request and I expect to die when I take the medication to be prescribed. I further understand that although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility.

I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.

Signed: ___________

Dated: ___________

DECLARATION OF WITNESSES


We declare that the person signing this request:

(a) Is personally known to us or has provided proof of identity;

(b) Signed this request in our presence;

(c) Appears to be of sound mind and not under duress, fraud or undue influence;

(d) Is not a patient for whom either of us is attending physician.

__________ Witness 1/Date

__________ Witness 2/Date

NOTE: One witness shall not be a relative (by blood, marriage or adoption) of the person signing this request, shall not be entitled to any portion of the person's estate upon death and shall not own, operate or be employed at a health care facility where the person is a patient or resident. If the patient is an inpatient at a health care facility, one of the witnesses shall be an individual designated by the facility.

[1995 c.3 s.6.01; 1999 c.423 s.11]

 

PENALTIES

127.990

[Formerly part of 97.990; repealed by 1993 c.767 s.29]

127.995 Penalties.

(1) It shall be a Class A felony for a person without authorization of the principal to willfully alter, forge, conceal or destroy an instrument, the reinstatement or revocation of an instrument or any other evidence or document reflecting the principal's desires and interests, with the intent and effect of causing a withholding or withdrawal of life-sustaining procedures or of artificially administered nutrition and hydration which hastens the death of the principal.

(2) Except as provided in subsection (1) of this section, it shall be a Class A misdemeanor for a person without authorization of the principal to willfully alter, forge, conceal or destroy an instrument, the reinstatement or revocation of an instrument, or any other evidence or document reflecting the principal's desires and interests with the intent or effect of affecting a health care decision. [Formerly 127.585]