Monday, December 17, 2018

A little closer to euthanasia for all in Canada

This article was published by OneNewsNow on December 17, 2018

A
Alex Schadenberg
special panel is questioning the ethics of legalized assisted suicide for psychiatric reasons.


Doctor-assisted death was legalized by Canada's high court two and a half years ago. Parliament set the guidelines, which includes gray areas of the law.

  1. Canadian report offers no clear direction on child euthanasia.
  2. Canadian report suggests that more research is needed on euthanasia for incompetent people.
  3. Canadian report is negative to the concept of euthanasia for psychiatric reasons alone.

Alex Schadenberg of the Euthanasia Prevention Coalition tells OneNewsNow the Council on Canadian Academies has looked into three areas of possible expansion to people who would qualify, and one area would be those seeking euthanasia for psychiatric reasons.
"So in Canada right now, you can't have euthanasia if you're not – quote – 'nearing death,' but that's not defined," Schadenberg reports. "A psychiatric condition does qualify for euthanasia, but they must also be nearing death, so there's a bit of grey area in the whole question of psychiatric conditions as it is standing right now."
The Academies report states that if "near death" is to include psychiatric conditions alone, then the gate would be wide open for expanding euthanasia, including to those experiencing natural depression over sad events in their lives.
"This is what they're acknowledging," the Coalition executive director explains. "According to how the law is written, if we allow this (euthanasia for psychiatric reasons alone), everyone would qualify, and that would create a serious problem. They made this statement that Canada would become the most liberal euthanasia regime in the world if we were to allow it for psychiatric suffering alone."
Schadenberg adds that even Belgium, where euthanasia of psychiatric patients has been allowed, is questioning the ethics of the practice.

Friday, December 14, 2018

Third Report From Québec’s Euthanasia Commission - 142 unaccounted deaths.

Published by Toujours Vivant - Not Dead Yet.

This report was researched and written by Amy Hasbrouck and Taylor Hyatt.


Three years ago, on December 10, 2015, Québec’s euthanasia program went into effect. Unlike the federal law, Québec provides euthanasia upon request to eligible persons, as well as “Continuous Palliative Sedation” without the eligibility requirements and safeguards connected to a euthanasia request.

The Commission on end of life care released its third report on the province’s euthanasia program on December 7, covering the period from July 1, 2017 to March 31, 2018, with cumulative data from December of 2015. The Commission adjusted the reporting period to coincide with Québec’s fiscal year, which runs from April 1 to March 31.

As in previous reports from Québec, the most striking fact in this third report is the difference between the number of euthanasia reports submitted by doctors, and the number of euthanasia reported by institutions and the Collège des médecins du Québec. During the reporting period, the Commission received 708 forms (including five for deaths administered in previous years) while this second stream of information from the College de medecin du Québec showed 845 cases of euthanasia (a difference of 142 deaths during the reporting period) representing almost 17 % of the deaths. The report does not acknowledge, or attempt to explain this difference.

We did a summary of the report’s statistics, which we will put up on our website in the documents/reports section.


The Commission reported that 45% of the forms filed by doctors needed follow-up for additional information. Letters and telephone calls were required for 334 forms, and 90 doctors received a second letter when they failed to provide the information the Commission asked for.


The Commission examined a total of 782 forms during the reporting period,

  • 741 were looked at for the first time. 
  • 41 were given a second look, in light of additional information received.  
  • 658 were forms that came in during the current period. 
  • 83 cases were held over from year.
727 cases were decided during the reporting period. Of those, the Commission found:
  • 90% (658) complied with the Québec eligibility criteria and safeguards; 
  • In 7% of cases (50) no determination of compliance was possible, because:
    • Additional information was not provided (23 cases) 
    • In 27 cases, the information provided was still not enough to decide whether the doctor complied with the law.
  • 3% (19 cases) did not comply with the eligibility criteria and safeguards. This included: 
    • three people who were not eligible because they did not have a “serious and incurable illness;” and
    • two instances where the doctor who approved and performed euthanasia only met with the person on the day euthanasia was provided.
Similar figures are shown in the cumulative statistics of Québec’s program for the period from December 10, 2015 to March 31, 2017. While the Commission states that 1,493 euthanasia reporting forms were received from doctors during the period, Institutions and the CMQ report 1,664 euthanasia deaths. Thus, 171 deaths are unaccounted for, probably unexamined and may or may not comply with eligibility requirements and safeguards.

In the past three years, the number of euthanasia has increased steadily in every six month period.

  • 161 – 1st period (12/15-6/16) 
  • 280 – 2nd period (7/16-12/16) 
  • 344 – 3rd period (1/17-6/17) 
  • 437 – 4th period (7/17-12/17) 
  • 542 – 5th period (1/18-6/18) (estimate based on 271 from 1/18-3/18)
Of the 1,374 total cases decided up until March 31, 2008,
  • 90% (1,245 cases) complied with the eligibility requirements and safeguards; 
  • In 4.8% (67 cases) no determination of compliance was possible: 
  • 4.5% (62 cases) did not comply:  
  • 9 cases – Doctor didn’t speak to the person on different occasions to ensure persistence of suffering and wish to die, and capacity;* 
    • 7 cases – Person was not eligible:  
      • 5 cases – Person did not have a “serious and incurable illness”; 
      • 2 cases – The person was not at the end of life;
  • 6 cases – Second doctor signed off before euthanasia request was signed;* 
  • 5 cases – The person who countersigned the request was not a health care professional;* 
  • 4 cases – The person did not have health insurance; 
  • 2 cases – Doctor did not ensure compliance with safeguards.* 
  • In the 29 remaining cases, the second doctor was not independent of the first. However this legal requirement was removed by the minister of health in February of 2017.
* In these cases, the failure of administrative safeguards could put the person’s life at risk.
  • So to recap, we have: 
    • A “medical treatment” that was supposed to be an exceptional option in exceptional cases, that is now in regular use, regardless of whether palliative care is in place; 
    • Substantial increases in the number of people being euthanized every six months, for a total of 1,664 (as of last March); not counting 1,831 continuous palliative sedations performed since 2015; 
    • 171 deaths unaccounted for; 
    • 67 deaths where compliance could not be determined; 
    • 22 deaths where important procedural safeguards were not followed; 
    • 7 deaths of people we know were not eligible for euthanasia; and 
    • Hundreds of instances where doctors don’t file reports, refuse or were unable to provide information necessary to determine whether they complied with safeguards or the person was eligible for euthanasia.
Isn’t that enough evidence to show that something's amiss?

Toujours Vivant-Not Dead Yet is a non-religious organization by and for disabled people. Its goal is to inform, unify and give voice to the disability rights opposition to assisted suicide, euthanasia, and other ending-of-life practices that discriminate against people with disabilities.

They present a weekly online discussion in English every Friday at 3 p.m. to offer up-to-date information about assisted suicide, euthanasia and ending-of-life practices for the disability community.


Please click on the link: https://www.youtube.com/watch?v=OpWjpN5ZLmE to join the webcast.

McGill study: Euthanasia requests precede palliative care.


Published by Toujours Vivant - Not Dead Yet.

This article was researched and written by Amy Hasbrouck and Taylor Hyatt.

On December 5th CTV News reported on a new study from McGill University Health Centre looking at whether euthanasia is actually used as a “last resort” after palliative care has been tried, as promotors claim. This study shows that, though the reasons people ask for euthanasia relate to issues that could be addressed by palliative care (and consumer-controlled personal assistance services), people who ask for euthanasia are often not getting these services before deciding to die, or palliative care hasn’t had time to take effect.

Researchers examined patient files at two teaching hospitals and a long-term care facility. Between December 2015 and the beginning of June 2017, a total of 80 people requested euthanasia; 43, or just over half, were euthanized.


Demographic information about people who asked to die was provided, but the researchers didn’t give those details about the sub-group of people who were killed. Five people under 50 years old sought euthanasia; the youngest being 32. The rest were split fairly evenly, with 36 people under 70 years of age and 39 between 70 and 92 years old. Eighty-one percent (65) of the applicants had cancer-related illness.


The reasons people wanted to die were described in more detail than in most studies. The researchers listed three broad categories: “suffering” (cited in 92% of the files), “control” (75%), and “loss of future” (25%), plus several others.


In the “suffering” category, the authors listed (actual, current) “pain, nausea, or difficulty breathing“ (cited by 30 people) whereas the “Control” category included the wish to “avoid future suffering,” (cited by 14) “avoid loss of capacity” (mentioned by 4 people) and “avoid a bad death” (5 people). “Physical suffering” was contrasted with existential suffering (cited by 19 people), psychological suffering (16 people) and exhaustion (mentioned by 4).


Additional reasons given for euthanasia requests include:

  • 27 people wanted to control the time and manner of their death; 
  • 16 wanted to minimize the impact of their condition on others; 
  • 15 people were concerned about “loss of autonomy;” 
  • 13 people cited the lack of treatment options and their deteriorating condition; 
  • 10 wanted to “avoid loss of dignity.”
Ten people (12.5%) gave no reason for wanting to die.

The authors noted that “physicians are often reluctant to tell patients they are dying, that conversations about death occur very late in the illness, and that palliative care/hospice options are often not discussed.”


In fact, 7 people (9%) had Level of Intervention (LOI) forms in their charts (similar to a Medical Order for Life-Sustaining Treatment) that called for life-saving interventions, while an additional 16 people (20%) had no LOI form, causing a default to life-saving treatment.


As well, most people were not receiving palliative care when they made their request to die.

  • 7 people had palliative care consults more than 100 days before the request, and another 7 had palliative care consults in the three months before they asked to die. 
  • 26 (32%) palliative care consults were requested 1–6 days prior to the request; 
  • 16 (20%) had a palliative care consult the day of or after they asked to die; 
  • 11 people, (14%) never had palliative care (usually because they refused).
As we mentioned, of the 80 people who asked for euthanasia, 43 (or 54%) were euthanized, while 37 people (or 46%) did not receive euthanasia:
  • 13 lost decision-making capacity after submitting their request; 
  • 8 people “did not meet the eligibility criteria.” including:
    • 4 who were deemed incapable of making a decision; 
    • 2 who weren’t at the end of life; 
    • 1 who was not in a state of “advanced and irreversible decline;” 
    • 1 whose suffering was not “constant and unbearable;”
  • 7 died before they could be euthanized. 
  • 5 people “changed their minds.” 
  • 2 chose palliative sedation (not clear if it was “Continuous”), 
  • For 2 people, no reason was documented for the denial of the request.
Of the 43 euthanasia, 38 took place after the federal law, with its 10-day “cooling off” period, went into effect. However the waiting period was waived in 60%, or 23 of those cases. In 19 of the 38 cases, euthanasia was performed one to six days after the request was made.

Only imminent death or loss of capacity is supposed to justify cancelling the waiting period, but the reasons given suggest that doctors didn’t apply that safeguard:

  • Fear of loss of capacity was cited in 7 cases. 
  • “worsening symptoms,” was noted in 5 cases. As the authors point out, this “may or may not have implied that death or loss of capacity was imminent.”
In the remaining 11 cases,
  • 6 doctors didn’t give a reason for dropping the waiting period; 
  • 3 files listed “avoiding provider-based delays”; and 
  • 2 doctors cited “patient demand”.
The study found that only 14 people out of 80, (18% of files reviewed), had consulted a palliative care provider more than a month before requesting euthanasia. That’s no assurance that services were in place to control pain, help process grief and maintain autonomy. Though Québec’s practice guidelines state that “[euthanasia] remains exceptional,” the researchers conclude that this is not what happens in real life. 

The “exceptional” practice of euthanasia is becoming the norm as it gains as the preferred treatment option for ill and disabled people.

Toujours Vivant-Not Dead Yet is a non-religious organization by and for disabled people. Its goal is to inform, unify and give voice to the disability rights opposition to assisted suicide, euthanasia, and other ending-of-life practices that discriminate against people with disabilities.  

They present a weekly online discussion in English every Friday at 3 p.m. to offer up-to-date information about assisted suicide, euthanasia and ending-of-life practices for the disability community. 

Please click on the link: https://www.youtube.com/watch?v=OpWjpN5ZLmE to join the webcast.

Canada: Recent History of Euthanasia Legalisation

By Richard Egan (with the Australian Care Alliance)

On 21 April 2010 the Canadian House of Commons defeated Bill C-384 An Act to amend the Criminal Code (right to die with dignity) by 228-59.

The Quebec National Assembly passed an “An Act respecting end-of-life care” by a vote of 94-22. It came into effect on 10 December 2015. This Act permits euthanasia on the request of an adult who is “at the end of life; with a serious and incurable illness; and in an advanced state of irreversible decline in capability”.

On 6 February 2015 the Supreme Court of Canada in Carter v Canada (Attorney General) declared that provisions in the Canadian Criminal Code making it an offence to aid or abet suicide “unjustifiably infringe” section 7 [“Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.”] of the Charter of Rights and Freedoms “and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” The declaration was suspended for a year, giving the opportunity for the Parliament to amend the offending laws by providing a scheme for physician assisted suicide.

The core paragraph in the judgement reads that: “The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable. The rights to liberty and security of the person, which deal with concerns about autonomy and quality of life, are also engaged. An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.”

The argument based on the right to life is specious as it takes no account of the inevitability that a law permitting euthanasia will result in wrongful deaths based on medical errors, coercion, discrimination against or differential treatment of the disabled and mentally ill and suicide contagion.

The argument from liberty, if pressed to its logical conclusion, would require a law permitting assisted suicide or euthanasia on request by any person, including a minor, with capacity.

The argument from security is based on a false claim that pain and other physical symptoms cannot be relieved by best practice palliative care.

In response to the Supreme Court judgment, the Canadian parliament passed Bill C-14 which came into effect on 17 June 2016 and legalised euthanasia and assisted suicide on request for any adult who has “a serious and incurable illness, disease or disability”; is in “an advanced state of irreversible decline in capability”; and whose “natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining”.

Increase in numbers

There have been three interim reports providing national data on euthanasia as well as reports on the data from Quebec, the most recent of which covers 1 July 2017 to 31 March 2018.

First report.
Comparing the data for the three six month periods covered by the national data reports - 17 June 2016-31 December 2016; 1 January 2017-30 June 2017 and 1 July 2017-31 December 2017 – the number of deaths by euthanasia almost doubled (189%) between the first and third six month periods from 805 to 1525 increasing from 0.6% of all deaths in Canada to 1.07% of all deaths.

Similarly the data for Quebec shows that official reports of euthanasia almost doubled from an average of 46 per month for the six month period 1 July 2016-31 December 2016 to an average of 90 per month for the three month period 1 January 2018-31 March 2018.

Reported acts of euthanasia in Quebec accounted for 1.18% of all deaths in 2017.

Unreported cases

There is a discrepancy of 171 cases of euthanasia between the number of official reports received (1493) and the number of cases reported by institutions (1664) in Quebec suggesting a failure by physicians to report in 10.3% of euthanasia cases.

Failure to comply with the legal processes

Quebec euthanasia
Six per cent of all forms reporting euthanasia in Quebec are received late and 42% off all forms received have insufficient information and require follow up requests.

Even after repeated requests for further information there is insufficient information to conclude whether or not the act of euthanasia complies with the law in 5% of cases.

In a further 5% of cases (62 cases out of 1374 for which a final assessment has been made) there was a failure to comply with the law, including:

  • 29 cases in which the consulting physician was not independent from the physician who carried out euthanasia. However, this has been addressed by officially slackening the interpretation of the requirements for independence! 
  • 9 cases in which the physician who performed euthanasia did not ensure that the request for euthanasia was voluntary, informed and persistent  
  • 6 cases in which the consulting physician examined the person before a request for euthanasia was formally made
  •  5 cases in which the approval was countersigned by an unqualified person  
  • 5 cases in which the person did not have a serious and incurable illness  
  • 4 cases in which the person did not have the required Quebec health insurance  
  • 2 cases in which the person was not at the end of life  
  • 2 cases in which the physician failed to verify that all the conditions for euthanasia were met.
In summary of these 62 cases at least 23 could be characterised as possible wrongful deaths.

Underlying conditions


Very limited data is provided on the underlying condition for which euthanasia is performed. In the last reporting period 9% of cases involved either an unreported condition or a condition other than cancer related, neurodegenerative or circulatory/respiratory system.

Some of the “other” conditions have included osteoarthritis, rheumatoid arthritis and “age-related frailty”.


The Canadian law only requires that “death be reasonably foreseeable”. The decision of the Ontario Superior Court of Justice in AB v Attorney General of Canada delivered on 19 June 2017, in paragraph 81, interpreted this requirement as not requiring any connection whatsoever between the underlying conditions for which euthanasia is sought and the reasonable foreseeability of death – which can be based simply on advanced age. The woman in this case was 79 years old.

Additionally there are the 5 cases from Quebec in which the person did not have a serious and incurable illness and the 2 cases from Quebec in which the person was not at the end of life.

Short time between initial request and euthanasia being performed

Section 29 (c) of the Quebec law requires that before performing euthanasia the physician must verify “the persistence of suffering and that the wish to obtain medical aid in dying remains unchanged, by talking with the patient at reasonably spaced intervals given the progress of the patient’s condition”.

Section 241.2 (3) (g) of the Canadian Criminal Code requires a physician to “ensure that there are at least 10 clear days between the day on which the request was signed by or on behalf of the person and the day on which the medical assistance in dying is provided or — if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstance”.

Nonetheless according to a recent study of euthanasia at three institutions in Quebec the median number of days between the request for euthanasia and the patient’s death was just 6 days.

This study also found that in 32% of cases a palliative care consultation only took place less than 7 days before euthanasia was requested and in a further 25% of cases it took place on the same day or AFTER euthanasia was requested. This suggests that euthanasia is being routinely provided to people before they have had a chance to experience the full effect of palliative care to relieve their suffering and concerns.

Reasons for requesting euthanasia

A study from an Ontario hospital reported that those who received euthanasia tended to be white and relatively affluent and 95% of them indicated that loss of autonomy was the primary reason for their request. Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life. Few patients cited inadequate control of pain or other symptoms.


Disability – the story of Candice Lewis


Candice Lewis with her mother.
Candice Lewis is a 25 year old Canadian woman who happens to have been born with cerebral palsy.

In September 2016 Candice went to the emergency room at Charles S. Curtis Memorial Hospital in St. Anthony after having seizures.

Dr. Aaron Heroux told her she was very sick and likely to die soon. He offered her assisted suicide. The doctor also proposed assisted suicide for Candice to her mother Sheila Elson.

This offer was repeated despite both Candice and her mother making it clear that this was not an option Candice would consider. Dr Heroux told Sheila she was being selfish by not encouraging her daughter to choose assisted suicide.

Candice describes how bad it made her feel that a doctor was offering her assisted suicide.

More than twelve months later Candice has recovered well and her health was much improved. Candice hasn’t been having any seizures, is now able to feed herself, walk with assistance, use her iPad. She is more alert, energetic and communicative. She was able to "walk" down the aisle as a bridesmaid at her sister’s wedding in August 2017. She is doing what she loves most, painting and being with her family.

Candice and her mother Sheila have been interviewed by Kevin Dunn, who produced a film on euthanasia and assisted suicide called Fatal Flaws. The film of the interview can be viewed here.

There are several take home lessons from Candice’s experience:

  • Doctors can get the prognosis wrong. Candice was told she was dying but was flourishing twelve months later. A wrong prognosis can lead to assisted suicide or euthanasia. A life can be thrown away needlessly;
  • People with a disability already suffer discrimination in health care. When assisted suicide and euthanasia are legal, people with a disability are more at risk of being offered death as a solution because doctors and others consider that they would be better off dead; 
  • Once doctors are authorised by the law to provide assisted suicide and euthanasia some of them will feel empowered to offer it to anyone they think would be better off dead. This undermines patients’ trust in doctors and can cause great distress.
Roger Foley
Financial issues: Denied assisted living but offered assisted suicide
Roger Foley, who has a crippling brain disease, has been seeking support to live at home. He is currently in an Ontario hospital that is threatening to start charging him $1,800 a day. The hospital has told Roger that his other option is euthanasia or assisted suicide under Canada’s medical assistance in dying law.

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