Tuesday, May 1, 2012

What the Quebec government Dying with Dignity report actually says.

Vivre dans la Dignité (Living with Dignity), a grassroots organization in Quebec that exists to promote palliative care and prevent the legalization of euthanasia and assisted suicide, has published a summary of the Quebec government Dying with Dignity report (the report). The report calls for improving palliative care and legalizing euthanasia.

The report was published on March 22, 2012 in French. The English version will be available in May. The report made 24 recommendations. The first 12 focused on recommendations for improving palliative and end-of-life care while the final 12 recommendations focused on the legalization of euthanasia.

The twelve page summary that was published by Vivre dans la Dignité provides the recommendations from the report and it summarizes the sections of the report.

The report advocates for euthanasia in spite of the fact that the majority of the presentations to the Dying with Dignity committee opposed the legalization of euthanasia. A report published by Vivre dans la Dignité showed that of the 427 presentations before the government committee, only 142 supported the legalization of euthanasia, 7 were somewhat in favour, while 8 were only in favour of assisted suicide, 220 opposed legalizing euthanasia, 34 were somewhat against euthanasia while 16 presented an unclear position.

The report advocates for the improvement of palliative care and establishes four goals to accomplish this end. The four goals were:

1. The Right to refuse or withdraw treatment.
The committee recognized the right of competent adults to refuse treatments or to request treatments be withdrawn, even if death is likely to follow. The report states that there is confusion on this topic because some people consider the withdrawal or refusal of treatment as a form of euthanasia. The report recommends that awareness by the public and caregivers concerning the right to refuse or withdraw treatment be increased.

Note: One of the groups that has created confusion concerning the right to refuse treatment is the Québec College of Physicians. Yves Robert, secretary of the College told the committee in February 2010 that:
"Québec is the only jurisdiction in Canada where patients can refuse medical treatment, which can lead to death.
This statement was false, every Canadian has the right to refuse treatment or have treatment withdrawn. What is interesting is that Québec is the only province that has not legislated advanced directives.

2. Development of Palliative Care.
* The Québec Department of Health and Social Services adopted a policy on palliative care at the end of life in 2004. This policy has yet to be implemented. The report states that this policy must be implemented quickly
* The majority of people wish to die at home. The report states that the development of palliative care in a home environment is an absolute priority.
* The report states that the training of health care professionals in palliative care must be improved.
* The report states that palliative care must be explicitly mentioned in the Law on Health and Social Services and health care institutions must be obligated to organize and provide palliative care for their patients.

3. Framework for Palliative Sedation
* The report states that there is significant divergence related to the use of palliative sedation and its ethical implications.
* It states that some people consider palliative sedation to be very close to euthanasia.
* The report states that a rigorous framework, including a practice guide and ethical norms must be provided for palliative sedation wherever it is offered.

Note: Palliative sedation when done properly, is not euthanasia. Palliative sedation can be abused, but the proper use of palliative sedation is rarely needed but at times necessary.

4. A Legal Recognition of Advanced Directives and promoting end-of-life care planning.
* The report states that Advanced Directives need to be recognized in the Québec Civil Code.
* The report is suggesting that communication needs to occur to determine the wishes of people at the end-of-life. This is socially contentious, especially in a society, like Québec, that is facing financial problems.

Note: Advanced directives should be established in Québec, in a similar way to Ontario, nonetheless, end-of-life care planning needs to be done without pressure being exerted on individuals.

Medical Aid in Dying:
The Second half of the report focuses on legalizing euthanasia, but not assisted suicide. The report emphasizes euthanasia as an option for exceptional cases. But when analyzing the the recommendations it is clear that the term "exceptional cases" is to promote the recommendations and does not reflect reality.

The report is promoting euthanasia based on providing another option for people who are suffering. They state that euthanasia conforms to the values of "compassion" and "solidarity."

The report suggests that allowing euthanasia will bring serenity to persons who are afraid of suffering because these people will know that euthanasia is an option.

The report states that Québec society has distanced itself from ideological or religious beliefs and has embraced the values of individual freedom, autonomy, and the integrity and inviolability of the person. They suggest that current Québec values are compatible with euthanasia.

Note: It is interesting how they can philosophically suggest that euthanasia upholds the values of integrity and the inviolability of the person when the act of euthanasia ends the life of the person.

The report suggests that since modern medicine can delay death for weeks, months or even years that this has led to more painful long-term conditions. The report compares the values of palliative care - that being the treatment of symptoms without prolonging life as being compatible with euthanasia.

Note: Not only is palliative care not compatible with euthanasia but recently the Canadian Society of Palliative Care Physicians came out against the Québec Dying with Dignity recommendations to allow euthanasia and they specifically condemned the notion that palliative care is compatible with euthanasia.

The report then suggests that because patients must freely consent to medical treatment and because the Québec Civil already recognizes the withholding or withdrawing of medical treatment therefore allowing euthanasia is an evolution and not a revolution.

Note: To withhold or withdraw medical treatment is not a form of euthanasia or assisted suicide. The report is deliberately confusing the issues.

The report states that in the Netherlands and Belgium abuses have not occurred, therefore they claim that it is possible to avoid abuses through the application of "strict safeguards."

Note: When I met with the Québec government Dying with Dignity commission I specifically gave them all of the pertinent studies related to the abuses the are occurring in the Netherlands and Belgium. During the media interviews, the chair of commission stated Jocelyn Downie, helped them with the report. Downie, a long-time euthanasia advocate was also credited with assembling the Royal Society of Canada Ending of Life Decision Making Committee and instrumental in producing its one-sided report.

The claim that no abuses have occurred in the Netherlands and Belgium is a lie. Read my commentary.
Read my commentary about the false study by Margaret Battin.

The claim that abuses can be avoided through "strict safeguards" assumes that they are proposing strict safeguards. Safeguards do not protect people, they protect doctors but further the report is not proposing "strict safeguards." There is no definition of terminal illness and no limit based on terminal illness, the definition of suffering is subjective, euthanasia applies to people with psychological suffering, it can be done to someone who is incompetent, etc (no real safeguards, only protections for doctors).

The report then claimed that there have been no abuses connected to the withholding and withdrawal of medical treatment and suggested that the there would be no abuses connected to euthanasia.

Note: Once again, withholding and withdrawing medical treatment is not euthanasia. At the same time, considering the cases in Ontario that are currently being litigated, it is unlikely that there has been no abuses related to the withholding and withdrawing of medical treatment in Québec, but rather it is likely that due to the cost of litigation, there have been no cases that have gone to court in Québec.

Recommendations for approving euthanasia in Quebec

The report recommends that euthanasia be a part of the continuum of end-of-life care, that it be associated with the relief of suffering and that it be based on the autonomy of the person.

Note 1: This recommendation is very similar to the model in Belgium where euthanasia is facilitated and paid for through the palliative care system.

Note 2: Recently the Canadian Society of Palliative Care Physicians stated that they oppose euthanasia and they will not participate in euthanasia.

The report states that the rules for approving euthanasia would be based on the following:
* The person is a resident of Québec (according to the Law on Health Insurance).

Note: According to the Quebec government official website, a person qualifies as a resident of Québec under the health insurance plan, after residing in Québec for three months unless they come from another part of Canada or they come from Denmark, Finland, France, Greece, Luxembourg, Norway, Portugal and Sweden. In other words, this recommendation will not protect Québec from euthanasia tourism.

* The person is an adult with the legal capacity to consent to treatment.

* The person requests medical aid in dying (euthanasia) in a free and informed manner.

Note 1: This is a serious question, is it possible to ensure that everyone who requests euthanasia does so in a free and informed manner? When considering issues related to depression or "feelings of hopelessness" and considering the prevalence of elder abuse in our culture, is it ever possible to ensure that this "safeguard" is not abused?

Note 2: The last definition of who qualifies for euthanasia includes people who are living with psychological suffering. Is it possible to ensure people who live with psychological pain are capable of freely consenting?

* The person suffers from a grave and incurable illness.

Note: This definition does not state that the person must be terminally ill, rather this definition would include people with disabilities and other people living with chronic conditions. Considering the last definition includes people with psychological pain, how does this definition protect anyone. Someone living with incurable psychological pain, such as those with chronic depression, should not be killed by euthanasia, but rather offered effective and caring treatment for their condition.

* The persons medical condition is characterized by a profound degradation of the persons capacities, with no possibility of improvement.

Note: Many people with disabilities live with conditions that are incurable and can be characterized as living with a profound degradation of their capacities, does that mean that society should be killing them by euthanasia. This definition is clearly oriented to eliminate people with disabilities, who are not terminally ill, and possibly not being provided basic opportunities to live. This section alone should cause people with disabilities to rise up against these euthanasia proposals.

* The person is living with physical or psychological suffering that is constant and unbearable and cannot be relieved by means that the person is willing to tolerate.

Note: This qualification for euthanasia basically allows a doctor to euthanize anyone who is living with a physical or cognitive disability, a person who lives with chronic depression or mental illness, a person who lives with chronic conditions, a frail elderly person who is "tired of living."

This definition will be able to be used to eventually euthanize anyone who reasonably requests euthanasia.

* Euthanasia can only be administered by a physician. The physician must consult another independent physician and the attending physician (the one who does the act), must submit a formal declaration of medical aid in dying (euthanasia) to a provincial board.

Note: The only safeguard in this section is the fact that it states that euthanasia must be done by a physician. A second physician approving euthanasia is not a safeguard. Doctors who are willing to euthanize their patients will know which physicians are willing to sign off on the paperwork.

The doctor who euthanizes the person submits the paperwork to the provincial board. Doctors will not self-report abuse, therefore the report to the provincial board is not a safeguard. This process does not protect the patient, it only protects the doctor.

The Legal Framework

The report indicates that although euthanasia is classified under criminal law, which is federal jurisdiction in Canada, the Dying with Dignity Committee is suggesting that euthanasia is a medical act which is classified under health law, which is provincial jurisdiction. The proposed regulations would be legislated in the Québec Civil Code within the Law on Health and Social Services.

Note: Classifying euthanasia as a medical act is an abomination of language. Medical acts are oriented to treating the medical condition of a patient, not ending the life of a patient. Administering a lethal injection cannot be considered a medical act of treatment.

The report states that since the province regulates medical professionals, therefore the legislation would include new regulations for professional medical associations to allow euthanasia. Recommendation 21 states that medical professionals will be allowed to object to euthanasia, but they are obligated to refer their patients to a medical professional who is willing to kill (euthanize) their patient.

Note: In other words, doctors and nurses are being told that you don't have to kill your patients but you must refer their patients to someone who will.

The report state that the attorney general in Québec will establish prosecution guidelines to ensure that people will not be prosecuted for euthanasia.

Note: These guidelines will protect doctors who euthanize their patients.

The Belgium Euthanasia Model
It is important to note that the "safeguards" that have been proposed by the Québec Dying with Dignity committee are identical to the Belgium Euthanasia Model.
* Belgium legalized euthanasia, but not assisted suicide;
* The reporting process in Belgium does not protect patients. The patient is dead before the report is submitted (after the death reporting). A study that was published in the BMJ - Oct 2010 found that 47% of the euthanasia deaths in the Flanders region of Belgium were not reported.
* A study published in the CMAJ - May 2010 found that 32% of the euthanasia deaths in the Flanders region of Belgium were done without request or consent.
* There are no reports of doctors who were prosecuted in Belgium for ignoring the safeguards.
* Belgium requires doctors to approve euthanasia, but nurses can do it. The report has stated that the Québec nurses association needs to change their code of ethics. A study published in the CMAJ - May 2010 found that 45% of the euthanasia deaths done by nurses were done without request or consent.

In fact euthanasia is out-of-control in Belgium.

The Québec Dying with Dignity report has not yet become the law. Legislators need to be urged to reject the recommendations to legalize euthanasia while supporting the recommendations to improve palliative care.

The safeguards that are being proposed are at best an illusion, especially since they allow euthanasia for people with depression, people with disabilities and people with chronic conditions based on a definition of suffering that cannot be defined or controlled.

The Québec National Assembly needs to change directions and properly plan to care for all of its citizens and not kill.

No comments: