Monday, June 24, 2013

Bill 52 is bad medicine for Québecers with disabilities.

The following article was originally published on June 20 on the Toujours Vivant - Not Dead Yet website.

By Amy Hasbrouck, the founder of: Toujours Vivant - Not Dead Yet

Amy Hasbrouck with John Kelly
Bill 52, which was tabled in Québec’s national assembly on June 12, will not relieve suffering so much as kill the people who are suffering. By turning care into killing, it will create a hodge-podge of programs, ethical standards, and medical practices that devalue and endanger the lives of elders and others with disabilities, chronic and degenerative illnesses. 

Promoters call it “death with dignity” assuming that disabled and elderly people must die to have dignity. At the same time, Bill 52 does nothing to help people live with dignity, by enabling them to control where and how they live with the natural changes that come with aging, illness and disability.

Bill 52 is discriminatory. The very fact that the national assembly is thinking of adopting euthanasia means that the lives of the elderly and disabled people who ask to die are considered less worth saving than others who are prevented from killing themselves. While a troubled adolescent or bereaved widower who want to die will be met with an array of suicide prevention services, those with serious illness might not even get a mental health exam before having the lethal injection. When governments adopt such laws, they endorse this devaluation and discrimination.

Bill 52 is unnecessary. Any person who wishes to die can do so in the usual way (suicide was decriminalized in Canada in 1972) or by refusing medical treatment while having comfort care. This right was established in the case of Nancy B. v. Hotel Dieu de Québec in 1992.

Supporters of the bill say it’s only a very small group of people who need the law. If so, why does the government want to risk the lives of a lot of elders and people with disabilities to help a few people die a little faster.

Bill 52 is confusing. It is supposed to be for “end of life patients” (sic) but those who want Medical Aid in Dying need only have a serious and advancing illness. That could describe someone with diabetes who loses a leg or a quadriplegic with a major skin breakdown.  Having these conditions does not mean life is over.  

The bill does not define “Terminal Palliative Sedation” – a central pillar of the program – nor are there any eligibility restrictions for this “service.” The definition of and standards for “medical aid in dying” are also left to individual institutions and health care administrators.

The WHO defines “palliative care” as relieving symptoms to improve a person’s quality of life. But this bill focuses on the terms “end of life care” and “terminal palliative sedation” which both refer to causing death. Bill 52 does not offer palliative care to every Québecer, it offers death.

Bill 52 is dishonest. It never uses the word “euthanasia” even though that is what is being proposed. It also presumes that there is a free and informed choice to be made. But when local medical services are inadequate to treat a person’s pain and restore function, when being forced to live in a nursing home means you pee on the institution’s schedule, not your own; when you can’t choose who will care for you and how, and when lack of access mean you can’t leave your house or have a job, where is the choice in that?

Bill 52 is a recipe for abuse. There are few safeguards or attempts at prevention. There is no established waiting period or psychological evaluation required. The doctor has no obligation to provide information about mental health or social intervention, or to ensure that needed services or supports are in place. An heir can fill out the euthanasia request form (“in case of physical incapacity”) and accompany the person to sign it before the “health or social service professional.” 

There is no court process to establish that the person is competent to make a “clear and informed” decision, and a third person (also an heir) can request “terminal palliative sedation.” The section on advance directives gives the person holding that directive the power to enforce or invalidate the directive once the patient is declared incompetent.

There is no procedure to verify that the required reports are filed when someone is killed.  The Commission created by the law is heavily weighted against patients, and it does not have powers to investigate problems. Commission reports at five year intervals seem designed to hide problems, rather than solving them.

Whatever good intentions may have been in the hearts of those who drafted this legislation, bill 52 is not healthy for Québecers who are elderly and/or have disabilities.

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