Monday, December 14, 2015

Ontario Government euthanasia report seeks to protect physicians but not patients.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Jocelyn Downie
The Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying released their pro-euthanasia report, one-day before the release of the report from the Federal Panel on Assisted Dying. Link to the report.

The Provincial-Territorial Expert Advisory Group featured a stacked deck of pro-euthanasia activists. Maureen Taylor, who describes herself, on Twitter, as an advocate of assisted death, was a co-chair, while Jocelyn Downie, Canada's leading promoter of assisted death, and Arthur Schaefer is a long-time advocate of euthanasia and assisted suicide were also members.

There are 43 recommendations in the report. Many of the recommendations are similar to the euthanasia laws in Belgium and the Netherlands and a few are particularly concerning.

The Advisory Group is urging the government to implement regulations that will completely protect physicians, or other medical professionals, that participate in euthanasia and assisted suicide, but the protections for the persons who will die, are weak. 

Alex Schadenberg
The 43 recommendations focus on the provision of death, not the protection of patients. I will focus on the following recommendations:
Recommendation 3: All provinces and territories should ensure access to physician-assisted dying, including both physician-administered and self-administered physician assisted dying. The recommendations set out in Appendix 3 should be implemented through provincial/territorial legislation.
3. The Advisory Group does not recognize a difference between euthanasia (physician-administered) and assisted suicide (self-administered).
Recommendation 4: Provinces and territories should require all regional health authorities to have an effective publicly funded care coordination system in place to ensure patient access to physician-assisted dying.
4. The Advisory Group supports the creation of  a death bureaucracy in every region of the country.
Recommendation 5: Provincial/territorial governments should publicly fund physician-assisted dying.
5. The Advisory Group supports tax-payer funded assisted death.
Recommendation 8: Provinces and territories should request that the federal government amend the Criminal Code to allow the provision of physician-assisted dying by a regulated health care professional (registered nurse or, if applicable, physician assistant) acting under the direction of a physician, or a nurse practitioner. Provinces and territories should in turn ensure that no regulatory barriers exist that would prevent these health care professionals from providing physician-assisted dying.
8. The Advisory Group supports nurse participation in assisted death. Since the majority of doctors do not want to participate in euthanasia or assisted suicide, this recommendation is designed to expand the number of willing participants in acts of killing.
Recommendation 9: Provinces and territories should ensure that health professionals are protected from liability for acts or omissions done in good faith and without negligence in providing or intending to provide physician-assisted dying.
9. The Advisory Group doesn't want doctors or nurses to face lawsuits when a family member believes that a family member was inappropriately killed. This recommendation will enable abuses of the law to remain covered up.
Recommendation 13: Within one year, provinces and territories, in collaboration with the federal government, should study whether patient declaration forms completed prior to the diagnosis of a grievous and irremediable medical condition might also be considered valid.
13. The Advisory Group is suggesting that the government should study the law to expand the law to people who made a prior request for euthanasia, such as through an advanced directive.
Recommendation 14: Substitute decision makers should not be given the legal authority to consent to/authorize physician-assisted dying on behalf of an incompetent patient.
14. In the future, Recommendation 13 may supersede recommendation 14.
Recommendation 17: Access to physician-assisted dying should not be impeded by the imposition of arbitrary age limits. Provinces and territories should recommend that the federal government make it clear in its changes to the Criminal Code that eligibility for physician-assisted dying is to be based on competence rather than age.
17. The Advisory Group is suggesting that children with disabilities should have access to lethal injection.
Recommendation 18: “Grievous and irremediable medical condition” should be defined as a very severe or serious illness, disease or disability that cannot be alleviated by any means acceptable to the patient. Specific medical conditions that qualify as “grievous and irremediable” should not be delineated in legislation or regulation.
18. The Advisory Group is suggesting that assisted death be limited to very severe conditions while offering no objective criteria to make this a reality. The Supreme Court decision was open to assisted death for psychological suffering, which cannot be defined or limited.
Recommendation 22: Two physicians must assess the patient to ensure that all criteria are met.
22. The Advisory Group is under the illusion that requiring two physicians to assess the patient will ensure that the criteria is met. This "safeguard" does not negate a request when one of the physicians believes that the criteria are not met, it only requires two physicians to agree.
Recommendation 26: We do not recommend a prescribed waiting/reflection period. Rather, the time between initial request and declaration will vary according to the time it takes for the attending and reviewing physician to be confident that the declaration is free and informed and made by a competent individual.
26. The Advisory Group does not recognize the importance of a waiting period as a time of reflection before lethally injection. Often, after a short time, a person will change their mind.
Recommendation 28: There should be no requirement that a physician be present at a self-administered assisted death.
28. The Advisory Group is not requiring physicians be present during an assisted suicide death and yet recommendation 29 requires physicians to file a report concerning the death. When a person ingests a lethal dose, how will we know, for sure, that it was voluntary? This recommendation negates effective oversight.
Recommendation 29: Following the provision of physician assisted dying, physicians should file a report with a Review Committee to support the review of each individual case. This review will ensure transparency and confirm compliance with existing policies and procedures.
29. The Advisory Group is trusting that somehow an after-the-death reporting system, that requires the physician who causes the death, to self-report the assisted death, provides transparency and confirm compliance with existing policies and procedures. Will doctors self-report abuse of the law? 

The only way to ensure transparency and confirm compliance is by instituting a before-the-death reporting and court approval process.
Recommendation 30: Physician-assisted dying should be listed as the manner of death on medical certificates of death across all provinces and territories and the name of the medical condition that qualified the patient for physician assisted dying should be listed as the cause of death.
30. At least the Advisory Group recognizes the importance of accurate death certificates.
Recommendation 33: Conscientiously objecting health care providers should be required to either provide a referral or a direct transfer of care to another health care provider or to contact a third party and transfer the patient’s records through the system described in Recommendation 4.
33. The Advisory Group does not support physicians conscience rights. Physicians who refuse to kill their patients should not be required to refer their patient to someone who will kill their patient.
Recommendation 38: Faith-based institutions must either allow physician-assisted dying within the institution or make arrangements for the safe and timely transfer of the patient to a non-objecting institution for assessment and potentially, provision of physician-assisted dying. The duty of care must be continuous and non-discriminatory.
38. The Advisory Group does not support the rights of faith-based institions. The institution is not required to directly participate in killing patients, but it is required to arrange for their patients to be killed in another institution.
Recommendation 39: Provincial and territorial governments should establish a Review Committee systems to review all cases of physician-assisted dying after the provision of the service to ensure compliance with relevant federal/provincial/territorial legislation and health professional regulatory standards, transparency and accountability.
39. Recommendation 39 relates to recommendation 29. The establishment of a review committee is necessary, but the system of reporting will not ensure compliance with relevant legislation, regulatory standards, transparency or accountability. The data that the committee reviews comes from the reports that  are submitted by the physician who causes the death, after the patient is dead. Physicians, like other human beings, will not self-report abuse of the law.
Recommendation 42: Professional organizations, regulatory authorities and universities should collaborate with each other and with patient groups to develop appropriate curricula and continuing education programs and training for students, physicians and health professionals that are related to the provision of physician-assisted dying.
42. The Advisory Group is urging the continued training of doctors in the killing of their patients.
Recommendation 43: Provinces and territories should provide public education about physician-assisted dying and apply best practices for public engagement to inform the continued development of end-of-life care law, policies, and practices.
43. The Advisory Group is urging the education of the public in the efficacy of the law.

The Euthanasia Prevention Coalition (EPC) knew, when the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying was appointed that they would produce a one-sided pro-euthanasia report. There is very little balance in this report and we are concerned by the minimal level of concern for the people who will die, if these recommendations are implemented.

EPC hopes that the Federal panel will publish a more reasonable report on December 15.

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