Wednesday, December 2, 2015

Québec euthanasia regulations are clear as mud.

By Amy Hasbrouck:

Amy Hasbrouck
When Québec passed its euthanasia law in 2014, we pointed out many problems, hoping that these would be remedied before the law came into effect.

Québec assisted dying law in conflict with the Criminal Code.

Eighteen months later we are on the verge of entering the euthanasia era in Québec, with many issues still unsettled. Thus far, Québec has:
  • Issued a set of regulations governing a narrow slice of the euthanasia process;
  • Offered a “five year plan” for palliative care which proposes “equitable” but not “universal” access to palliative care;
  • Through the college of physicians, issued guides to performing euthanasia and continuous palliative sedation, and offering care “at the end of life.”
The government of Québec has also threatened hospices which refuse to perform euthanasia with loss of funding, in direct violation of § 72 of the law. The government is also requiring doctors who refuse to kill their patients to provide a referral for euthanasia.

Despite these actions, many standards and procedures remain unclear:
  • The application process still lacks any provision for accessibility to people who have communication disabilities. Nor are there guarantees that people with mobility impairments will receive medical care in a timely manner on equipment which is accessible to them.
  • There are still no protections against family members with financial interests who witness or fill out the forms on the person’s behalf.
  • There are no procedural barriers to serial applications in case of refusal, or “doctor shopping.”
  • Neither a psycho-social evaluation, nor a home visit is required to verify capacity to make decisions, that the decision is free and informed, or to ensure the person is not being abused or coerced.
  • The competency determination does not appear to involve the judicial process already used for determining capacity in Québec.
  • There is no requirement that the person receive palliative care or other support services to enable him or her to live well until natural death occurs. The “choice” to die remains an illusion where the person does not have a choice in where or how to live.
  • The definition of “end of life” is entirely subjective, and can range from two months to eight years. 
  • The eligibility decision is made only by the treating physician, who could be a generalist or a specialist, even in an unrelated area. The government doesn’t take into account that 25% of Québécois do not have a primary care doctor.
  • The treating physician must consult a specialist in the person’s disease or condition, but does not have to follow the advice of the second doctor.
  • The treating physician has the right to bring in an interdisciplinary team to provide advice, but the person doesn’t have the same right to the advice of an interdisciplinary team.
  • There are no objective measures that need to be met to determine eligibility. The doctor must simply “assure” him or herself that the person meets the criteria, without explicit procedures for how to do so.
  • Doctors are supposed to “develop proficiency” in the techniques of euthanasia, with no indication of how much training they must take to achieve and maintain this proficiency.
  • The length of the cooling off period is not stated.
  • Though individual doctors are supposed to have “conscience rights” to refuse to perform euthanasia, they must nonetheless determine eligibility, but are barred from providing a second opinion. Multiple passages discourage doctors from following their conscience and refusing to kill.
  • Nurses and pharmacists must participate in the preparation for euthanasia, including preparing the dosage and setting up the IV, though they may opt out of performing the lethal injection.
  • It appears the person’s medical record will not be part of the application for euthanasia, only the request form and results of a physical exam will be included.
  • The oversight Commission has not yet been appointed.
  • The data collected will be insufficient to track doctor shopping and the reasons applicants are refused. Data will only be kept for five years, making long-term analysis impossible.
  • The Commission’s oversight is after-the-death, which doesn’t help the person who died because of a slipshod eligibility determination.
  • The commission has no responsibility to police the practice of euthanasia beyond the reports that are submitted.
  • Plans are already in the works to extend eligibility to children and other groups.
Amy is a lawyer and the founder of disability rights group Toujours Vivant - Not Dead Yet.  Amy is also the VP of the Euthanasia Prevention Coalition.

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