Wednesday, December 21, 2016

Québec euthanasia report: 14% non compliance rate with the law.

Amy Hasbrouck
President, Euthanasia Prevention Coalition.
Director, Toujours Vivant-Not Dead Yet.

December marks the first anniversary of Québec’s euthanasia program, and serious questions about compliance with the law are already emerging.

Thus far, the Commission on end-of-life care has provided two reports, one at the six-month mark, and one at nine month mark. 

The Québec euthanasia commission report that was filed on August 31 stated that 262 euthanasia were reported by doctors in Québec, and 263 continuous palliative sedations were reported by institutions as of June 30. 

The number of completed euthanasia's were more than three times higher than the original estimate given by Québec’s health minister, Gaetan Barrette, who believed there would be about 100 euthanasia deaths in the first year.

The reports from the Commission consist of information from institutions (for the first six months), as well as the forms filled out by doctors each time they perform euthanasia (over nine months). At the six month mark, the institutional data showed 167 euthanasia as of June 9. However as of June 30 only 161 doctors’ forms had been filed. This discrepancy leads us to question whether doctors are reporting every instance of euthanasia.
As of August 31, the Commission was already behind in reviewing and ruling on doctors’ reports of euthanasia. According to the nine-month totals, only 198 of the 262 euthanasia records had been examined. Of those, only 148 had been evaluated for compliance with the law.

Of the 21 cases in which the commission found a failure to comply with the law, 18 failed because the second doctor was not independent of the first physician. Health Minister Barrette stated in media interviews that he is considering making some adjustments to simplify the paperwork and ease the obligation of seeking a second opinion from an objective and independent doctor.

Of the remaining three cases, the Commission found that two of the people were not at the “end of life” as defined by the law. In the other instance, the Commission ruled the person did not have a “serious and incurable illness.”
The 21 cases that did not conform to the law represent 14.2% of 148, while the three found with eligibility violations represent a 2% error rate.
The report includes no information about the underlying cause of the request, the nature of the “intolerable suffering” or any demographic information about the people making the request, or the doctors granting them.

This report raises many questions. First, is the commission equipped to examine and rule on the number of euthanasia cases it will face if it already had a backlog before the end of the first year?

Second, how do we know that doctors are actually reporting all euthanasia deaths? This is a chronic and serious problem in Belgium; who’s to say it won’t become a problem in Canada?

Third, if the government’s response to the 14% error rate is to remove the requirement that the second doctor be independent, how will it respond to the 2% of cases where errors of eligibility occurred? What penalties will those doctors face who do not comply with the eligibility requirements? Who will enforce the law?

Fourth, the information furnished in the report is not comprehensive enough to enable the reader to know if those who received euthanasia were eligible, and if all safeguards were followed. Without detailed information, researchers will not be able to study the demographics and reasons people request euthanasia, to understand the public policy impact of this law. 

1 comment:

ParaTir Quebec said...

Dear Amy,

Those are very weighty concerns indeed.

Thank you for the outstanding work.

We are definitely walking in the wilderness now. And the exile is likely to be long.

In order to eventually push back in an effective manner will require solid facts. Therefore, your efforts to collate reliable information from slippery, hard to obtain, and (increasingly as time goes by) perhaps deliberately obscure sources, is of the first priority.

As such, I believe it would also be helpful to involve a greater part of the volunteer base in these efforts.

For instance, the exercise of directly engaging the powers that be, through the simple act of polite -- but persistent -- requests for information meetings might not materially effect the value of our final statistics, but it does certainly bring our concerns home to a greater number of administrators, lets them know that they are and will be asked to behave in a rigorous fashion (subject to future scrutiny) and most importantly, takes advantage of that mysterious "x-factor" which comes from networking personally with the actual people in positions opposite to ours.

I am quite sure that you have been doing this very thing at the highest level. My suggestion, today, would be that we think about moving down one organisational echelon, to the regional health authorities (counting subdivisions in Montreal, I believe there are something like 31 territorial jurisdictions running health care in QC) and undertake a systematic initiative of meeting with all of these instances, using a structured and uniform template

I would suggest this as an initiative designed to engage more of our people, not only with the "decision makers" and adversary advocates, but with the ordinary people who find themselves, as administrators, accidentally on the front lines of implementation.

In any case, whatever the chosen form, as you feel the need of more warm bodies for more face-to-face contacts and more follow-ups in more places, you know where I am to be found.

Feel the Love,

Gordon from Montreal