Why was Nitschke let into the UK?

This article was written by Dr Peter Saunders and published on his blog on June 23.

By Dr Peter Saunders - Campaign Director for the Care Not Killing Alliance UK

Dr Peter Saunders

Dr Philip Nitschke

Last week I wrote to the Home Secretary Theresa May advising her about the visit of Australian assisted suicide enthusiast Philip Nitschke urging her to prevent him entering Britain to conduct a seminar on methods people can use to kill themselves.

Today Nitschke was detained at Gatwick airport, but eventually let into the country several hours later after having some ‘items’ temporarily confiscated by border police.

Nitschke (aka Dr Death) is an extremist and self-publicist whose presence in the UK puts the lives of vulnerable elderly, depressed and disabled people at grave risk. 

His workshop in London on Tuesday under the auspices of ‘EXIT International’ now looks likely to go ahead and will advise on the sourcing, supply and use of barbiturates, helium, nitrogen and other means to commit suicide. 

In 2001, Nitschke said that his so-called ‘peaceful pill’ should be ‘available in the supermarket so that those old enough to understand death could obtain death peacefully at the time of their choosing’.

Asked who would qualify for access he replied that ‘all people qualify, not just those with the training, knowledge or resources to find out how to “give away” their life and someone needs to provide this knowledge training or resource necessary to anyone who wants it, including the depressed, the elderly bereaved, (and) the troubled teen’. 

A 2010 report demonstrated that coroners were aware of 51 Australians who had died from an overdose of Nembutal, a lethal barbiturate that Nitschke has promoted since the late 1990’s as ‘a peaceful way to die’.

Of the 38 cases fully investigated by coroners, only 11 people were known to have suffered chronic physical pain or a terminal illness before their deaths. Of the 51, 14 were Australians in their 20’s and 30’s.

Journalist Michael Cook put it to Nitschke in 2011 that ‘nearly two-thirds of the Australians who died after quaffing Nembutal... were under 60, and quite a few were in their 20s and 30s... [suggesting that] that mental illness or depression, not unbearable pain, was the reason for the suicide.’

Nitschke responded, ‘There will be some casualties... but this has to be balanced with the growing pool of older people who feel immense well-being from having access to this information, [about suicide drugs].’

In the past, Nitschke's workshops have focused on the use of drugs and gas to commit suicide, with around half the time being used to explain how Nembutal, a veterinary sedative, can be used to end life.  

He has explained to attendees the best way to administer drugs and gas in order to bring about death, and has advertised test kits for Nembutal. 

Currently he is the subject of an inquiry by the Australian Health Practitioners Agency (AHPA) in connection with a company called 'Max Dog Brewing' which he has set up in order to sell nitrogen cylinders to the public. Its website claims that they can be used for home brewing (nitrogen produces the bubbles in stout) but Nitschke has admitted on Australian national media that they can equally be used to commit suicide.

The Suicide Act, as amended in 2009, states that ‘an act capable of encouraging or assisting the suicide or an attempted suicide of another person’ is illegal, ‘whether or not a suicide, or an attempt at suicide, occurs’; the emphasis is on whether the accused ‘intended to encourage or assist suicide or an attempt at suicide’.

I believe that what Nitschke has done at previous workshops falls within the scope of these offences, because the information shared was capable of encouraging or assisting an attendee to commit suicide and the workshop was intended to encourage or assist people to commit suicide by offering them advice about the ‘best way’ of doing it.

Nitschke’s activities present a real and present risk to vulnerable members of the British public.

With the growing elderly population, failure of the care system and worsening economic situation a growing number of frail, disabled, ill and depressed people in Britain will be feeling under even greater pressure to end their lives, either for fear that they will not cope, or so as to be less of a burden to relatives.

They deserve better protection from suicide predators like Nitschke than they are currently getting.

Let’s hope that no vulnerable person is ‘helped’ over the edge by attending his seminar or as a result of the inevitable media hype that will accompany his visit.

Quite why the Home Secretary allowed him into the UK remains a mystery but Britain deserves an explanation.

Previous articles about Philip Nitschke:

- Philip Nitschke appears to be trolling the internet for peaceful pill customers and death clients.
- Philip Nitschke continues to promote veterinary drugs for suicide.

- Were Robert Miller and James Robertson influenced by Philip Nitschke? 

- Legalizing euthanasia, there will be casualties.

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.

Washington State's Annual Assisted Suicide Report: What it Doesn't Say

Margaret Dore

By Margaret K. Dore, Esq.

The Washington State Department of Health has released its annual Death with Dignity Act Report for 2012.[1] The report is most interesting for what it doesn't say, as follows:

The Act

The report states that Washington's assisted suicide act "allows adult residents in the state with six months or less to live to request lethal doses of medication from physicians."[2] This is an oversimplification. The act applies to persons estimated to have less than six months to live, which as explained below, can include those with many years to live. Moreover, the act's significance is not that people can request a lethal dose, they could always do that, but that physicians and other persons can provide that dose for the purpose of causing a patient deaths without getting into trouble.[3] 

A Small Number of Deaths

Per the report, there were 121 "participants" of the act, meaning persons who were dispensed a lethal dose under the act during 2012.[4]  Of these persons, 104 are known to have died, of which 83 died after ingesting the lethal dose.[5]  These deaths are but a small fraction of all deaths occurring in Washington state, which totaled 49,386 in 2011, the most recent year for which an overall total is available.[6]

Demographics

The report states that 48% of participants had a baccalaureate degree or higher.[7]  Such persons with a college education are often people with money, i.e., the middle class and above.

The report also states that most participants were age 55 and older.[8] According to a 2009 study by Met Life Mature Market Institute, "The older population owns the largest proportion of wealth in the U.S."[9] Moreover, "older people with money" are a prime demographic for abuse. The study states: 

"Victims may even be murdered by perpetrators who just want their funds and see them as an easy mark."[10]

No Information on Patient Consent

The report gives no information as to whether administration of the lethal dose was voluntary on the part of the 83 people who died after ingesting the lethal dose. The report merely describes the fact of ingestion.[11]

The word "ingest" means "to take (food, drugs, etc.) into the body, as by swallowing, inhaling, or absorbing."[12] This can be on a non-voluntary basis. Consider, for example, a patch placed on the patient's arm, allowing the lethal dose to be absorbed into the patient's body while he is sleeping. The patient would not necessarily even know that the patch was in place.

By using the word, "ingestion," the report provides no information on patient consent one way or the other.

Patients May Have Years to Live

Washington's act, which is based on a similar act in Oregon, applies to "terminal" patients defined in terms of less than six months to live.[13] Oregon's act has the same definition.[14]

Such persons are not necessarily dying. This is because medical predictions of life expectancy can be wrong.[15] Moreover, treatment can lead to recovery. Consider Oregon resident, Jeanette Hall, who was diagnosed with cancer and told that she had six months to a year to live. In a 2012 affidavit, she states: 

I wanted to do our law and I wanted [my doctor] to help me.  Instead, he encouraged me to not give up and ultimately I decided to fight the cancer.  I had both chemotherapy and radiation. . . .

This July, it was 12 years since my diagnosis. If [my doctor] had believed in assisted suicide, I would be dead.[16].

Conclusion

The Department of Health Report, if accurate, documents a small number of people using Washington's assisted suicide act. The reported persons are, however, in a vulnerable demographic for abuse including murder. The report's lack of information about consent to administration of the lethal dose is disturbing. The act, regardless, encourages people with many years to live to throw away their lives.

Margaret Dore is an attorney in Washington State where assisted suicide is legal. She is also President of Choice is an Illusion, a nonprofit corporation opposed to assisted suicide and euthanasia. See: www.margaretdore.com and www.choiceillusion.org

Footnotes:
1.  See Washington State Department of Health 2012 Death with Dignity Act Report, June 20, 2013, available at: http://www.doh.wa.gov/portals/1/Documents/Pubs/422-109-DeathWithDignityAct2012.pdf 
2.  Report page 1 ("Executive Summary")
3.  See Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009 and Washington's Act, RCW 70.245.190(1)(a), available at: http://apps.leg.wa.gov/RCW/default.aspx?cite=70.245.190 ("A person shall not be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with this chapter")  
4. Report page 1 at note1.
5. Report page 1 ("104 are known to have died; 83 died after ingesting the medication; 18 died without ingesting the medication").
6.  Washington State Department of Health, Vital Statistics Data, Death Tables by Year, for 2011 http://www.doh.wa.gov/DataandStatisticalReports/VitalStatisticsData/DeathData/DeathTablesbyYear.aspx 
7.  Report, page 5
8.  Report, page 5, table 2 (regarding age)
9. The MetLife Study: "Broken Trust:  Elders, Family and Finances," 2009, page 19, available at: https://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf 
10. Id, page 24.
11. See entire report
12. http://www.yourdictionary.com/ingest (transitive verb)
13. RCW 70.245.010(13)
14. ORS 127.800 s.1.01(12)
15. See Nina Shapiro, "Terminal Uncertainty," Washington's new "Death with Dignity" law allows doctors to help people commit suicide - once they've determined that the patient has only six months to live. But what if they're wrong? The Seattle Weekly, January 14, 2009. http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty
16.  Affidavit of Jeanette Hall, Leblanc v. Canada, available at:  http://choiceisanillusion.files.wordpress.com/2013/05/jeanette-hall-affidavit.pdf .

Philip Nitschke detained at London England airport.

Philip Nitschke

Yahoo news reported today that Philip Nitschke, Australia's Dr. Death, was detained by immigration officials at the London Gatwick airport earlier today. Nitschke is on a European tour promoting his suicide devices, drugs and techniques.

The Yahoo news article stated:

British officials are not commenting on why Australian euthanasia advocate Philip Nitschke was detained at London's Gatwick Airport for several hours overnight. 

Upon arrival Dr Nitschke says he was called out by name and escorted to a room where various items he uses for his workshops were taken away. 

He says eventually they were returned and he was allowed entry to the UK after a delay of several hours.

The article quoted Nitschke as responding to the detention:

Dr Nitschke says he was shocked when an immigration official told him he should not have been surprised at his detention because of what he does. 

"I was a little taken aback by that statement because what I do is lobby for changing the law on voluntary euthanasia and giving people choices," he said. 

"If that means that every time you come into a country like Britain it means you're going to be taken out of the queue, have officers waiting for you, be paged off the plane and then searched thoroughly because of what I do, it's a little bit disappointing." 

He says although he was carrying test kits and demonstration items, he was not carrying any drugs or prohibited items.

"We were taken down into the basement of Gatwick airport. All of our luggage has been gone through," he said. 

"A number of items have been taken away for inspection. 

"They include bits and pieces used at workshops, flow regulators and the like, associated with the euthanasia pieces of equipment that we use as demonstration."

Dr Richard Choong

Nitschke is also being challenged by the Australian Medical Association for promoting assisted suicide, suicide devices and drugs. A recent article from ABC news Australia stated:

Dr Nitschke appeared in Perth promoting nitrogen canisters which he says can help people legally end their life. 

His claims have prompted the AMA to speak out on the euthanasia issue for the first time. 

The Association's WA President Richard Choong says he is strongly opposed to Dr Nitschke's product, regardless of whether it is technically legal. 

"What he preaches is still wrong," he said. 

"It is still breaking legislation, encouraging people to break laws. 

"Encouraging people to believe this is an option, that's inappropriate when there are other options available." 

The Association says Dr Nitschke's claim the product is legal is dumbfounding. Dr Choong says euthanasia is illegal for a good reason. 

"Any machine that can help you kill yourself can be abused, misused and maliciously used," he said. 

"And that's a real danger and something we should be aware about. 

"That's why we have legislation protecting us against this."

The laws that protect people from euthanasia and assisted suicide in Australia and the UK are nearly identical to the Canadian law. Nitschke has been recklessly promoting assisted suicide and suicide techniques, drugs and information for many years.

Previous articles concerning Philip Nitschke:

- Nitschke left 'high and dry' without cover.
- Philip Nitschke appears to be trolling the internet for peaceful pill customers and death clients.
- Philip Nitschke continues to promote veterinary drugs for suicide.

Good coverage news coverage for Montana assisted suicide court case.

The following letter was printed yesterday in the Independent Record newspaper in Montana. The letter was written by Bradley Williams.

Bradley Williams

I am the President of Montanans Against Assisted Suicide. Thank you for your Associated Press article about our lawsuit against the Board of Medical Examiners. We are awaiting the results of the court hearing. Meanwhile, I would like to alert your readers to our upcoming event “Assisted-Suicide: Whose Choice?” The title refers to the reality of legalization in which the choice of whether someone dies can be determined by someone other than the patient. Consider this observation by Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition, who will be our keynote speaker. He states:

“A 2009 report by MetLife Mature Market Institute describes elder financial abuse as a crime ‘growing in intensity.’ The perpetrators are often family members, some of whom feel themselves ‘entitled’ to the elder’s assets. The report states that they start out with small crimes, such as stealing jewelry and blank checks, before moving on to larger items or coercing elders to sign over the deeds to their homes, change their wills, or liquidate their assets. The report also states that victims ‘may even be murdered’ by perpetrators.”

Our event will be on Saturday, June 29 at the Great Falls Hilton Garden Inn. For more information, go to www.montanansagainstassistedsuicide.org or call 531-0937.

Assisted suicide deaths increase in Washington State in 2012.

The number of assisted suicide deaths in Washington State, increased by 17% in 2012. Assisted suicide was legalized in March 2009, after a ballot measure.

The number assisted suicide deaths in Washington State were: 83 in 2012, 70 in 2011, 51 in 2010. There has been a 63% increase in the number of assisted suicide deaths in Washington State since 2010.

The number of prescriptions for assisted suicide were: 121 in 2012, 103 in 2011, 87 in 2010. There has been a 39% increase in the number of prescriptions for assisted suicide in Washington State since 2010.

In Oregon, where assisted suicide has been legal since 1998, the number of assisted suicide deaths has also been continuously increasing. Since 2009, there has been a 30% increase in the number of assisted suicide deaths and a 21% increase in the number of lethal dose prescriptions in Oregon.

Similarly, in Belgium, where euthanasia is legal, there was a 25% increase in the number of assisted deaths in 2012.

In Washington State: 

• Only 3 of the 121 people who were prescribed a lethal dose were offered given a psychiatric evaluation.

• One person died 150 weeks after receiving the lethal dose while 17 of the participants died more than 6 months after receiving the lethal dose.

• The physician who prescribed the lethal dose, was present only 5 times during ingestion.

• One person died 16 hours after taking the lethal dose.

• The report is incomplete. Of the 121 prescriptions for lethal dose, 10 of the Written Request forms were not submitted, 13 Death Certificates were not received, 4 of the Pharmacy dispensing forms were not submitted and 11 of the Consulting Physician forms were not submitted.

The data that we have concerning the practice of assisted suicide in Washington State is submitted, after the death, by the physician who prescribes the lethal dose. Because they use a self-reporting system, abuses are difficult to uncover.

Links to other recent articles:

• Maine House overwhelmingly rejects assisted suicide bill.

• Don't be fooled by Lord Falconer's modest assisted suicide proposal in the UK.

• Suicide Clinic in Washington State.

• Oregon 2012 assisted suicide statistics.

Why the BC Court of Appeal should overturn BC Court ruling on assisted suicide.

The following article was written by Derek Miedema and published by the Institute for Marriage and Family.

Why the BC Court of Appeal should overturn BC Court ruling.

Derek Miedema

By Derek Miedema - June 19, 2013

While Quebec is busy legalizing euthanasia, the B.C Court of Appeal could decide by month’s end to force federal politicians to make it legal across Canada.

The British Columbia Supreme Court overturned Canada’s law against euthananasia last June through the ruling in Carter versus Canada. This ruling also gave Gloria Taylor, living with ALS, the right to have a doctor help her kill herself before any laws changed.

The case landed in the B.C. Court of Appeal, where a decision is due any day now. While we don’t know how it will go, we can hope that British Columbia will learn from the Irish example.

Just this past April, the Supreme Court of Ireland upheld their law banning assisted suicide.

The case presented to Irish courts was closely modeled after the case in B.C.

The B.C. court had heard evidence of abuses where euthanasia and/or assisted suicide are legal. These included thousands of people killed without their consent in the Netherlands.

The court was told there was no evidence of vulnerable people being endangered by Dutch law. Note that killing infants without their consent is legal in Holland.

Despite this, Justice Lynn Smith of B.C. concluded that: 

“In my view, the evidence supports the conclusion that the risks of harm in a regime that permits physician-assisted death can be greatly minimized.”

She decided that the plaintiff’s right to life included a right to assisted suicide.

The case was promptly appealed.

In the meantime, pro-legalization forces in Ireland modeled their case on the Canadian one, putting forth similar evidence.

However, after hearing that evidence, the Irish judges decided to uphold their law.  This happened first in the Irish High Court, and then was repeated in the Irish Supreme Court.

Explicit disagreement with the B.C. Supreme Court

The Irish High Court found Justice Smith’s dismissal of a slippery slope “too sanguine”.

They wrote: 

“…the fact such a strikingly high level of legally assisted deaths without explicit request occurs in countries such as Belgium, Netherlands and Switzerland without any obvious official or even popular concern speaks for itself as to the risks involved in any such liberalisation.”

The Irish Supreme Court viewed the Canadian decision as an outlier. “…It is not consistent with many judgments from supreme and constitutional courts of other nations.”

They concluded, contrary to Justice Smith, that the right to life afforded in their constitution “does not import a right to die.”

As hard as the lawyers argued that the Canadian case should be its guide, the Irish courts viewed it as a breach of international standards, not as the new common wisdom.

Does the right to life include the right to die?  

In Canada, Justice Lynn Smith blazed a new trail in deciding it does. In Ireland the answer was no because the justices recognized that suicide itself is not a right in Irish law.

The Irish High Court considered the issue of deaths without consent to be an important one. Are even a few such deaths acceptable or are they evidence of deadly abuse?

The fact that the Irish Supreme Court came to the opposite conclusion as Justice Smith shows that there is reason for the B.C. Court of Appeal to quash her decision. 

“[M]any elderly people in the Netherlands are so fearful of euthanasia that they carry cards around with them saying that they do not want it,” according to a statement in the British House of Lords.

If the B.C. Court of Appeal doesn’t overturn Justice Smith’s decision, the Canadian market for such cards could heat up.

Belgium is moving closer to allowing euthanasia of children.

An article published in Expatica.com on June 20, 2013 is reporting that Belgian lawmakers are moving closer to legalising the euthanasia of minors, so long as they are judged capable of deciding for themselves.

The Quebec government has recently introduced a bill to legalize euthanasia based on the Belgian euthanasia law.

The article stated:

Four senators from parties in the governing coalition formally put forward changes to a 2002 law that made Belgium the second country in the world after The Netherlands to legalise mercy killing in certain cases. 

Their parties said they would back the changes and parliament is likely to approve them in coming months. 

Euthanasia is currently legal only for those aged 18 but experts have told parliament that in practice euthanasia on children was already taking place, without any set guidelines. 

Changes to the law were submitted for debate in parliament in December and legislators have been discussing them there since February. 

Discussions have centred on the minimum age should the law be changed, and senators on Thursday settled on a young person's "capacity to discern", which would be assessed by a psychiatrist. ... 

A separate issue of whether to extend the law to those suffering from a mental deficiency remains unresolved. 

Belgium recorded a record 1,432 cases of euthanasia in 2012, up 25 percent from the previous year. They represented two percent of all deaths.

Considering the fact that the Belgian euthanasia law is already being abused, one would think that Belgium would not be expanding their euthanasia law but rather attempting to control their euthanasia law.

For instance, recent studies concerning the Belgian euthanasia law found that: 32% of the assisted deaths are done without request and 47% of the assisted deaths go unreported in the Flanders region of Belgium. Another recent study found that even though nurses are prohibited by law from doing euthanasia, that in fact nurses are euthanizing their patients in Belgium. There has never been an attempted prosecution for abuses of the Belgian euthanasia law.

The book, Exposing Vulnerable People to Euthanasia and Assisted Suicide uncovers data proving that unreported euthanasia deaths and the abuse of the euthanasia laws in jurisdictions, such as Belgium and the Netherlands, where it is legal, uncovers euthanasia deaths without request not only occur but represent a threat to vulnerable patient groups.  

Order the book: Exposing Vulnerable People to Euthanasia and Assisted Suicide.

Links to other recent articles on the same topic:
- Belgium and the Netherlands escalate their child euthanasia programmes.
- Quebec euthanasia bill (Bill 52) is a very dangerous bill.
- Belgium is planning to extend euthanasia to children with disabilities.

Quebec is trying to legalize euthanasia by calling it something else. It's still wrong.

The following article was written by Margaret Somerville and published in the Globe and Mail on June 19, 2013.

Margaret Somerville

Margaret Somerville - Globe and Mail, June 19, 2013

So, you call your pet duck, which lives with you, a dog, because the law prohibits keeping a duck in your apartment, but allows dogs. A court will convict you for breaking the law.

Now you are the Quebec provincial government and you table a bill in which you call euthanasia, which is prohibited as murder under the Canadian Criminal Code, “medical aid in dying” (MAD) and claim it is medical treatment. You define “end-of-life care” as including MAD and you pass a law which states that physicians must administer MAD to “end-of-life patients,” who fulfill the necessary conditions, unless the physicians have conscientious objections. You also require that “institutions,” such as hospitals and certain “residential and long-term care centres,” must be able to give patients, who qualify, access to MAD.

On the face of the record, a court would convict physicians who did so of criminal offences and the participating institutions as parties to the physicians’ offences and, possibly, guilty of the separate crime of conspiracy to commit an offence.

Bill 52 does not expressly define MAD; rather, it leaves it to the council of physicians, dentists and pharmacists of each institution “in accordance with the clinical standards established by the professional orders concerned, to adopt clinical protocols applicable to terminal palliative sedation and medical aid in dying”. But it’s clear that MAD is a euphemism for euthanasia or, at the least, is intended to include euthanasia.

Likewise, the definition of “the practice of medicine” in the Quebec Medical Act is extended to include a physician “administering the drug or substance allowing an end-of-life patient to obtain medical aid in dying under the Act respecting end-of-life.”

These approaches allow the Quebec government, first, to avoid expressly contravening the Criminal Code in Bill 52 by directly authorizing euthanasia and, second, are almost certainly meant to boost the government’s argument that MAD (euthanasia) is a medical treatment. That characterization is necessary to support the Quebec government’s claim that the legal governance of MAD is within provincial and not federal jurisdiction.

But physicians have never regarded killing as medical treatment. Indeed, the Hippocratic Oath, which has been foundational in medical ethics for over two millennia, originated in order to separate the two roles – healer and executioner – of traditional “medicine men,” the predecessors of physicians. Today’s physicians pledge to care always, cure where possible, and never intentionally to inflict death. Quebec’s proposed legislation directly negates this last obligation.

Bill 52 would give “end-of-life patients” a choice of “fast” or “slow” euthanasia. Fast euthanasia (MAD) would be a lethal injection; slow euthanasia would be what the Bill calls “terminal palliative sedation.” This term is confusing, because some sedation at the end of life is not euthanasia and some can be. It’s an example of the strategy of promoting euthanasia by confusing it with interventions which are not euthanasia and are ethically acceptable and arguing that there are no relevant differences among them and all are ethical and acceptable.

“Palliative sedation,” which is relatively rarely indicated as an appropriate treatment for dying people, is used when it is the only reasonable way to control pain and suffering and is given with that intention. It is not euthanasia. “Terminal sedation,” in which the patient is sedated with the primary intention of precipitating their death, is euthanasia.

Euthanasia advocates argue that we can’t distinguish the intention with which these interventions are undertaken and, therefore, this distinction is unworkable. But the circumstances in which such an intervention is used and its precise nature allow us to do so. For instance, if a patient’s symptoms can be controlled without sedation, and especially if the patient is not dying and food and fluids are withheld, sedating the patient is clearly euthanasia.

In the Netherlands, terminal sedation is not defined as euthanasia and there has been a substantial increase in its use. Some commentators have pondered whether it’s being used instead of lethal injections, because it allows physicians to avoid the reporting and other requirements euthanasia entails. The same would be likely under the Quebec provisions. The requirements for using “terminal palliative sedation” seem to be at the discretion of the physician, provided that the patient or, if they are incompetent, their surrogate decision-maker gives informed consent. The requirements for access to and reporting on MAD are far more onerous and more limiting, and a surrogate decision-maker could not authorize it.

That said, the Quebec Bill would allow MAD to be carried out pursuant to a patient’s advance directive consenting to it. Most jurisdictions which have legalized euthanasia or physician-assisted suicide have limited it to adults who are competent and consenting at the time it is administered,

It is an open question whether MAD includes physician-assisted suicide, as the media have constantly reported it does. The uncertainty arises because Bill 52 provides that “If a physician determines …that medical aid in dying may be administered to a patient requesting it, the physician must administer such aid personally and take care of the patient until their death.” And the Quebec Legislative Assembly committee report which informed Bill 52 rejected physician-assisted suicide.

The reasons to exclude PAS might include that it’s more difficult to frame suicide as a “medical act;” that the Quebec government doesn’t want to promote the idea that suicide, in general, is an appropriate response to suffering; that they want to maintain the current medical norm that the appropriate medical act in dealing with attempted suicide is to try to save life; or that they are doing an end run around the precedent in the Rodriguez case, in which the Supreme Court of Canada upheld the constitutional validity of the crime of assisted suicide.

Finally, who is an “end-of-life” patient who may have access to MAD? Among other requirements, they must “suffer from an incurable serious illness; suffer from an advanced state of irreversible decline in capability; and suffer from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable.” In other words, they need not be terminally ill and might be mentally, but not physically, ill. Many disabled, old, frail and vulnerable people would fulfil these criteria. And recall that MAD may be administered in “residential and long-term care centres” or a person’s home.

These comments on Bill 52 are far from comprehensive and are intended simply to identify some of the arguments, reasoning and strategies that it manifests and issues it raises. I hope they serve as early warning signals of just some of the dangers Bill 52 presents.

Margaret Somerville is the founding director of the Centre for Medicine, Ethics and Law at McGill University.

Ontario premier, Kathleen Wynne, appears to be considering Quebec euthanasia proposal

Kathleen Wynne, the Liberal premier of Ontario, appears to be considering similar proposals as Quebec did last week when it introduced Bill 52, to legalize euthanasia in Quebec.

Last week, CBC news reported Wynne making overtures of support to Bill 52, to legalize euthanasia in Quebec, and now the Toronto Sun has published an interview with Wynne, who uses careful but supportive language.

Kathleen Wynne

The article published in the Toronto Sun quotes Wynne as stating:

we need to have a chat about “end-of-life” decisions — such as the euthanasia debate Quebec Premier Pauline Marois ignited in her province recently.

Wynne was then quoted to have said:

In a frank, wide-ranging interview Tuesday, Wynne told the Toronto Sun she considers the debate about euthanasia and end-of-life decisions, “the great health-care issue of our time.” 

The Silver Tsunami — the huge number of baby boomers poised to retire and who’ll require greater medical care as they age and die — will prompt debate about when to end life, as governments across the country struggle to cope with this ticking time bomb and as seniors seek to take control of their own lives and destinies. 

“It’s a huge ethical debate, so I think it’s something that every person in this country is going to have to confront and discuss and obviously the people of Ontario are not going to be exempt from that. It’s going to be thrust upon us.” Wynne added individuals and groups are pushing governments to allow terminally ill patients to take control of the way they die through assisted suicide. 

“I don’t think it’s something we’re going to be able to choose to talk about or not,” she said. It’s part of a larger discussion around palliative care and hospices, she said.

The article then quoted from the Ontario government report issued by Don Drummond on government cost savings that stated:

In his report last year on how to rein in provincial spending, economist Don Drummond said that doctors need to engage middle-aged people on end-of-life decisions. 

“Primary care physicians need to open the dialogue about a living will that lays out how individuals wish to be cared for when they are unable to do so, including the need to discuss the living will with family beforehand to mitigate any possible conflicts later,” Drummond said in his report. 

It’s not a cheerful thought, but in bald economic terms, the older you get, the more you cost the health-care system. Don’t forget, Drummond’s report was about saving money — not lives.

Euthanasia is not the same as "living wills" or Power of Attorney for Personal Care documents. 

Alex Schadenberg

I have always stated that when the economic gurus get involved with the euthanasia lobby, then watch out. I fear the economic mismanagement that has occurred in Ontario, Quebec and other provinces, will lead to the promotion of euthanasia.

Euthanasia is sold to the public under the false premise that it will be based on personal autonomy and to eliminate suffering.

When analyzing the outcome of legal euthanasia it becomes apparent that it is often done with request and it is rarely done to eliminate physical suffering.