Monday, March 1, 2021

MAiD (euthanasia) for mental illness ignores safeguards for vulnerable people

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr K. Sonu Gaind
Dr. K. Sonu Gaind who is an associate professor of psychiatry at the University of Toronto, a past president of the Canadian Psychiatric Association (CPA) and a member of the Council of Canadian Academies expert advisory group on MAiD was published yesterday by the Conversation concerning the approval of euthanasia for people with mental illness alone.

Gaind explains why this topic is being considered:
People whose suffering is caused by mental illness alone do not currently have access to MAID. However, the Senate recommended Bill C-7 contain a “sunset clause” that would lift this exclusion in 18 months. The Trudeau government has extended the clause to 24 months but has otherwise accepted it, meaning that in 18 to 24 months, MAID will be provided to those suffering solely from a mental illness.
Gaind examines the known evidence on this topic:
The fundamental underpinning of all MAID requests is supposed to be the presence of “a grievous and irremediable medical condition.” The blunt and indisputable reality is that, unlike for much more predictable medical conditions with better understood biologies, it remains currently impossible to predict whether mental illness is irremediable.

The Centre for Addiction and Mental Health has concluded: “There is simply not enough evidence available in the mental health field … to ascertain whether a particular individual has an irremediable mental illness.”

After 15 months of studying global evidence, the Council of Canadian Academies came to the same conclusion, as did the Expert Advisory Group on MAID. Both the American Psychiatric Association (APA) and Royal Australian and New Zealand College of Psychiatrists (RANZCP) have also concluded that there’s no evidence to support providing MAID solely for mental illness.

Gaind explains why safeguards are not effective for people with mental illness:
Those who advocate expanding access to MAID propose mitigating this reality with “safeguards.” This ignores the fact that irremediability is itself the primary safeguard built into the MAID framework, and bypassing it renders all other supposed “safeguards” meaningless.

Because we cannot predict irremediability, there is 100 per cent certainty that MAID will be provided to some people who could recover — there is no safeguard against that. Suggesting otherwise is akin to a society that declines to use the death penalty over concerns of potentially executing the innocent, but then implements the death penalty anyway with false “safeguards” to reassure the public even as the wrongly convicted are executed.
Gaind challenges the Canadian Psychiatric Associations for focusing on opinion and ignoring evidence:
Regrettably, while the APA and RANZCP have provided meaningful evidence-based guidance in their societies’ debates on MAID and mental illness, Canadian psychiatric associations have not. After failing to consult members for two years, the Canadian Psychiatric Association released its position statement in 2020 that “patients with a psychiatric illness … should have available the same options regarding MAID as available to all patients.” Remarkably, the association also said that its statement was “never intended to … examine whether psychiatric conditions are irremediable and if so, how this should be assessed.”

Equally remarkably, the president of the Québec Psychiatric Association (AMPQ) responded to concerns about the lack of supporting evidence by saying in recent Senate hearings: “This is not a data-driven question, this is an ethical question.” That sentiment is reflected in an AMPQ document offering guidance on developing a MAID framework for mental illness.
Gaind continues by presenting his position based on the evidence:
Other evidence highlights the risks of providing access to easy death to suicidal, vulnerable and marginalized people who are not dying but suffering from psychosocial life stress. Even the Office of the United Nations High Commissioner for Human Rights has raised the alarm that Canada’s pending MAID policy will prematurely end vulnerable lives.

These concerns simply serve as icing on the cake to the indisputable, evidence-based reality that there is no predictably irremediable mental illness for which MAID can be provided. And the government’s 24-month sunset clause is as meaningful as a decree telling coronavirus to disappear — non-existent evidence cannot simply be commanded to appear.
Gaind continues with his concerns based on how common mental illness is:
We are poised to provide death for mental illness to potentially suicidal, non-dying marginalized people suffering from life distress who have the potential to recover — all based on less evidence than is required for the approval of any sleeping pill. Given the ubiquity of mental illness, no family needs to look very far to appreciate the implications.

Years ago, I had the pleasure of meeting our prime minister’s mother, Margaret Trudeau, to present her a mental health advocate award from the Ontario Psychiatric Association. I recall her vibrancy as she spoke of her life experiences and graciously mingled with my colleagues and me after dinner. I also recall the poignancy of her descriptions of despair during her periods of deep depression, including hopeless times she wished to die.
Gaind finishes his article by calling for honesty in the debate:
If Canada wants to provide MAID to people who are suffering but whose illness might get better, we should have an honest debate and our MAID framework should reflect that. But if MAID is meant for irremediable conditions, evidence shows it would be a dishonest and hypocritical deception to offer it for mental illness.

Unfortunately, in Canada’s debate about medical assistance in dying, evidence has already been provided a medically assisted death.
More articles on this topic:

Life insurance and Canada's (MAiD) euthanasia law.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was recently contacted by a doctor with a patient, who is not terminally ill, but wants to die by (MAiD) euthanasia after Bill C-7 has passed. The patient said that he and his wife have medical issues and if he were to die, then his life insurance would pay for the care that his wife requires.

When euthanasia was legalized in Canada the life insurance industry took the position that legalizing euthanasia would have a minimal effect on life insurance because the law required that a person's natural death be reasonably foreseeable. People who are terminally ill do not qualify to purchase life insurance.

EPC disagreed with the life insurance industry based on the phrase: natural death is reasonably foreseeable was not defined, nonetheless everything changes with Bill C-7, that is being debated by parliament.

Bill C-14, the bill that legalized euthanasia in Canada did not affect insurance contracts. Bill C-14 stated:

Whereas it is desirable to have a consistent approach to medical assistance in dying across Canada, while recognizing the provinces’ jurisdiction over various matters related to medical assistance in dying, including the delivery of health care services and the regulation of health care professionals, as well as insurance contracts and coroners and medical examiners;

Bill C-7 eliminates the requirement that a person's natural death must be reasonably foreseeable, meaning that people who are not dying can be killed by euthanasia.

It is possible that a person who intends to die by euthanasia, qualifies for life insurance, even though the policy would likely be rated, nonetheless, a rated policy would be cheap if a person intends to die soon.

Sign the petition: No to euthanasia for mental illness and incompetent people! (Link)

Contact your member of parliament to reject the Senate amendments and Bill C-7. Members of Parliament contact list:

What about the two year suicide restriction that the insurance industry uses for suicide?

Canada's legislation does not define (MAiD) euthanasia as a suicide. Therefore the two year suicide restriction used by the insurance industry does not affect (MAiD) euthanasia deaths.

I recognize that it would not be common for someone to qualify and purchase a life insurance policy knowing that they intend to be killed by (MAiD) euthanasia, nonetheless it is a concern and it would cause an increase in life insurance rates for legitimate life insurance policies.

As stated before, even a heavily rated policy is cheap when someone who is not terminally ill purchases life insurance with the intention of being killed by MAiD.

Saturday, February 27, 2021

Toronto Star Editorial: Trudeau government should rethink its flawed changes to assisted dying

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

When the Toronto Star, which is usually a Liberal newspaper, says in its editorial that the Trudeau government changes to the (MAiD) euthanasia law are flawed, then you know that the message is getting out.

Sign the petition: No to euthanasia for mental illness and incompetent people! (Link)

Contact your member of parliament to reject the Senate amendments and Bill C-7. Members of Parliament contact list:

The February 26 Toronto Star editorial stated:
Twelve months ago, before the COVID-19 pandemic overwhelmed our lives and pushed almost every other issue to the margins of public attention, we sounded a warning that Canada seemed to be sliding toward what amounts to a system of death on demand.

We worried that the right to medical assistance in dying, or MAID, was at risk of being stretched far beyond its original conception: to ease the pain of suffering people in the final stage of life, of allowing them a so-called “death with dignity.”

Today, that possibility is no longer a risk but a reality...

As it stands now, Bill C-7 would greatly expand the right to MAID in ways that many doctors, ethicists and even experts from the United Nations find deeply problematic. By eliminating the requirement that a patient’s death be “reasonably foreseeable,” they say the bill will undermine the rights of disabled people and make it more likely they will accept assisted suicide rather than be provided with proper treatment and supports.

The bill even opens the door to extending the right to assisted suicide to people whose only underlying medical condition, their sole reason for seeking death, is suffering due to a mental illness. The potential for abuse is both obvious and frightening.
These comments are from the Toronto Star editorial, not the Euthanasia Prevention Coalition. The editorial continued:
Nor is any of this necessary. The federal government is bringing in these changes as a response to a Quebec Superior Court ruling in 2019, in which the judge decided that the law’s provision that death must be “reasonably foreseeable” is unconstitutional.

The government could have, indeed should have, appealed that flawed decision. Instead, it promised to bring the law into line with this one lower-court ruling, launched lengthy consultations on the whole issue of MAID, and eventually came up with a series of proposed changes laid out in Bill C-7. The Commons adopted them, then the Senate weighed in with amendments, and this week the government said it would accept some of those proposals.

One is that the right to MAID would be extended to people who are suffering solely from an underlying mental illness, though that wouldn’t take effect for two years. This is a complete about-face for the government, since its first version of C-7 explicitly excluded mental illness as grounds for demanding the right to an assisted death.

You don’t have to ponder this too long to see the potential for tragic outcomes. No doubt some people suffer in a “grievous” (the law’s language) way from mental illness, but surely those very conditions put an enormous question mark over their capacity to make final, irreversible decisions.
The Toronto Star editorial also disagrees with the euthanasia lobby but agree with the disability groups:
Advocates for the change say it’s discriminatory not to include mental illness, and argue that the law must respect the autonomy of the individual, the right of everyone to decide their own fate regardless of the type of medical condition they are suffering from.

That sounds lofty, but as many psychiatrists and advocates point out, how much true autonomy does a person have if society doesn’t offer them proper support to live their lives as fully as possible, if they are marginalized, unable to earn a living or access treatment, and feel they are a burden to others? Won’t they feel pressure to take advantage of an expanded MAID system just to escape all that? Is that really what we want — to set up a system where more and more people feel disposable, and in fact become disposable?

All that may apply to people with chronic conditions or disabilities as well, which is why hundreds of organizations advocating for them have come out against C-7. Added to that is a team of UN experts who concluded that the bill violates the UN Convention on the Rights of Persons with Disabilities, which Canada has ratified. “Disability should never be a ground or justification to end someone’s life directly or indirectly,” they wrote. “Such legislative provisions would institutionalize and legally authorize ableism.”
The Toronto Star editorial challenges other parts of the bill and then finishes by urging the government to get it right.
The government’s proposed bill includes other questionable changes as well. For one, it would eliminate a 10-day waiting period between the request for MAID by a person whose death is foreseeable and its carrying-out, a pause designed to make sure there aren’t second thoughts. Only one witness, not two, would be required.

It’s important that we get this right. Better to put up with more delay than to rush through a flawed bill that hasn’t had the full public debate it deserves. The government should think again.

Sign the petition: No to euthanasia for mental illness and incompetent people! (Link)

Contact your member of parliament to reject the Senate amendments and Bill C-7. Members of Parliament contact list:

Friday, February 26, 2021

Peru judge grants death by euthanasia to woman with chronic condition

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ana Estrada
The Merco Press reported that a Peruvian Judge has approved the euthanasia death of a woman with a non-terminal chronic condition. According to the report:
Judge Jorge Ramirez, of the Superior Court of Lima, said in his ruling that the professional who helps Ana Estrada, 43, to die will not be punished with three years in prison, as established by law. The authorization does not open the possibility of more euthanasias but will only be applicable to Estrada's case.
Estrada lives with polymyositis which is a chronic condition that causes weakening of the muscles. There is no cure for polymyositis but it is not a terminal condition.

The decision must be appealed 

Even though Judge Ramirez stated that the decision only applies to Estrada, based on precedent, it is not possible to permit the killing of one person without opening the law to permitting the killing of other people with similar conditions.

It is concerning that this precedent approves euthanasia for a person with a chronic condition, meaning, if this precedent becomes law it would be a very wide open law.

This decision is contrary to the position of United Nations experts who published a press release on January 25, 2021 titled: Disability is not a reason to sanction medically assisted dying. 

The United Nations experts expressed alarm at a growing trend of nations enacting legislation enabling access to medically assisted dying based largely on having a disability or disabling conditions, including old age (Link to the Press Release). The Press release stated:
“Disability should never be a ground or justification to end someone’s life directly or indirectly.”

Such legislative provisions would institutionalize and legally authorize ableism, and directly violate Article 10 of the UN Convention on the Rights of Persons with Disabilities, which requires States to ensure that persons with disabilities can effectively enjoy their inherent right to life on an equal basis with others.

Catalina Devandas who was the Special Rapporteur on the rights of persons with disabilities for the UN Human Rights Council published a statement, in March 2020, concerning her report the New Eugenics and ableism in medical practise.

Devandas expressed her concerns on the impact of euthanasia for persons with disabilities. She stated:
"If assisted dying is made available for persons with health conditions or impairments, but who are not terminally ill, a social assumption could be made that it is better to be dead than to live with a disability," the expert warned. 
"People have the right to live and to die with dignity, but we cannot accept that people choose to end their lives because of social stigma, isolation or lack of access to personal assistance or disability-related services." 

The Peruvian decision specifically approves euthanasia for a woman with a disability. 

Conservatives slow down euthanasia expansion bill in parliament. Contact your MP today.

Sign the petition: No to euthanasia for mental illness and incompetent people! (Link)

Contact your member of parliament to reject the Senate amendments and Bill C-7. Members of Parliament contact list:

Alex Schadenberg
Executive Director, 
Euthanasia Prevention Coalition

An article by Joan Bryden with the Canadian Press reported that the Quebec Superior court has extended the stay of the Truchon decision until March 26, 2021 to give the Liberal government time to pass Bill C-7, the bill to expand Canada's (MAiD) euthanasia law. The Truchon decision struck down the requirement in law that a persons death must be foreseeable.

The court imposed deadline is an arbitrary date. Even if Bill C-7 is not passed before March 26, it really doesn't matter since Bill C-7 is worse than the Truchon decision.

Last week I reported that Canada's Senate passed Bill C-7, the bill to expand Canada's (MAiD) euthanasia law, with dangerous amendments that further expands the law.

A few days ago, I reported that the Trudeau government  accepted the most dangerous Senate amendment, that being expanding euthanasia to people with mental illness alone, but with a 24 month reprieve to enable the government time to develop guidelines. The government did reject the amendment permitting euthanasia for incompetent people who asked for death in their advanced directive.

Bryden reports that the Conservatives are filibustering Bill C-7.
...the bill is stalled in the Commons, where the Conservatives refused for the third straight day today to facilitate debate on a motion laying out the government's response to amendments passed last week by the Senate.
Bryden also reported that the Bloc Québecois have agreed with the Trudeau government decision to extend euthanasia to people with mental illness alone. Therefore, unless back bench Liberal MP's reject euthanasia for mental illness, it will pass.

Contact your member of parliament to reject the Senate amendments and Bill C-7. Members of Parliament contact list:

Whatever the House of Commons approves, Bill C-7 will once again go back to the Senate for approval or amendment.

Thursday, February 25, 2021

Do not follow Oregon’s example. It is dangerous for patients and society. Vote No to Connecticut Bill 6425.

State of Connecticut General Assembly Committee on Public Health

Vote NO on Bill No. 6425, An Act Concerning Aid in Dying for Terminally Ill Patients

Dr Kenneth Stevens
Testimony of Dr. Kenneth R. Stevens, Jr., MD,
Professor Emeritus, Radiation Oncology, Oregon Health & Science University, Portland, OR

February 24, 2021

To Members of the Committee on Public Health,

I have been a cancer doctor in the practice of Radiation Oncology for 52 years in Oregon, treating cancer patients from 1969 to 2019.

I have studied and closely followed the implementation of Oregon’s assisted-suicide law since its passage in 1994. I have also continued to teach and practice medicine in a society where there exists such a law, taking note of its tragic results. The more I have learned and witnessed, the more I realize the significant harm and danger of assisted suicide to the vulnerably ill and to society. The following includes some of those harms and dangers.

There has been a profound negative shift in attitude towards terminally ill patients in Oregon. The commitment to care has become a commitment to the option of killing. There has been a distinct change of attitude in society and in members of the medical profession to patients who are terminally ill and eligible for assisted suicide. There is reduced incentive to evaluate and provide for the palliative care needs of patients who are eligible for assisted suicide. The legalization of assisted suicide results in a deterioration of caring for patients’ medical needs and symptoms.

Oregon’s assisted suicide law is not necessarily for only patients who are dying. Many who request/use the law are not dying already. The mere presence of legal assisted suicide steers patients to suicide.

As in Oregon, Bill 6425 supposedly applies to patients predicted to have less than six months to live. In 2000, I had a cancer patient named Jeanette Hall. She was referred to me with an inoperable low rectal cancer. She plainly told me that she did not want to be treated, and that she was going to “do” our law, i.e., end her life with a lethal dose of barbiturates. She had voted for the law and it was a very much settled decision for her. Her referring surgeon, who had determined that her cancer was inoperable, informed her that without treatment (radiation & chemotherapy) that she had a six month to one year life expectancy, so she qualified for Oregon’s assisted suicide law. Patients refusing appropriate treatment may be deemed “terminal” under current interpretation of the Oregon law. After consulting with her, I informed her that her cancer was treatable with chemotherapy and radiation and her prospects were good. She was not interested in treatment. She had made up her mind, but she continued to see me. On the third or fourth visit, I asked her about her family and learned that she had a son in his late 20s. I asked her how he would feel if she went through with her plan. Shortly after that, she agreed to be treated, the cancer melted away, and she is alive and active today. Twenty years later, she says “It’s great to be alive”. For her, the mere presence of legal assisted suicide had steered her to suicide. An 18-year-old girl with insulin-dependent diabetes would be eligible, if she stopped taking life-sustaining insulin.

Pain is not the issue. It is very significant that there are many cases of assisted suicide being used to address psychological and social concerns, but it is very rare for assisted suicide to be used in the case of actual untreatable pain.

Depressed people are dying from assisted suicide in Oregon. In 2008, researchers at Oregon Health & Science University reported 25% of terminally ill patients pursuing assisted suicide in Oregon met criteria for depression.  Yet, the Oregon Health Department annual reports for the years 2018 and 2019 reported that only 1% (4 of 366) of patients dying from assisted suicide had a psychiatric evaluation. Your bill dangerously permits social workers to evaluate patients’ mental status.

There is no real monitoring of Oregon’s assisted suicides. When David Prueitt’s failed suicide was made public in 2005, the Department of Health Services (DHS) publicly stated that they had “no authority to investigate individual Death with Dignity cases. The state law authorizing physician-assisted suicide neither requires of authorizes investigations by DHS.”

We are dependent on self-reporting by doctors, and in in most cases the prescribing doctor is not present when the drugs are taken.

There are financial and societal dangers that assisted suicide may be pressured as a cost savings. The Oregon Health Plan (Medicaid) pays for assisted suicide and does not pay for some cancer treatment to extend life. In 2008, cancer patients Barbara Wagner and Randy Shoup received letters from the Oregon Health Plan that the Plan would not pay for beneficial chemotherapy, but would pay for [among other things] physician-assisted suicide. Ms. Wagner’s comment to the media was “they will pay for me to die, but won’t pay for me to live.” 

Oregon’s regular suicide rate has increased since the legalization of assisted suicide. According to the U.S. Center for Disease Control (CDC), Oregon had the 2nd highest suicide rate in the U.S. for the years 1999-2010.

I urge you to vote no on this bill. Do not follow Oregon’s example. It is dangerous for patients and society.

Thank you,
Dr. Kenneth R. Stevens, Jr., M.D.

Organ donation following euthanasia (at home procedure)

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A letter published in JAMA (Journal of the American Medical Association) clarifies that people who die by euthanasia will often refuse to participate in organ donation because they prefer to die at home. In his letter, Dr Johan Sonneveld explains that a procedure permits euthanasia at home followed by organ donation.

To be clear, Sonneveld explains that the person is sedated at home and then transported to the hospital to have the organs removed. The letter states:
The patient is only sedated at home, which marks the start of euthanasia in legal terms but is medically only intended to remove consciousness while vital functions are maintained and secured. Coma induction and the start of the agonal phase subsequently take place in the intensive care unit after farewells at home and transportation. With the 5 minutes “no touch,” the total warm ischemia time until death decided was less than 7 minutes in this procedure.
By linking organ donation to euthanasia, then euthanasia becomes a "societal good." The advantage to linking euthanasia to organ donation is that the organs are vital, being removed from a person who has not died, and in many cases, is not near to dying a natural death.

But let's not be innocent about this. The question is why kill the person with lethal drugs before removing the vital organs? The plan is to kill the person, so why not kill the person by removing the vital organs?

Second Thoughts CT leader Cathy Ludlum on opposing assisted suicide: “there is no safeguard that can counter the social stigma of needing help with intimate care."

This article was published by Not Dead Yet on February 24, 2021.

By John B. Kelly, the director of the disability rights group, Second Thoughts.

On January 14, Second Thoughts CT leader Cathy Ludlum joined WPLR host John Voket on his show “For the People” to explain why legalized assisted suicide is simply too dangerous to implement. The full transcript is here.

In the 15-minute segment (beginning at 37:20), Cathy meets Voket where he is, and agrees that on its surface, many people would think it’s “a good idea to put the choice of when and how one dies into the hands of the individual.”

But when you start presenting people with other things to think about, a lot of times people may support the theory, but then the implementation worries them and they cannot support it as they had in the past. In other words, talking to one of us or all of us often gives them “second thoughts.” So that’s where the name of our group came from and we’ve been active and mobilized since 2013, as I said.

Cathy pulls the conversation from a narrow focus on individual autonomy to the realities of a society prejudiced against disabled people, who “already have challenges whenever we go to the hospital or we try to get healthcare.”

What those of us in the disability community are trying to get across is, there is no safeguard that can counter the social stigma of needing help with intimate care, of having to rely on others for support, or of seeing your caregivers tired and wondering if the world would be better off without you.

Indeed, Oregon doctors reported that in 2019 “feeling like a burden” motivated more than half of the patients who were prescribed a lethal overdose. Cathy doesn’t get into the details, but the other top four “end-of-life concerns” also relate to psychological distress about the disabling aspects of serious illness, not physical pain as proponents insist.

There is also no possible safeguard to prevent coercion:

with no independent person there at the time of death, how can we ever know that it was the individual’s choice instead of a person who has been threatened or coerced or feels that they have no other choice than to end their own life?

Whenever disabled people point out the dangers of assisted suicide, journalists and legislators routinely ask, as Voket does, whether “legislation can be crafted to carve out the disability community that is so significantly concerned.”

Cathy patiently explains that the legislation “changes the way healthcare is structured” by codifying in law a medical practice that produces death as a beneficial outcome. “And so it changes the doctor-patient relationship. It changes the way insurance and financial reimbursement and such work.”

If some people are understood in state law and medical practice to be literally “better off dead” than alive, “it involves changing the whole way we look at life and death.” I would add that legalized assisted suicide logically leads to doctors and people in a patient’s orbit recommending, persuading, and instigating that death. We have the examples of Kathryn Judson, who overheard her husband’s doctor telling him that he should commit suicide to spare her the trouble of caring for him, or Kate Cheney’s family that was intent on her death.

There is no way to protect disabled people because

there is a tendency in the medical system already to think of us as terminally ill even though we may all live on for years with the right support. I understand the need to try and create some middle ground, and I wish we could do that, but I don’t see a way of making that happen.

It’s long been known that doctors and medical personnel underestimate the “quality of life” experienced by disabled people, who love our lives as much as nondisabled people.

Voket asks whether the legislation has gone terribly wrong in other places, and Cathy refers to a list of abuses and complications compiled by the Disability Rights Education and Defense Fund (DREDF). Cathy mentions without name the case of Michael Freeland, “with a 40-year history of suicide attempts being given the drug.”

It’s also been true that, once established as a benefit, assisted suicide (or in some other countries, straight up euthanasia) gets extended to more and more conditions, such as non-terminal conditions like diabetes and multiple sclerosis in Oregon, and depression and feeling “tired of life” in other countries. People can become “terminal” because their insurance denies coverage to and people can’t afford necessary treatment, or they stop their life-sustaining treatment.

Voket concludes the interview by asking Cathy if Second Thoughts CT could support “the other potential proposals involving end-of-life legislation that might hit the State House floor this session?”

Cathy affirms Second Thoughts’ support for “palliative care and anything that would support a person as they are nearing the end of life,” and of “good suicide prevention strategies.”

Our question is, how can the State of Connecticut be promoting suicide prevention while possibly at the same time promoting suicide assistance? And the difference is what label you wear, whether you are deemed as terminally ill, elderly, having a “complete” life — which is something they use in other places, or “disabled.”

Cathy loves her life and is upbeat about how supports can meet the challenges of disability. As she stated at the beginning of the interview, the problem isn’t disability but the deadly prejudice against it. And the answer is to remove that prejudice, not the people it targets for death.

Wednesday, February 24, 2021

Trudeau government agrees to permit euthanasia for mental illness alone.

Sign the petition: 
No to euthanasia for mental illness and incompetent people! (Link)

Contact your member of parliament to reject the Senate amendments and Bill C-7. Members of Parliament contact list:

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Last week I reported that Canada's Senate passed Bill C-7, the bill to expand Canada's (MAiD) euthanasia law, with dangerous amendments that further expands the law.

As bad as Bill C-7 was, the Senate passed five amendments to Bill C-7. The primary amendments were expanding euthanasia to people with mental illness alone (with an 18 month reprieve for the federal government to develop rules) and incompetent people who had requested death in their advanced directive.

By passing Bill C-7 with amendments, the bill went back to parliament for debate on the amendments.

Joan Bryden, reported for the Canadian Press that the government accepted the most dangerous Senate amendment, that being, expanding euthanasia to people with mental illness alone, but with a 24 month reprieve to enable the federal government to develop guidelines. Bryden reported:
The Trudeau government has agreed with the Senate that Canadians suffering solely from grievous and incurable mental illnesses should be entitled to medical assistance in dying — but not for another two years.

The two-year interlude is six months longer than what was proposed by senators.

Since this is a minority government, it is possible that members of parliament will reject this amendment.
The mental illness alone amendment felt like a "set-up" after Justice Minister, David Lametti, announced on November 24 that, once Bill C-7 passed, he wanted to expand euthanasia to people with mental illness alone.
With a minority government, parliament is able to reject the Senate amendments.
Sign the petition: No to euthanasia for mental illness and incompetent people! (Link)

Bryden also reported that the government has rejected the Senate amendment permitting euthanasia for incompetent people who have requested death in their advanced directive. Bryden reported:
The government has rejected another Senate amendment that would have allowed people who fear being diagnosed with dementia or other competence-eroding conditions to make advance requests for an assisted death.

It has also rejected one other amendment and modified two others in a motion that is to be debated today in the House of Commons.
If the House of Commons approves the government's response, the bill will go back to the Senate, where senators will have to decide whether to accept the verdict of the elected chamber or dig in their heels.

The Senate had no right to consider expanding euthanasia to people who request death in their advanced directive since the issue was not even studied by the House of Commons or Senate hearings on Bill C-7. The Senate simply reacted to an emotionally compelling speech by Senator Wallin.

What did Bill C-7 do before it was amended?

1. Bill C-7 removes the requirement in the law that a person’s natural death be reasonably foreseeable in order to qualify for assisted death. Therefore, people who are not terminally ill can die by euthanasia. The Quebec court decision only required this amendment to the law, but Bill C-7 went further.

2. Bill C-7 permits a doctor or nurse practitioner to lethally inject a person who is incapable of consenting, if that person was previously approved for assisted death. This contravenes the Supreme Court of Canada Carter decision which stated that only competent people could die by euthanasia.

3. Bill C-7 waives the ten-day waiting period if a person's natural death is deemed to be reasonably foreseeable. Thus a person could request death by euthanasia on a "bad day" and die the same day. Studies prove that the “will to live” fluctuates.

4. Bill C-7 creates a two track law. A person whose natural death is deemed to be reasonably foreseeable has no waiting period while a person whose natural death is not deemed to be reasonably foreseeable would have a 90 day waiting period before being killed by lethal injection.

5. As stated earlier, Bill C-7 falsely claims to prevent euthanasia for people with mental illness. The euthanasia law permits MAiD for people who are physically or psychologically suffering that is intolerable to the person and that cannot be relieved in a way that the person considers acceptable. However, mental illness, which is not defined in the law, is considered a form of psychological suffering.

Bill C-7 went much further than the Quebec Superior Court Truchon  decision and now the Senate has made it worse. 

Join more than 52,000 people who have signed the petition: Reject euthanasia Bill C-7 (Link).

Contact your member of parliament to reject the Senate amendments and Bill C-7. Members of Parliament contact list:

Legal euthanasia makes killing the norm, not the exception

By Henk Reitsema

Henk Reitsema
Henk Reitsema wrote an insightful article that was published in the Times UK on February 23, 2021. Reitsema is responding to the campaign to legalize euthanasia in Scotland. Reitsema comments on the expansion of euthanasia and the growth in acceptance of other acts that cause death, but are not defined as euthanasia. He writes:
Campaigners plan a new move to legalise assisted suicide in Scotland this year. The Netherlands, which legalised euthanasia in 2001, should offer a cautionary tale. My country expected a fall in backdoor euthanasia and the stopping of incremental extension by pinning down the definitions in law. But 20 years later it is clear we were profoundly mistaken.

There has been a massive greying of the lines, with a significant increase in life-shortening treatments that are not being called euthanasia. The term “unbearable suffering” has been expanded from physical suffering to include psychological and existential suffering — now even the term “tired of life” is sufficient. We have also seen the restrictions on age and mental competency shift.

The debate started in response to the many life-lengthening medicines that were being developed in the late 1960s. Rather than debate the medical imperative of treating patients one could not heal, professionals started taking matters into their own hands, with the first court case taking place in 1973 when a nurse killed her mother with a morphine overdose. Though the nurse got a one-week suspended sentence, more importantly the courts stipulated which procedures they would have wanted to have seen met in this case. This opened the door to legalisation in 2001.

Initially, it looked like reform had slowed down the euthanasia rate. From 2001 to 2005 numbers dropped from 3,500 to 2,300. Subsequently they started to rise again and are now at roughly 6,500 cases a year. This is more than 4 per cent of all deaths in any given year.

Once active killing by physicians was legalised, their attitudes towards pain treatments that shortened life changed. Palliative sedations, in which a patient is sedated for the final phase of life without hydration or food, rose from 5.6 per cent of all deaths in 2001 to 8.2 per cent in 2005. Now roughly 25 per cent of all deaths take place under these circumstances.

Since legalisation, the incentive to improve palliation has diminished and euthanasia has gone from being an exceptional situation to becoming the norm, with people who feel they are a “burden” to their next of kin requesting to end their lives even when they do not really want it.

When euthanasia is ever more frequently used, the tendency is then to move in the direction of euthanising those who are not able to request it owing to dementia or other incapacity. Paradoxically, that which was supposed to provide autonomy could lead to the ultimate loss of autonomy.

Reitsema started opposing euthanasia after his grand father was killed without request or consent. 

Tuesday, February 23, 2021

No to euthanasia for mental illness and incompetent people!

Petition to the Political Party Leaders.
Canada legalized euthanasia (MAiD) in June 2016. At that time the legislation was sold to Canadians as a compromise by permitting euthanasia for physical or psychological suffering but requiring that a person’s “natural death be reasonably foreseeable” before they qualified to be killed by lethal injection.

In September 2019, a Quebec Superior court judge, in Truchon, struck down the requirement in the law that a person’s natural death be reasonably foreseeable. The government did not appeal the decision.

In December, parliament passed Bill C-7, which claimed to be the government’s response to the Quebec Truchon court decision, and yet Bill C-7 goes much further. The government also decided, through Bill C-7, to eliminate the 10-day reflection period in the law, create a 90-day reflection period for people who are approved for euthanasia but not dying and reduce the number of witnesses for the request from two to one and allowing the one witness to be a care giver and more.

As bad as Bill C-7 was, the Canadian Senate voted last week to pass Bill C-7 with 5 amendments. Essentially the Senate approved euthanasia for mental illness alone, but provided the government 18 months to establish rules for euthanasia for mental illness and they approved euthanasia for incompetent people who wrote in their advanced directive that they would want to die by euthanasia.

Legalizing euthanasia gives medical professionals the right in law to lethally inject their patients, but permitting euthanasia for mental illness and through advanced directives directly contradicts the need for effective consent.

We the signed oppose Bill C-7 and demand that parliament reject euthanasia for mental illness and incompetent people.

Links to more articles on this topic:

Stephen Mendelsohn - Testimony opposing Connecticut assisted suicide Bill HB 6425

Testimony in strong opposition to HB 6425 

An Act Concerning Aid in Dying for Terminally Ill Patients February 26, 2021 

Senator Abrams, Representative Steinberg and members of the Public Health Committee:

Stephen Mendelsohn, Second Thoughts
I am an autistic adult and one of the leaders of Second Thoughts Connecticut, a coalition of disabled people opposed to the legalization of assisted suicide. Our group works with national disability rights organizations including Not Dead Yet and the Disability Rights Education and Defense Fund to oppose such legislation. Second Thoughts Connecticut is a member of the Connecticut Suicide Advisory Board. Personally, I serve on the board of directors of Euthanasia Prevention Coalition-USA and previously served on the Connecticut MOLST Task Force. 

HB 6425 would codify lethal and systemic disability discrimination into law. It does so by redefining the suicides of a subset of disabled people as somehow not suicide, but a “medical treatment option,” using the focus-group-tested euphemism “aid in dying.” 

Suicide is defined as the act of taking one’s life intentionally. The person who intentionally ingests a prescribed lethal overdose more closely fits the dictionary definition of suicide than the despondent person who jumps off a bridge. The desire for suicide is a cry for help, even when redefined as a “medical treatment option.”

The Connecticut State Suicide Prevention Plan 2025 posits a clear intersection between assisted suicide and other suicide. Connecticut has the only comprehensive state suicide prevention plan that includes disabled people as a high-risk population. To quote the relevant section (pp. 57-58): 

Discussions about assisted suicide for those with terminal illness intersect in important ways with suicide prevention. The active disability community in Connecticut has been vocal on the need for suicide prevention services for people with disabilities… [William] Peace writes that “Many assume that disability is a fate worse than death. So we admire people with a disability who want to die, and we shake our collective heads in confusion when they want to live.” 

Connecticut’s suicide prevention plan makes a number of important recommendations, including “Do not assume suicide is a ‘rational’ response to disability or chronic illness.” 

By contrast, Oregon’s state suicide prevention plan only deals with youth suicide—not adults of any age, and certainly not disabled people or older people as high-risk groups. A quarter century of legalized assisted suicide in that state has led to a culture where the suicides of old, ill, and disabled people are viewed as mere “acceptable losses” by suicide prevention authorities—who all too often harbor ableist attitudes our state suicide prevention plan rejects. 

In addition to attempting to redefine suicide, proponents of assisted suicide promote other falsehoods. 

Proponents claim assisted suicide is only available to people who will soon die. Yet not only do many people far outlive “terminal” prognoses, including those who have received lethal prescriptions, but many disabled people are perceived as “terminally ill” by medical professionals. Laws allow treatable medical conditions like diabetes to qualify as “terminal diseases,” and HB 6425 is no different, as the definition of “terminal illness” in Section 1 (20) does not say “regardless of treatment options.” Moreover, proponents have long sought to expand suicide assistance to those with non-terminal disabilities

They claim that their legislation is only for people in “deep and dire pain,” yet nothing in HB 6425 requires those seeking lethal overdoses to be in pain. Pain or the fear of it has never been in the top five reasons people give for seeking assisted suicide, according to Oregon’s annual reports. The overwhelming reasons people ask for assisted suicide involve not wanting to live the way disabled people do

Proponents claim that there have been no abuses in states that have legalized assisted suicide, when the Disability Rights Education and Defense Fund has documented a list of abuses and complications, including cases of prolonged and agonizing deaths. Moreover, as the Oregon Department of Health and Human Services stated: “We are not given the resources to investigate [assisted suicide cases] and not only do we not have the resources to do it, but we do not have any legal authority to insert ourselves.” The only reason more abuses have not been documented is that assisted suicide laws are designed to conceal them. 

HB 6425 is actually worse than laws in other states by allowing both of the witnesses to the request for the lethal prescription to be family members, heirs, or employees of the health care facility where the patient resides, who can have a fiduciary interest in the patient’s earlier death. The 2015-2020 Connecticut assisted suicide bills that were rejected all forbade either witness from being in these categories. Along with the lack of any witness at the time of death, this provision is an open invitation to elder abuse. Other ostensible safeguards are overcome by doctor-shopping, which this bill makes easier than previous versions by allowing the attending and consulting physicians to work together in the same office. 

Advocates claim to be about patient choice, yet there have been instances when insurance companies would pay for assisted suicide but not curative care. A state senator who serves on this committee and is a leading assisted suicide proponent authored an op-ed in the Hartford Courant proposing a separate bill that would “require the completion of advanced directives in order to sign up for Medicare, Medicaid or private health insurance.” He spoke of his proposal as a way of getting people to forgo curative care, thereby reducing healthcare costs. 

Proponents like to compare assisted suicide with pet euthanasia, but when we put animals down—most of the time because they are unwanted or have behavior problems—the animals do not get to choose. As the cheapest “treatment,” assisted suicide similarly diminishes choice, and especially so for people of color, disabled people, and others who have been historically marginalized in our health care system. 

Proponents demand legislation that mandates the falsification of death certificates. HB 6425 requires the underlying terminal illness be listed as the cause of death. If Connecticut follows the lead of Oregon and Washington, this will forbid any mention of the lethal overdose. Connecticut’s Division of Criminal Justice has twice submitted testimony in opposition to death certificate falsification, stating: 

Section 9(b) effectively mandates the falsification of death certificates under certain circumstances. It states: “The person signing the qualified patient’s death certificate shall list the underlying terminal illness as the cause of death.” This is simply not the case; the actual cause of death would be the medication taken by or given to the patient… The practical problem for the criminal justice system and the courts will be confronting a potential Murder prosecution where the cause of death is not accurately reported on the death certificate. 

Finally, there is the issue of further expansion. Some proponents may claim they only want a limited bill, but HB 6425 already guts some of the “safeguards” from previous bills. Moreover, we only need to look at what Compassion & Choices and other proponents are saying, and what bills they are pushing in other states. We can all remember when Compassion & Choices’ president emerita Barbara Coombs Lee came to Hartford in October 2014 declaring support for assisted suicide for people with dementia and cognitive disabilities unable to consent; in her words, “It is an issue for another day but is no less compelling.” 

We can also look at current expansion legislation being pushed by Compassion & Choices in other states, particularly those in states that already have legalized assisted suicide, including Oregon (which already has expanded its law), Washington, California, and Hawai‘i, as well as bills in New Mexico. These bills have provisions that would dramatically shorten and/or waive the mandatory waiting period, allow APRNs and PAs to prescribe lethal drugs, waive the requirement for a second doctor to confirm the ostensibly terminal diagnosis, allow almost anyone who does counseling for a fee to qualify in the rare case that the patient is referred for a mental health evaluation, allow mail-order delivery of lethal overdoses, and compel objecting providers to refer patients to other providers who will dispense lethal prescriptions. 

This last provision, which is in California SB 380, is a threat to patient safety, as noted by the example of Jeanette Hall, who sought to die under Oregon’s law but was persuaded by her doctor to accept cancer treatment and is still alive more than 20 years later. Under a “do or refer” regime supported by Compassion & Choices, people like Jeanette Hall would have their lives cut short by years or even decades as ethical doctors will be forbidden to use their professional judgment to encourage their suicide-minded patients to seek lifesaving treatment. 

Moreover, once the concept of certain people having a right to assistance with their suicides to end their suffering is codified into law, there is no limiting principle to prevent it from being extended to other disabled people who also may claim to be suffering. If HB 6425 were enacted, further expansion will move into the hands of judges. While we in the disability-rights community view legalizing assisted suicide as a violation of the Americans with Disabilities Act and the disability equal protection clause (Article XXI, amending Article V) of the Connecticut Constitution—people with certain disabilities are thus denied the benefit of suicide prevention services—judges could easily use both of these provisions to require extending the “benefit” of this “end of life option” to other disabled people. The limitations of “six months,” “terminally ill,” “mentally competent,” and “self-administer” in HB 6425 all discriminate on the basis of disability. Indeed, back in 1999, former Deputy Attorney General of Oregon David Schuman wrote this response to state senator Neil Bryant regarding the issue of self-administration: 

“The Death with Dignity Act does not, on its face and in so many words, discriminate against persons who are unable to self-administer medication. Nonetheless, it would have that effect....It therefore seems logical to conclude that persons who are unable to self-medicate will be denied access to a ‘death with dignity’ in disproportionate numbers. Thus, the Act would be treated by courts as though it explicitly denied the ‘benefit’ of a ‘death with dignity’ to disabled people....” 

Indeed, the Connecticut Supreme Court’s ruling in State v. Santiago, striking down a prospective repeal of the death penalty in favor of full repeal, shows how our courts can expand laws beyond the intent of this legislature using equal protection grounds. The same principle is at work with HB 6425, which gives suicide assistance to some while others get suicide prevention, and the arbitrary difference is what disability they have. 

So what about the person with ALS who has a six month prognosis, but has lost the ability to self-administer? What about the person with Parkinson’s disease, who will have tremors for years before dying? What about people with communication disabilities who may not be able to make the request on their own? What about Grandma with dementia, or the person with a severe psychiatric disability? Once the door to assisted suicide is pried open, Compassion & Choices will seek to open it further through the courts, going from six months terminal to one year, to perhaps five years; from assisted suicide to euthanasia; and from euthanasia for terminal illness, to chronic illness, to mental suffering. This is how we go down the same road as Canada, which is currently debating Bill C-7 to allow euthanasia even for non-physical conditions, and where hospitals routinely deny treatment to disabled people while offering euthanasia instead. For Compassion & Choices, these are merely issues for another day, and for them, no less compelling. 

Legislators and the public should not be fooled by a privileged lobby that seeks to sell suicide as a solution to their own disability-phobia. We should follow the recommendations of the National Council on Disability’s report, “The Danger of Assisted Suicide Laws,” and reject codifying lethal and systemic disability discrimination into law.