Monday, January 20, 2020

Luxembourg reports 71 euthanasia deaths in 10 years. The euthanasia lobby want more death.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

RTL News reported that Luxembourg has had 71 euthanasia deaths in the past 10 years, but the euthanasia lobby want more.

According to RTL news, a recent survey found that only 40% of the people in Luxembourg know that euthanasia is legal. The response by the euthanaia lobby is to promote more euthanasia.

The legalization of euthanasia in Luxembourg resulted in a constitutional crisis. Grand Duke Henri of Luxembourg refused to sign the bill into law forcing the Duchy of Luxembourg to change its constitution by removing the power of the Grand Duke to sign legislation before it becomes the law of the land.


Grand Duke Henri
Grand Duke Henri argued that the legalization of euthanasia was unnecessary because the fear of suffering for people with terminal conditions can be effectively treated by palliative care. He further argued that it was unjust to legalize the practise of killing people and that his conscience could not permit him to sign such a bill into law.

Grand Duke Henri was a Hero
. Very few world leaders have had the strength to stand up for justice and oppose euthanasia. Even though the Grand Duke could not stop the legalisation of euthanasia, he forced the Luxembourg Chamber of Deputies to change the constitution before it could enact into law the direct and intentional killing of its most vulnerable citizens by euthanasia.

Approximately 5000 Canadians died by euthanasia in 2019 and 13,000 since legalization

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.



The media is reporting that there have been more than 6700 MAID deaths in Canada since it was legalized. I estimate that there have been at least 13,000 euthanasia deaths and here is how I defend this estimate.

First, the 6700 statistic was based on the Fourth Interim Report on Medical Assistance in Dying released by Health Canada on April 25, 2019 which stated that there were 6700 assisted deaths up to October 31, 2018. The data in the report from Quebec and the three Territories was incomplete. The Quebec data in the Health Canada report was up until March 31, 2018. (Link to my commentary on the report)

The Health Canada report was sloppy by stating that the number assisted deaths represented 1.12% of all deaths. The Health Canada report divided the number of reported assisted deaths into the total deaths, but they did not remove the total Quebec deaths from March 31 - October 31 from the equation.

The accurate number of assisted deaths as of December 31, 2018, was 7949.

On March 21, 2019 I reported that there were 7949 assisted deaths in Canada as of December 31, 2018 representing 4235 assisted deaths in 2018, an increase of 50% over 2017, representing almost 1.5% all deaths in 2018. The data from my report was obtained from a presentation by Jocelyn Downie, an academic euthanasia activist, who spoke on March 15, 2019 to a Royal Society of Canada luncheon in Ottawa.

Similar to the Netherlands and Belgium, nearly all of the assisted deaths are euthanasia (lethal injection) rather than assisted suicide.

We don't have national assisted death statistics for 2019 but we do have accurate data from Ontario and Alberta


The Ontario Office of the Chief Coroner sends monthly updates on the number of assisted deaths. According to the data there were 1789 reported assisted deaths in 2019, 1499 in 2018, 841 in 2017. There was almost a 20% increase in Ontario assisted deaths in 2019. What is more striking about the data is the increase in the second half of 2019 where there were 1015 assisted deaths in the second half of 2019 up from 774 in the first six months of 2019, meaning that Ontario will likely have more than 2000 assisted deaths in 2020.

Alberta Health Services updates there assisted death data regularly. The Alberta data indicates that there were 377 assisted deaths in 2019 up from 307 in 2018, and 206 in 2017. The data indicates a 23% increase in Alberta assisted deaths in 2019.

Since both Ontario and Alberta had approximately a 20% increase in 2019, I would assume that there was a similar increases nationally. Therefore there approximately 5000 
(4235 + 20%) assisted deaths in Canada in 2019 and 13,000  assisted deaths since legalization. Even if the numbers were slightly lower than 5000 in 2019, today is January 20, so it is safe to say that there has been 13,000 assisted deaths since legalization.

But that is not the whole story.

Canada's data collection system does not account for under-reporting of assisted deaths, but Quebec's data collection system can account for under-reporting. Quebec employs a multi report system making it possible to uncover the number of times a physician didn't report the assisted death.

Based on an analysis by Amy Hasbrouck and Taylor Hyatt, the Quebec interim report indicated that between April 1, 2017 – March 31, 2018 there were 142 unaccounted assisted deaths in the data representing 17% of all assisted deaths. The Quebec Interim report also indicated that 7 assisted deaths did not fit the criteria of the law, 22 assisted deaths did not follow procedural safeguards and in 67 assisted deaths, the physician did not provide the necessary information to determine if the patient fit the criteria of the law.


Based on the Quebec Interim report, if we extrapolate the data to all of Canada, it would suggest that there may have been more than 2000 (17%) unreported assisted deaths in Canada and approximately 60 assisted deaths that did not fit the criteria of the law.

This article is based on hard facts and conservative estimates. The fact is that Canada's assisted death law is quickly going out of control. The recent federal government consultation, that employs biased questions, is not concerned about Canadians whose lives are taken without due process.

MAID in Canada: A Thankless Fight

This article was published by Convivium on January 20, 2020

Peter Stockland
As Canadians weigh in on prospective changes to MAiD laws, Peter Stockland sits down with Euthanasia Prevention Coalition’s Alex Schadenberg to discuss his serious concerns with the country’s trajectory.



By Peter Stockland

Alex Schadenberg has been leading the Euthanasia Prevention Coalition in the thankless fight against doctor-administered death for more than 20 years.

In the nearly 10 years that I’ve known him in that capacity, I’ve never heard him so close to almost terminal frustration. Irrepressible by apparent genetic disposition, Schadenberg continues to urge on the battle. But the federal government’s latest “public consultation” on revisions to the 2016 Medical Assistance in Dying law has him sending out signals of serious retrenchment.

“My focus is becoming far more heavily on how we protect our own,” the EPC executive director says with a discernible tinge of weariness in his voice. “It’s important (to remind) the whole compassionate care community, those who recognize the nature of the human person, that just because you think euthanasia is wrong doesn’t mean that in your own time of darkness, you will not also succumb. We have to recognize that’s how humans are and how we react.”
Alex Schadenberg
Schadenberg’s reaction to recent events in the pushing forward of MAiD is a far cry from his unwavering certainty a decade ago that euthanasia and assisted dying not only could, but would, be stopped by battling on all fronts from the legislative and legal to media-shaped popular opinion.

Long invariably irenic, he sounds incensed describing the fight that has blown up in B.C. where the provincial government has ordered a hospice in the Vancouver suburb of Delta to begin permitting medical assistance in dying contrary to its founding principles. But there is a special scorn in his voice for Ottawa’s online “consultations” that were launched Jan. 13 and will end next Monday.

*Delta Hospice Must Not Be Forced to do Euthanasia (Link).
Federal Justice Minister David Lametti and two of his Liberal cabinet colleagues are shepherding the process in response, at least purportedly, to a 2019 Quebec lower court ruling that found Ottawa’s MAiD law to be unconstitutional. A one-judge decision in September held that the Criminal Code cannot require death to be “foreseeable” before poison can be injected into a patient’s veins. An equivalent stipulation in a bill passed by Quebec’s National Assembly was also struck down. The judgement will have the force of law in the province by March 11.
*Guide to answering the Canadian MAID Consultation Questionnaire (Link).
Schadenberg scoffs at the very idea of the federal government asking the public for direction when it failed to even do its constitutional duty and appeal the low court verdict through the Quebec appeal courts and ultimately to the Supreme Court of Canada. He also finds it darkly laughable that Justice Minister Lametti is reassuring Canadians the decision applies only in Quebec.
“They (the federal government) know there’s not a judge in the land who’s going to let a prosecutor go after a physician for performing euthanasia on someone whose natural death was not reasonably foreseeable. It’s been decided by the Quebec court already, and whether I like it or you like it, it is a national decision and the law has technically been changed anyway,” he says.
In Schadenberg’s eyes, the online appeal for public advice is a “dog and pony show…a set up…almost a sham” for the foregone conclusion of expanding MAiD far beyond the initial limits embedded in the already-flawed 2016 federal legislation. He picks apart several of the questions being put to Canadians, particularly one that asks whether MAiD should be available only when doctor and patient agree reasonable efforts to relieve suffering have been tried without success.
“Writing the question the way they did assumes I agree MAiD should be available. But of course I don’t agree with that. They’ve very carefully left me no way, though, to answer that I don’t agree. I don’t like people playing with me or using me like that.”
Hard as it might seem, he fears there’s worse coming. The consultation does not ask, for example, about extending MAiD to children, something many of its advocates began pushing for almost before the ink was dry on the 2016 legislation. That might seem cause for relief – except to someone who’s been face first in the euthanasia and assisted suicide issue for more than two decades.
“It makes me think they’re not done yet,” Schadenberg says. “As much talking as they’ve done about adding children, maybe they didn’t think now was the right time to do it. They left children off this list because they’ll be back looking at another list of changes in the future.”
As bleak – and gruesomely cynical – as all that sounds, the warrior in him refuses to say “die” and abandon the field. He finds hope in the prospect of applying pressure at the provincial level to limit at least the worst excesses of administering medical aid in dying. Even Ottawa’s woeful attempt at ersatz public consultation is worth indulging if only to remind those opposed to euthanasia and assisted suicide that their defiance must remain stalwart in the darkest of times.
“Silence is not golden. I can’t just be quiet and hope it’s all going to turn out well in the end because I don’t think it will turn out well in the end if we stay quiet. So, please, participate. Who knows? This might be the best time of all to express your opposition.”

Sunday, January 19, 2020

Three Belgium doctors will go on trial this week in the euthanasia death of a woman diagnosed as Autistic.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Tine Nys's sisters, Sophie and Lotte
The trial of three Belgian doctors who participated in the euthanasia death of Tine Nys on April 27, 2010 will begin on Tuesday, January 21 in Ghent. A BBC news article reported

Nys's family argue that her reason for seeking to end her life was because of a failed relationship, far short of the "serious and incurable disorder" as required under Belgian law. 
The three doctors from East Flanders who are going on trial have not been named, but they include the doctor who carried out the lethal injection and Nys's former doctor and a psychiatrist.
Tine Nys (center)
The Associated Press (AP) article from November 2018 provides more information about the charges. The AP article states that Nys (38) had been diagnosed as having a form of Autism known as Asperger's.

A International Business Times article reported in November 2018 that the family believes that Tine was falsely diagnosed as Autistic so that she would qualify for euthanasia. The family claimed that the law was broken because Tine never received treatment. The IBTimes reported:

Her sisters, however, told investigators that her suffering was caused by a broken heart after a failed relationship and not by autism. They also accused the doctors of making a rushed decision. They said the law was broken because Nys was never treated for autism and hence it had not been proven that she was suffering “unbearably and incurably.”
Dr Lieve Thienpont
The AP article reported that Psychiatrist, Lieve Thienpont, who had approved the death, had tried to prevent thee case from being prosecuted and reportedly stated:

“We must try to stop these people,” 
“It is a seriously dysfunctional, wounded, traumatized family with very little empathy and respect for others,”
Thienpont has been criticized for her handling of other psychiatric euthanasia cases.


It is positive that Belgium is prosecuting this case. I hope that this case is treated as a criminal case rather than using this case to establish a precedent for future euthanasia deaths for psychological suffering.

Friday, January 17, 2020

Vancouver area hospice fights death order


Sign the petition: Hospice Organizations Must NOT be Forced to do Euthanasia (Link).
Vancouver area hospice is asking the government to reconsider their proposal to give up $750,000 a year in funding so that it not be required to violate its mandate of care and compassion for patients by providing Medical Assistance in Dying (MAiD) at its facility. (Link to the original letter).

The health authority’s demand is unnecessary, the hospice contends, noting that the MAiD option is widely available at many other facilities, including one next door.


By forfeiting the government funding, the hospice would be under the 50% threshold set by the government and therefore exempt from providing MAiD.


Angelina Ireland, President of the Delta Hospice Society, said that the Society’s Charter specifically mandates it to provide compassionate care and support for persons in the last stages of living, so that they may live as fully and comfortably as possible.

“Helping and supporting patients to live fully and comfortably in their last days and giving support to them and their families is what our patients and families come to us for and expect and it is certainly what our staff are dedicated to providing. Taking steps to end a patient’s life is not providing care and support so that ‘they may live fully.’”
Fraser Health Authority ordered the Delta Hospice Society late last year to provide Medical Assistance in Dying (MAiD) claiming that failure to do so would be a breach of the Society’s agreement with the authority.

Ireland said in order to comply with the Authority’s instruction it would have to violate its legal commitments under the province’s Societies’ Act which requires them to follow their Charter. Further, DHS is not in breach of the Agreement. There is nothing in the Agreement which requires DHS to provide MAiD or allow it to be provided on its premises. The FHA is attempting to amend the Agreement by making a unilateral decision to impose an obligation, which in itself would be a contravention of the Agreement. The Fraser Health Authority’s new directive puts the Hospice Society in a difficult position of either honouring their Charter and legal obligations or acceding to what she called “an agenda-driven demand which ignores our primary function and pays no heed to the needs or wants of those patients and families we are caring for.”


The Delta Hospice Society has tried to work with the health authority, explaining the dilemma the order places upon them, outlining their function to assist patients live fully in their final days before natural death, and offering options to help settle the dispute but the Fraser Health Authority has refused to budge.


On January 15, 2020, Delta Hospice Society wrote the Fraser Health Authority to ask that they reconsider the proposal to give up the $750,000 a year in funding so that they may benefit from the exemption set out in a Ministry of Health policy.


Ireland said that giving up the funding would cause the Society to focus exclusively on their Hospice operations. The other services the Society provides to the community would be put on the back burner until alternative funding partnerships can be established. The Society is committed to continuing to provide the quality care it has provided since its founding in 1991, and protecting the Society’s mandate and organizational integrity.


Ireland noted further that there are many locations where MAiD is already available to those wishing to avail themselves of that option, including a facility next door.

“Nobody wanting such a service would be prevented access. The issue is not accessibility. It seems to be a purely agenda-driven demand that runs rough shod over both Delta Hospice Society’s desire to live up to its legal requirements under our Charter, as well as ignoring the reality that we are dealing with patients and families in a very vulnerable and delicate position.”
“Our goal,” she added, “is to fulfill our mission. And that is to help patients and their loved ones live quietly, comfortably, and as fully as possible in their final days of life.”

She reiterated the hospice’s desire to negotiate an equitable arrangement with the Fraser Health Authority to maintain Delta Hospice’s role of serving its patients well.


Contact: Angelina Ireland 778-512-8088; irelandangelina@gmail.com

Canada poised to expand euthanasia law.

This article was published by OneNewsNows on January 17, 2020

By Charlie Butts

A spokesman for a non-profit organization that opposes euthanasia and assisted suicide says Canada has opened the gates to more death.


*Guide to answering the Canadian MAID consultation questionnaire (Link).


Alex Schadenberg
Euthanasia has been available in Canada for people with a terminal illness, but a Quebec court has now abolished the "near death" requirement.
"By removing the terminal illness requirement, that means you can have euthanasia for physical or psychological suffering," explains Alex Schadenberg of the Euthanasia Prevention Coalition. "I do believe this situation is going to be opening up the gates to far more deaths by euthanasia. At the same time, our euthanasia numbers have just been skyrocketing. So as much as we have seen this huge increase in euthanasia, they're only going to be opening the doors more."
Parliament is currently conducting a consultation, considering ideas to expand the practice even further to include psychological reasons such as depression. It could even affect anyone who is no longer mentally competent to agree to euthanasia, so Schadenberg is urging people to oppose expansion during the consultation.
"The reality of this whole thing is we need to reverse this whole trend of allowing killing, because what we've done in law is we've given physicians the right to kill their patients, and we've done so by also granting them pretty tight immunity from ever having to worry about prosecution," the Coalition spokesman submits.
The consultation ends January 27th, and the court has imposed a deadline of March 11th for the government to overhaul its euthanasia law.

Indiana assisted suicide bill fails to protect objecting practitioners

This article was published by the Protection of Conscience Project on January 16, 2020

Assisted suicide evolves from "assistance" to "medical care" 

Affirmation has serious consequences for objecting Indiana physicians

By Sean Murphy

Introduction

On 7 January, 2020, Representative Matt Pierce introduced HB1020: End of life options in the Indiana General Assembly.1 HB1020 is the fourth assisted suicide bill introduced by Pierce since 2017; three previous bills died in committee without hearings.2,3,4,5,6 Parts of HB1020 relevant to protection of conscience are reproduced on the Project website.7
 

Overview

The bill permits physician assisted suicide for Indiana residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. Candidates must be competent to make health care decisions and must apply in writing for a lethal prescription; the application must be witnessed by two independent witnesses. Lethal medication can be prescribed or dispensed by an attending physician after a fifteen day waiting period if the patient is acting voluntarily and making an informed decision.

Neither the attending physician nor any other person need be present when the lethal medication is taken, though the attending physician must tell the patient that someone else should be present. The lethal medication must be self-administered. If the medication does not cause death, no one is authorized to kill the patient. 


HB1020 imposes obligations upon "attending physicians"8 and "consulting physicians"9 and it assumes the cooperation of pharmacists in dispensing lethal medication. There is some ambiguity in the description of what is expected of attending physicians. Section 4(a)(13) makes provision or prescription of lethal medication an absolute obligation if all of the conditions specified in the bill are met (". . .the attending physician shall. . ."). On the other hand, Section 4(c) seems to leave some discretion to the attending physician to refuse, even if the conditions are met (". . . the attending physician may . . ."). A later protective provision indicates that an attending physician can refuse, but the ambiguity in the wording of Section 4 remains.

Protective provisions: biased, insufficient and conflicting

The bill makes no reference to freedom of conscience or religion, but Section 12 offers some protection for "health care providers."

Under Section 12(d) a hospital (health care provider) can prohibit physicians (individual health care providers) from participating in assisted suicide on its premises, and, provided it has notified them in advance, can take action against those who defy the prohibition. This would seem to be broad enough to include a prohibition against assessing patients and arranging for assisted suicide elsewhere.

However, Section 12(e) pits health care "facilities" against health care "providers." A facility cannot prevent a physician from "providing services consistent with the applicable standard of medical care." This includes at least providing information about assisted suicide, being present at a suicide, and referring a patient for assisted suicide. What is not clear is whether or not this includes doing so on the facility's premises, notwithstanding a facility prohibition of participation in assisted suicide.

Unfortunately, HB1020 does not explain the distinction between a health care "provider" and a health care "facility." And while the Indiana Code defines both terms, it offers three different definitions of "health care facility"10 and five differing and very lengthy definitions of "health care provider."11 The latter can include individuals (thus covering attending physicians) but also health facilities and incorporated entities. This further complicates interpretation of Section 12(e).

Section 12(a) provides immunity against professional, criminal and civil liability, but only for those who prescribe or dispense assisted suicide medication or are present when it is taken. Those who refuse are unprotected. The bias in favour of assisted suicide practitioners and disadvantage imposed upon those unwilling to provide the service is obvious.

Section 12(b) protects both health care providers who participate and those who refuse to participate in assisted suicide against private disciplinary or punitive actions by professional associations, organizations and other health care providers. It offers the same protection for health care providers who provide "scientific and accurate information" about the service - but not those who refuse to do so.

Section 12(c) states that a health care provider cannot be required to participate in "the dispensing or providing of medication", but this does not clearly protect objecting physicians from demands that they do everything but dispense or prescribe lethal drugs.
Assisted suicide evolves from "assistance" to "medical care"

In 2017, HB1561 Section 12(a) described participation in assisted suicide as "provid[ing] assistance in the completion of a request for medication." It granted professional, civil and criminal immunity to those providing "assistance."

The following year, HB1157 Section 12(a) used the same phrase to describe participation. It conferred immunity upon those providing such "care."

In 2019, HB1184 Section 12(a) evolved further, so that participation in assisted suicide is described in HB1020 as the provision of "medical care," including prescribing or dispensing lethal medication and being present at a patient's suicide. The addition of Section 12(e) in HB1020 reflects and reinforces this evolution when it refers to participation in assisted suicide that conforms to "the applicable standard of medical care."

Now, in 2019 the American Medical Association (AMA) reaffirmed its rejection euthanasia and assisted suicide as contrary to medical ethics,12 so the AMA would presumable reject the bill's supposition that there can be a "medical standard of care" for either procedure. In this respect, the author of HB1020 may be looking to a future in which a medical standard of care is developed as a result of the legalization of physician assisted suicide.


When assisted suicide becomes "medical care"
 

Seven Canadian physicians have described what that future looks like.
"For refusing to collaborate in killing our patients," they write, "many of us now risk discipline and expulsion from the medical profession," are accused of human rights violations and "even called bigots."13
How did this come about?

An important part of the explanation is the Canadian Medical Association's (CMA) classification of assisted suicide and euthanasia as "therapeutic service[s]"14 and "legally permissible medical service[s]."15

Since there is no dispute that physicians have a professional obligation to provide or arrange for therapeutic medical services for their patients, the change in CMA policy implicitly made participation normative for the medical profession (and, by extension, for other health care workers and institutions). From that perspective, as the Canadian physicians note, refusing to provide or arrange for euthanasia and assisted suicide services for legally eligible patients "became an exception requiring justification or excuse." Hence, discussion in Canada is now largely about "whether or under what circumstances physicians and institutions should be allowed to refuse to provide or collaborate in homicide and suicide."13

The seven Canadian physicians authors can't be dismissed as outlying cranks. Almost 60 Canadian physicians from across the country endorsed the article, which appeared in the World Medical Association's professional journal. Signatories included a Canadian Medical Hall of Fame member known as the father of palliative care in North America,16,17 a member of an expert advisory group on euthanasia and assisted suicide convened by Canadian provinces and territories,18 and a regional director of palliative care who resigned when a health authority demanded that objecting hospices permit euthanasia and assisted suicide on their premises.19

Thus, in the long term, statutory affirmation that assisted suicide is not only permitted but is a form of "medical care" would likely have serious adverse consequences for objecting Indiana physicians.


Notes

1. US, HB 1020, End of life options, 121st Gen Assembly, 2nd Reg Sess, Ind, 2020 [Internet]. Indianapolis: Indiana General Assembly; 2020 Jan 7 [cited 2020 Jan 14].

2. US, HB 1561, End of life options, 120th Gen Assembly, 1st Reg Sess, Ind, 2017 [Internet]. Indianapolis: Indiana General Assembly; 2017 Jan 23 [cited 2020 Jan 14].

3. US, HB 1157, End of life options, 120th Gen Assembly, 2nd Reg Sess, Ind, 2018 [Internet]. Indianapolis: Indiana General Assembly; 2018 Jul 1 [cited 2020 Jan 14].

4. US, HB 1184, End of life options, 121st Gen Assembly, 1st Reg Sess, Ind, 2019 [Internet]. Indianapolis: Indiana General Assembly; 2019 Jul 1 [cited 2020 Jan 14].

5. Hussein F. Indiana lawmaker proposes assisted suicide bill. Indianapolis Star [Internet]. 2018 Jan 4 [cited 2020 Jan 14].

6. Arthur V. Assisted suicide legislation stalls in Indiana. Today's Catholic (Fort Wayne, IN) [Internet]. 2019 Apr 4 [cited 2020 Jan 14].

7. Indiana: House Bill 1020 (2020): End of life options [Internet]. Powell River (BC): Protection of Conscience Project; 2020 Jan 14 [cited 2020 Jan 14].

8. "'Attending physician' means the licensed physician who has the primary responsibility for the treatment and care of the patient. For purposes of IC 16-36-5, the term includes a physician licensed in another state." IN Code § 16-18-2-29 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14].

9. The term is undefined, so it appears to refer to any licensed physician.

10. For "health care facility" see IN Code § 16-18-2-161 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14].

11. For "health care provider" see IN Code § 16-18-2-163 (2018) [Internet]. Mountainview, CA: Justia [cited 2020 Jan 14]

12. Frellick M. AMA Reaffirms Stance Against Physician-Aided Death. Medscape [Internet]. 2019 Jun 11 [cited 2020 Jan 14].

13. Leiva R, Cottle MM, Ferrier C, Harding SR, Lau T, Scott JF. Euthanasia in Canada: A Cautionary Tale. WMJ 2018 Sep [cited 2020 Jan 14]; 64:3 17-23.

14. Doctor-assisted suicide a therapeutic service, says Canadian Medical Association [Internet]. CBC News; 2015 Feb 06 [cited 2020 Jan 14]. Emphasis added.

15. CMA Policy: Medical Assistance in Dying [Internet]. Canadian Medical Association; 2017 May [cited 2020 Jan 14]. Emphasis added.

16. (Dr. Balfour Mount). Phillips D. Balfour Mount [Internet]. Montreal (Quebec): McGill University; 2016 May 03 [cited 2020 Jan 14].

17. The Canadian Medical Hall of Fame. Dr. Balfour Mount, 2018 Inductee [Internet]. [cited 2020 Jan 14].

18. (Dr. Nuala Kenny). Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying. Final Report [Internet]. Toronto (Ont): Government of Ontario, Ministry of Health and Long Term Care; 2015 Nov 30 [cited 2020 Jan 14].

19. (Dr. Dr. Neil Hilliard). Fayerman P. Delta hospice rebels against Fraser Health's mandate to provide medical assistance in dying [Internet]. Vancouver Sun; 2018 Feb 06 [2020 Jan 14].


Thursday, January 16, 2020

Euthanasia deaths rise quickly in Ontario: Nearly 1800 reported assisted deaths in 2019

Alex Schadenberg
Executive Director

Euthanasia Prevention Coalition

The Ontario Office of the Chief Coroner released the updated data for MAiD (euthanasia and assisted suicide deaths) indicating that from June 17, 2016 until December 31, 2019 there have been 4318 reported assisted deaths in Ontario.

According to the data, there were 1789 reported assisted deaths in 2019, 1499 in 2018, 841 in 2017 and 189 in 2016.

There was a significant increase in the second half of 2019 with 1015 reported assisted deaths up from 774 reported assisted deaths in the first half of the year in Ontario.

recent article in the Calgary Herald, reported that there has also been a significant increase in reported assisted deaths in Alberta with 377 in 2019, 307 in 2018, and 206 in 2017.


Sadly, the increase in assisted deaths is also linked to a wider use of the law. Recently an Ontario doctor agreed to his experience with several controversial assisted dying cases published.
I expect a further increase in assisted deaths since a Quebec court struck down the terminal illness requirement in the law. The Quebec court decision was not appealed by the government causing an incremental extension of the law to people who may be psychologically suffering.

After the government did not appeal the Quebec court decision, Prime Minister Trudeau announced that a first priority for the government is to amend Canada's euthanasia law.

The Euthanasia Prevention Coalition (EPC) is urging its supporters to participate in the Canadian Department of Justice Medical Assistance in Dying (MAiD) consultation (Link).

Do you have a personal euthanasia story? Sharing your story may help us prevent other euthanasia deaths. Contact us at: 1-877-439-3348 or info@epcc.ca.

Disability rights leaders praise Massachusetts court decision that there is no right to assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition


*Massachusetts Court explains why assisted suicide should be prohibited (Link).

John Kelly, Second Thoughts
Disability rights leaders praised the Massachusetts court decision that there is no right to assisted suicide. The assisted suicide lobby doctors have decided to appeal the decision. 

The Second Thoughts Massachusetts media release stated:
Second Thoughts Massachusetts praises the decision by Suffolk Superior Court Judge Mary K. Ames rejecting a right to physician-assisted suicide in the state. She ruled that any Massachusetts doctor who prescribes a lethal dosage of drugs could be subject to prosecution for involuntary manslaughter. 
Second Thoughts director John B. Kelly said, “we are gratified that the court reaffirmed the law against assisted suicide, and referred the matter to the legislature where lawmaking belongs. Disability rights advocates will continue to press the legislature that assisted suicide is just too dangerous.” 
Judge Ames wrote that at the point of a patient ingesting the lethal drugs, they would be vulnerable to improper persuasion. “In such a situation, there is a greater risk that temporary anger, depression, a misunderstanding of one’s prognosis, ignorance of alternatives, financial considerations, strain on family members or significant others, or improper persuasion may impact the decision.” 
Ruthie Poole is president of the board of MPOWER, a group of people with lived experience of mental health diagnosis, trauma, and addiction. Poole said, “Personally, as someone who has been suicidal in the past, I can relate to the desire for ‘a painless and easy way out.’ However, depression is treatable and reversible. Suicide is not. The current bill in the legislature pretends otherwise.”
The Cape Cod Times reported that the assisted suicide doctors, who brought the case to the Massachusetts court, are appealing the decision. The report stated:
“We’re disappointed that the court didn’t rule in our favor,” Kligler said. “We’re hoping that the appellate court or Supreme Judicial Court will.”
The Euthanasia Prevention Coalition (EPC) emphasized that the Massachusetts court decision is not the only court decision stating that there is no right to assisted suicide. EPC hopes that this decision will prevent the legalization of assisted suicide in Massachusetts.

Wednesday, January 15, 2020

Guide to answering the Canadian MAID consultation questionnaire.

Alex Schadenberg
Executive Director, 

Euthanasia Prevention Coalition

I urge EPC supporters to participate in the Canadian Department of Justice Medical Assistance in Dying (MAID) consultation questionnaire


(Link to the consultation webpage).

I wrote this guide to answering the Maid consultation questionnaire because some of the questions are biased and imply support for MAID. 

Please complete the consultation questionnaire and express your opposition in the comments section. The questionnaire provides an opportunity to leave additional comments and I strongly urge you to do so.

(Link to the Consultation Questionnaire).

Section A requires your demographic information. No problem.

Section B outlines the MAID criteria in Canada. Notice how that the law was changed based on the Quebec court decision. The law now states: A person does not need to have a fatal or terminal condition to be eligible for MAID.

Section C asks the question:
​​1. Do you think the current safeguards would prevent abuse, pressure or other kinds of misuse of MAID after eligibility is broadened to people whose deaths are not reasonably foreseeable?

The answer is NO.

2. The next section asks about potential "safeguards":
a) A different reflection period (currently a 10-day reflection period) between the submission of a person’s written request for MAID and receiving MAID

(This question is not clear whether the "different reflection period" would be more than 10 days or less than 10 days. Answer this question how you want.)

​​b) MAID should be available only when the practitioner and the patient both agree that reasonable treatments and options to relieve the person’s suffering have been tried without significantly improving the person’s situation.
(This question assumes that MAID should be available).

Answer: Very Important

​​c) A mandatory psychological or psychiatric assessment to evaluate the person’s capacity to consent to receiving MAID.

Answer: Very Important

​​d) Making sure the person requesting MAID is aware of all the means available to potentially relieve their suffering, including health and social support services (for example counseling, disability support, palliative care)

Answer: Very Important

​​e) Mandatory consultation with an expert in the person’s medical condition and circumstances (for example a gerontologist, psychiatrist, or social worker), in addition to the already mandatory 2 medical assessments

Answer: Very Important

​​f) Retrospective review of MAID cases by a committee to verify that the eligibility criteria and safeguards were satisfied and in place

Answer: Very Important

​​g) Special training and tools to assist physicians and nurse practitioners to assess areas of potential vulnerability (for example mental health issues, or potential outside pressures or influences)

Answer: Very Important

​​h) An obligation for the physician and nurse practitioner to offer to discuss their patient’s situation with their family members or loved ones with the patient’s consent

Answer: Fairly Important

3. Do you have any other comments you want to share about possible safeguards for people who are eligible for MAID, but not at the end of life?

(Please comment on the lack of oversight of the law. The law allows doctors or nurse practitioners who approve a death, to also carry-out the death, to also report the death. This system allows doctors and nurse practitioners to self-report, meaning there is no oversight over the law).

Section D deals with advanced requests for MAID.

The question asks:
1. Imagine that a person makes a request for MAID, is found to be eligible, and is awaiting the procedure. A few days before the procedure, the person loses the capacity to make health care decisions, and cannot provide final consent immediately before the procedure. In your opinion, should a physician or nurse practitioner be allowed to provide MAID to a person in these circumstances?


Answer: NO

​​2. Imagine that a person is diagnosed with a medical illness that, over time, will affect their mind and take away their decision-making capacity, such as Alzheimer’s disease. The person prepares a document that says they consent to receive MAID if specific circumstances arise at a later date, after they no longer are able to consent.

​​In your opinion, should a physician or nurse practitioner be allowed to provide MAID to a person in this situation once the circumstances in their document have arisen and they otherwise meet the MAID criteria, even if they can no longer consent?


Answer: NO

​​3. Do you have any other comments you want to share about allowing MAID to be provided to a person who has an advance request but is not able to consent to MAID at the time of the procedure?


Allowing MAID (euthanasia) for someone who cannot consent denies the person the right to change their mind since only competent people have the legal right to change legal documents. Further to that, the person cannot consent to have their life ended, a decision that is irrevocable.

Section E asks for additional comments.

Please express your opposition to euthanasia (MAID).

(Link to the consultation questionnaire).

If you have any concerns, email me at: alex@epcc.ca


Please read some of these articles to help with providing additional comments:
  • Historical: Canadian Senate passed euthanasia law in time for summer break (Link).
  • Canada's euthanasia deaths increased by 50% in 2018 (Link).
  • Ontario euthanasia deaths are rising quickly (Link).
  • UN Disability rights envoy urges changes to Canada's euthanasia law (Link).
  • Québec court expands euthanasia law by striking down the terminal illness requirement (Link).
  • Physically healthy depressed man died by euthanasia in BC (Link).
  • Ontario doctor experiences abuse of euthanasia law (Link).
  • Québec Fourth Interim Euthanasia Report, 13 deaths did not comply with the law (Link).
  • BC Health Minister orders Delta Hospice to do euthanasia by February 3 (Link).

Lethal Problems with Medical Futility and Disability Bias

This article was published by Nancy Valko on January 15, 2020.

Nancy Valko
By Nancy Valko

In 2018, Chris Dunn survived a freak diving accident that left him paralyzed, mostly blind and on a ventilator to breathe. He spent most of the next year in an ICU in rural Maine.

Unable to see, eat, breathe or move on his own, the 44 year old father and concrete work spent his days in bed listening to the History Channel and hoping for a chance to show he could do more.

Efforts to find a rehab center failed. Even worse, hospital administrators and others were encouraging Chris’s mother Carol to put him in hospice to die. As the article states:
“Drugged up and confined to bed, Chris waited while dealing with a hospital staff that didn’t know what to do with him. ‘There would be nurses that would come in and tell me, ‘You know you’re making your son suffer,’ says Carol. ‘I mean, what’s a mother to do with that?’” (Emphasis added)
However, Carol refused to give up trying to find help for Chris and after 7 months, finally contacted the United Spinal Association. Jane Wierbicky, a longtime nurse and a member of the Association’s Resource Center team worked to help find a rehab center in Atlanta.

Now Chris only uses the ventilator a few hours a night, got outdoors to catch a fish, and returned home to spend Thanksgiving with his mother and girlfriend.

With the help of his mother and a team of advocates, Chris hopes to eventually live in an accessible apartment.

Medical care for Chris was not futile.

Medical Futility

The National Council on Disability defines “medical futility” as
“an ethically, medically, and legally divisive concept concerning whether and when a healthcare provider has the authority to refuse to provide medical care that they deem ‘futile’ or ‘nonbeneficial’. A “medical futility decision” is a decision to withhold or withdraw medical care deemed “futile” or “nonbeneficial.” (Emphasis added)
Because of my professional and personal experiences with disability bias as well as my volunteer work with people with disabilities, I have seen firsthand the potentially lethal effects of medical futility decisions based on disability. I have been writing on this topic for years, most recently on Missouri’s Simon’s Law enacted after the parents of a baby with Trisomy 18 and a heart defect who died later found out that doctors had ordered a “Do Not Resuscitate” and withheld life-sustaining treatment without their knowledge due to a secret medical futility policy at the Catholic hospital treating their son.

Recently, I found out that the National Council on Disability just published a 82 page comprehensive report titled “Medical Futility and Disability “ as part of a five-report series on the intersection of disability and bioethics.

In a letter to President Trump, the Council chairman states that the series:
“focuses on how the historical and continued devaluation of the lives of people with disabilities by the medical community, legislators, researchers, and even health economists, perpetuates unequal access to medical care, including life-saving care.
and notes that:
“In recent years, there has been a push to regulate medical futility decisions on the state and institutional levels. State laws, which vary greatly in their content and approach, define the protections, or lack thereof, of a patient’s wishes to receive life-sustaining treatment. Hospitals have turned to process based approaches, utilizing internal ethics committees to arbitrate medical futility disputes. Despite the increased attention, however, disability bias still finds its way into futility decision making.” (All emphasis added)
The Council identifies four factors that are influencing the futility debate today: “Advanced life-saving medical technology, Changes in healthcare reimbursement, Evolving concepts of patient autonomy and the Rise of the right-to-die movement”.

The report also extensively explores the legal issues and several court decisions involving medical futility like the Terri Schiavo and Haleigh Poutre cases.

State Laws

The Council report also evaluated current state laws regarding medical futility decisions and found only 11 with strong patient protections, 19 without patient protections, 19 with weak patient protections, and 2 with time-limited patient protections.

Further complicating the state laws is the lack of transparency for patients or other family members regarding an institution’s medical futility policies. Hospitals are rarely transparent with their medical futility policies, as in the Simon’s Law case. The report is right when it states that “the disclosure of medical futility policies is essential to providing patients, their surrogates, and their families with the information they need to protect their rights and ensure accountability”.

The Council also notes that “Disability nondiscrimination laws, including the ADA and Section 504 of the Rehabilitation Act, provide a viable, yet largely unexplored vehicle for enforcing the rights of people with disabilities in the medical futility context.”

The report ends with recommendations for Congress, the executive branch, medical and health professional schools, professional accreditation bodies, healthcare insurers and state legislatures to combat the problem of disability bias in healthcare.

Conclusion

One of the reasons I chose to become a nurse decades ago was the strong ethical principles in medicine. We were educated to treat all patients to the best of our ability regardless of race, disability, socioeconomic status, etc. “Quality of life” was something to improve, not judge. The traditional hospice philosophy was to neither hasten nor prolong dying.

But over time, I saw ethics change. As the report itself notes, the advances in technology, changes in health care reimbursement, evolving concepts of patient autonomy and the rise of the right-to-die movement led to radical changes in both law and medical ethics.

The concept of medical futility was no longer limited to medically certain circumstances of treatment ineffectiveness but, all too often, also to the patient’s (and sometimes the family’s) perceived “quality of life”.

Such disability bias is often unrecognized, even by the medical professionals caring for the person, but it is a real bias that must be eliminated in our society.

I admire people like Chris Dunn and his determined mother who show us the possibilities when people with even severe disabilities get a chance to have the best life possible.

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