Oregon doctor to Quebec lawmakers: say no to assisted suicide

Global News interview with Dr Stevens and Jeanette Hall from Oregon on October 27. The two Oregon residents explained why Quebec should not legalize assisted suicide. The link to this interview includes a video interview.

By Billy Shields - Global News Montreal, October 27, 2013

Oregon physician Dr. Kenneth Stevens warns that if Quebec’s proposed assisted suicide law passes, it could end several people’s lives who would eventually decide to live.

“The concern I have is that of people who are not necessarily dying,” he said. They are “sort of lured into assisted suicide.”

A former patient of his, Portland resident Jeanette Hall, was convinced she wanted assisted suicide 13 years ago. It recently had become legal under Oregon law, and she had been diagnosed with colon cancer. She didn’t want to become a burden on members of her family, but Stevens was telling her she could recover if she underwent chemotherapy.

“She had really given up on her life, and so I was able to provide her with some hope that there was some reason to live,” Stevens said.

He convinced her to undergo chemotherapy after pointing out that she might not live long enough to see her son get married. Thirteen years later, Hall is trying to convince jurisdictions to turn its back on assisted suicide.

“Every day, when I look up and breathe and see leaves falling, something new, it’s great to be alive,” she said.

In Quebec, advocate physician Dr. Paul Saba warns the proposed law offers up a broad definition of who would be eligible for assisted suicide.

“People with chronic diseases can be included in their category of suffering. People with depression. People with lung or heart disease or arthritis,” he said. “They’re promoting death, they’re not promoting health care.”

When Social Services Minister Veronique Hivon proposed the bill, she said she did it to limit suffering for Quebec patients. Only one out of five Quebec patients have access to palliative care. But advocates warn if it becomes law, Bill 52 – as it’s called in English – would move the government away from caring for patients and toward trying to end their lives before their time.

“What has happened in medicine?” Stevens said. “Our governments should be looking out for us rather than causing our death.”

It isn’t clear what will happen should the law pass. Currently, assisted suicide is illegal in Canada under the Criminal Code. Quebec lawmakers have said in the past that Bill 52 would fly under an exception as it would be somehow governed by civil law.

Belgium considering unprecedented law to grant euthanasia for children, dementia patients.

The Associated Press published the following report concerning the Belgian debate to extend euthanasia to children and people with dementia.

The Associated Press report that was published on October 31, 2013 stated:

In Belgium, where euthanasia is now legal for people over the age of 18, the government is considering extending it to children — something that no other country has done. The same bill would offer the right to die to adults with early dementia. 

Advocates argue that euthanasia for children, with the consent of their parents, is necessary to give families an option in a desperately painful situation. But opponents have questioned whether children can reasonably decide to end their own lives.

Belgium is already a euthanasia pioneer; it legalized the practice for adults in 2002. In the last decade, the number of reported cases per year has risen from 235 deaths in 2003 to 1,432 in 2012, the last year for which statistics are available. Doctors typically give patients a powerful sedative before injecting another drug to stop their heart.

Only a few countries have legalized euthanasia or anything approaching it. In the Netherlands, euthanasia is legal under specific circumstances and for children over the age of 12 with parental consent (there is an understanding that infants, too, can be euthanized, and that doctors will not be prosecuted if they act appropriately). Elsewhere in Europe, euthanasia is only legal in Luxembourg. Assisted suicide, where doctors help a patient to die but do not actively kill them, is allowed in Switzerland.

In the U.S., the state of Oregon also grants assisted suicide requests for residents aged 18 or over with a terminal illness.

In Belgium, the ruling Socialist party has proposed the bill expanding the right of euthanasia. The Christian Democratic Flemish party vowed to oppose the legislation and to challenge it in the European Court of Human Rights if it passes. A final decision must be approved by Parliament and could take months.

Charles Foster

In the meantime, the Senate has heard testimony on both sides of the issue.

The debate has extended to medical ethicists and professionals far from Belgium. Charles Foster, who teaches medical law and ethics at Oxford University, believes children couldn’t possibly have the capacity to make an informed decision about euthanasia since even adults struggle with the concept.

“It often happens that when people get into the circumstances they had so feared earlier, they manage to cling on all the more,” he said. “Children, like everyone else, may not be able to anticipate how much they will value their lives if they were not killed.”

There are others, though, who argue that because Belgium has already approved euthanasia for adults, it is unjust to deny it to children.

Dr. Patrick Cras, a neurologist at the University of Antwerp, said people with dementia often change their minds about wanting to die.

"They may turn into different people and may not have the same feelings about wanting to die as when they were fully competent," he said. "I don't see myself killing another person if he or she isn't really aware of exactly what's happening simply on the basis of a previous written request (to have euthanasia). I haven't fully made up my mind but I think this is going too far."

Penney Lewis

Penney Lewis, a professor and medical law expert at King's College London, agreed that carrying out euthanasia requests on people with dementia once they start to worsen could be legally questionable.

"But if you don't let people make decisions that will be respected in the future, including euthanasia, what you do is encourage people to take their own life while they have the capacity or to seek euthanasia much earlier," she said.

In the past year, several cases of Belgians who weren't terminally ill but were euthanized — including a pair of 43-year-old deaf twins who were going blind and a patient in a botched sex change operation — have raised concerns the country is becoming too willing to euthanize its citizens. The newest proposals have raised eyebrows even further.

"People elsewhere in Europe are focused on assisted dying for the terminally ill and they are running away from what's happening in Belgium," Lewis said. "If the Belgian statutes go ahead, this will be a key boundary that is crossed."

Belgium bill would extend euthanasia to children with disabilities and people with dementia.

Quebec euthanasia bill is based on the Belgian euthanasia bill.

Your Life Counts: Make a Promise to Live.

Your Life Counts is asking you to:

Make a  Promise To Live - for yourself
and your loved ones, today! Do it now...

It's a promise to LIVE and NOT to die by suicide.

Here's why...

So often we hear people say things like ... "if I die my family will get over it..." or "no-one cares about me..." or  "it doesn't matter if I'm here or not..." or "just can't go on......"  or "I just can't go on...I want to sleep and never wake up..." or "everyone would be better off if I wasn't here..." or "things will never change, I can't live like this anymore..." and so on... sounds familiar? 

Make a Promise to Live - find out more and download the wallet sized pledge card here.

Do you know the signs and the symptoms of suicide? Do you know what to do? Read more at the Your Life Counts Knowledge Centre here.

Your Life Counts: International Suicide Prevention Day.

False disability claims by euthanasia movement in the UK

The following article was written by Kevin Fitzpatrick and published on the Not Dead Yet UK blog on October 28, 2013. Kevin Fitzpatrick is also the executive director of EPC - Europe and he will be speaking at the Euthanasia Symposium 2013 on November 8/9 in Toronto.

By Dr Kevin Fitzpatrick.

Kevin Fitzpatrick

Have you heard of the new Disabled Activists for Dignity in Dying (DiD)? And their claim that 75% of disabled people support assisted suicide/euthanasia? Is that really true?

And why should DiD feel there is any need for a ‘disability voice’ FOR euthanasia? There is no special pleading necessary for disabled people under their proposed law. Or are they arguing for disability rights for euthanasia? That makes no sense (as Paul Russell, CEO of HOPE pointed out recently).

DiD have always claimed their campaign is not to change the law for disabled people, but is meant to help those with only a few weeks or months to live.

Therefore, is DiD really a lobby for assisted suicide for all disabled people and sick people, rather than people who are very sick and soon to die?

Remember the report of the self-styled ‘commission’ funded by DiD recommends that physician-assisted suicide should not be offered to people with disabilities who are not terminally ill ‘at this point in time’.

So what is DiD’s real reason for suddenly claiming the support of a huge percentage of disabled people?  – indeed what is their real objective?

So who are the DiD ‘activists’?

Lord Falconer's ‘Assisted Dying Bill’ effectively places doctors above the law

This article was written by Dr Peter Saunders and published on his blog on October 30, 2013

By Peter Saunders, the campaign director for the Care Not Killing Alliance in the UK.

Peter Saunders

Lord Falconer’s Assisted Dying Bill, which aims to legalise assisted suicide for mentally competent adults with less than six months to live, had its first reading in the House of Lords in the UK last May.  

It is due to return for a second reading (debate stage) in Spring 2014.

In an interview for Pulse magazine today Lord Falconer was asked if GPs were likely to get into trouble with the police for authorising assisted suicide under his proposed bill should it ever become law.

His answer was quite revealing.

He said that the bill would make it ‘very difficult’ for GPs to face any proceedings in court as long as it was ‘their genuine view’ that this was the patient’s position.

He said: 

‘Of course they have to give their genuine view, and of course they have to take reasonable care in relation to it, but as long as they do that they would have absolutely nothing to worry about. It would be no different to any part of their practice as general practitioners.’

In other words, it is not necessary for the patient to be mentally competent, at least 18 years old, or with less than six months to live. All that is required is for the doctor to say that it is his 'genuine view' that these conditions apply and no court will be able to touch him.

George Jonas: "It seems evident that passing legislation to expressly permit killing on request opens a door that should remain firmly locked."

The following article is an excerpt of an article written by George Jonas and published in the National Post on October 25, 2013 under the title: The rock outside your window.

George Jonas

When my father was nearing 90, he started slowing down. Sometimes he barely stirred from his big leather armchair. Visiting him one day, I found him standing, leaning heavily on his cane, reluctant to take that first step with which a journey of a thousand miles must begin, according to Mao Zedong.

“What would you like, Dad?’’ I asked him. “I’ll get it for you.”

“Ha!” Father’s reply was an exclamation of dry mirth. “If I knew what I wanted, I’d get it myself.”

This was cocky but not quite accurate. Although the deterioration of father’s memory came first, his body didn’t take long to catch up. Remembering what he wanted was no guarantee that it would show up in his hand.

My mother loved my father, as did I, but my love was cost-free and my mother’s wasn’t. That was because I wasn’t looking after him, except financially, which is piffle, but my mother had to so physically, which is anything but. Looking after old people is hard work, and when I first saw my mother about a year after my father’s passing, she looked 10 years younger.

“The love of your life passes away, and you look 10 years younger,” I said to her, partly to compliment her and partly to pull her leg. “What kind of a woman are you”

“Love has nothing to do with it, dear,” she explained. “Sleep does. After your father passed away I could sleep through the night for the first time in years.”

Sleep deprivation is, of course, torture. Interrogators do it to enemy agents, and the rest of us do it to loved ones when we are old and sick. Some of us may add insult to injury and complain to the people we deprive of sleep about being old and useless and wanting to die.

"He’d wake up,’ the woman said bitterly, ‘complain about us not letting him die, then go back to sleep, as if nothing happened, the bastard’"

Father never did that, my mother said, but there was one woman at the hospital whose husband was going on about wanting to die all the time. “He’d wake up,” the woman said bitterly, “complain about us not letting him die, then go back to sleep, as if nothing happened, the bastard.

“By then, I hadn’t slept for five days,” the woman said. “Boy, was I ever tempted.”

This illustrates why assisted suicide is such a conundrum. On the one hand, it’s arbitrary, arrogant, cruel, indeed sadistic, to deny a suffering human being a peaceful exit when one is so easily available; and on the other hand, there’s the risk (I’d say, the near-certainty) that without an outright, no-exceptions, absolute, flat ban on euthanasia of any kind for any reason, sick and helpless people will be put to sleep, not because it is their carefully considered individual choice, but because it assures a better allocation of available sleep resources throughout the community — or some such nebulous reason of social engineering cooked up by medical-ethicists.

To me, it seems evident that passing legislation to expressly permit homicide on request, which is what assisted suicide would be, opens a door that should remain firmly locked. The minute a society endorses a category of permissible homicide for humanitarian reasons, the quasi-007 licenses issued will bear only a faint resemblance to the legislation’s original purpose.

"As long as we don’t give the state a license to kill us but retain our natural license to die, we haven’t surrendered all authority over our lives."

It couldn’t have escaped anyone’s notice, however, that unofficial euthanasia is widely practiced in most civilized countries. Under the guise of pain management and other palliative practices, caring physicians and family members have long reached a tacit understanding on the quiet provision of end-of-life services to patients and loved ones.

This isn’t the perfect solution, or even a good one, but it’s time-honoured and better than the alternatives proposed. As long as we don’t give the state a license to kill us but retain our natural license to die, we haven’t surrendered all authority over our lives.

Quebec Liberal leader suggests euthanasia Bill 52 needs amendments.

The Toronto Star reported today that Philippe Couillard, the leader of the Quebec Liberal party and a former neurosurgeon, stated that Bill 52, the euthanasia bill  in Quebec, does not have sufficiently strict guidelines.

Philippe Couillard

The Toronto Star reported Couillard as saying:

... the Parti Québécois government’s euthanasia bill as it stands now doesn’t set sufficiently strict conditions that must be met before terminally-ill patients can ask to be euthanized by a doctor.

Couillard continued:

“The importance of the legislative process is to make things more precise and comprehensible and to know what we’re talking about, how we’re talking about it and what types of acts we’re talking about.” 

He said that in his experience there are very few cases in the dying days of a terminally ill patient where pain and suffering cannot be alleviated by doctors and drugs. 

“I understand that there can be situations that are truly exceptional. But I would like them to be more precise about what those situations are.”

The Quebec government voted 84 to 26, today, at second reading to send bill 52 to committee. It appears that Couillard will be pushing the separatist government in Quebec to amend Bill 52.

Legal scholars are also saying that Bill 52 is unconstitutional. Euthanasia is prohibited in Canada's federal Criminal Code as a form of homicide. Bill 52 redefines euthanasia as medical treatment by calling it "medical aid in dying."

Couillard's comments reflect the results of a recent poll of 500 Quebec citizens conducted by Abingdon Research from October 23 - 28 for LifeCanada.

The poll found that only 35% of those polled supported Bill 52, as written, while 14% opposed it and 47% thought that the issue required further study.

The poll also highlighted problems with the bill's use of the vague term, “medical aid in dying.” Before being given the definition, only 30% answered correctly that “medical aid in dying” as proposed by Bill 52, involves “a doctor giving a patient a lethal injection.” 

The Quebec euthanasia bill is a very dangerous bill. It is rife with false claims, euphemisms and ambiguous language and it is bad medicine for Québecers with disabilities.

Letter: Euthanize Bill 52, not patients

The following letter was written by Dr Nicolas Newman and published in the Montreal Gazette on October 28, 2013

Do you need a hip replacement? If so, you might well qualify, instead, for medical aid in dying. (If you do not believe me, read section 26 of the proposed end-of-life Bill 52. The conditions under which someone would be eligible for medical aid in dying could apply to someone needing a hip replacement.)

A lethal injection is a lot cheaper than an operation, and may be more appealing to the hard-pressed taxpayer and to the finance minister who see the health-care budget going over the roof.

Euthanasia Prevention Coalition (EPC) launches complaint concerning CBC National program

To the CBC National:

The Euthanasia Prevention Coalition (EPC) has noticed that the CBC National is focusing on the issue of euthanasia next week.

We are concerned that we will once again witness one-sided propaganda programs.

There has been no attempt, by CBC National to contact EPC and there has been no attempt by you to contact any of our contacts.

In your program you are using the term Dying with Dignity which represents the name of the group that promotes legalizing assisted suicide.

You continue to avoid talking about the real evidence of direct danger to Canadians if this were legalized.

You will likely put a spin on the recent court decisions.

By the way, it is also not balanced programming to produce a 10 minute segment that includes a 10 or 15 second comment from someone opposing euthanasia or assisted suicide.

A public broadcaster should be balanced.

If you choose to be unfair and unbalanced EPC will do everything possible to challenge your programming to the applicable authorities. We are also seeking legal advice concerning other avenues.

These issues are far from being one-sided. There are many strong arguments against euthanasia and assisted suicide that should be heard and aired equally.

CBC National contact. or CBC contact.

Complaints to the CRTC. or CRTC link.

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

1-877-439-3348

info@epcc.ca

Quebec Euthanasia, putting the elderly at risk: A personal experience.

The following article was written by Irene Ogrizek and published on her blog on October 26, 2013.

Author’s disclosure: I have no religious affiliation and my politics, if you are new to this site, are left of centre. In online debates about this topic, two assumptions are frequently made about me: that I have conservative politics and am against Bill 52 on religious grounds. (Bill 52 will introduce euthanasia to Quebec.) My concerns are secular: I worry about the effect this bill will have on the elderly and the vulnerable in Quebec.

Irene asks: This is my picture now,
What will I be worth at 75?

The current euthanasia debate in Quebec frightens me. As a woman of a certain age, I fear I am heading into a future where I may lose meaningful control of my life. Whether I live or die may hinge on the kindness of individuals unknown to me, perhaps nurses or doctors, who will be put in the position of determining my worth. If I’m lucky and live past my retirement, evidence of all the things I’ve accomplished in my career will be gone. How will I look as a 75 year-old to myself and others? How will I be judged?

When it comes to euthanasia, the slippery slope aspect of it keeps being swept under the carpet. For me, it is the single most compelling reason not to go forward and here’s why: I have seen the slippery slope played out in the care my mother receives at her nursing home.

First I’d like to say that I chose this nursing home carefully; the staff to resident ratio was good and the building was clean and bright. It is located in a large Canadian city and is part of a government network of homes. My mother’s pension plan covers her monthly bill, so I use leftover money to pay for extras, like paid companions, to visit her. She has been disabled by a stroke and needs help wheeling herself around.

Despite having helpers, my mother has experienced three bouts of unauthorized medicating. I believe she has been given medications that make her drowsy and docile and are not included on her chart. Because of her fragile health, and the fact that she tires naturally, I had some difficulty, at least initially, detecting the problem.

The first time I noticed something was awry, it took a few visits to make sure I wasn’t catching my mother during an unstable phase in her health. When I saw her drowsiness was ongoing, however, I brought it up with a nurse, who said my mother was simply tired. I asked to see her chart anyway, just in case her medications had been changed and they’d forgotten to tell me.

The nurse promised to leave a note for the doctor, reporting my mother’s lethargy and asking him to examine her. I didn’t hear back from anyone, but on my next visit, my mother was back to her old self, sharp as a tack and telling me I needed to do a better job combing my hair before I left the house. It was a good sign and when I asked about the doctor’s examination, I was told it had been conducted and that there were no new developments. I let the matter go, but of course wondered.

Oregon cancer doctor and his patient tell their story and warn Quebecers.

Media Release: 

Montreal, Canada Newswire - October 25, 2013

The Coalition of Physicians for Social Justice presented a doctor and his patient from Oregon where assisted suicide is legal.

Dr. Kenneth Stevens is a practicing cancer doctor with more than 40 years' experience. He is also a Professor Emeritus and a former Chair of the Department of Radiation Oncology, Oregon Health & Sciences University,Portland, Oregon. He has treated thousands of patients with cancer.

Jeanette Hall, Dr. Stevens' patient, is thrilled to be alive 13 years after he talked her out of "doing" Oregon's law, i.e., killing herself with a lethal dose of barbiturates.

In 2000, Jeanette was diagnosed with cancer by another doctor and told that she had six months to a year to live. This was without treatment. The other doctor had referred her to Dr. Stevens for radiation and chemotherapy. Jeanette, however, had voted for Oregon's law.  She had made a firm decision to go forward with Oregon's law instead.

Dr. Stevens did not believe in assisted suicide. He also believed that Jeanette's prospects for treatment were good. He convinced her to be treated instead of doing Oregon's law.

Dr. Stevens talked about how the mere existence of legal assisted suicide steered Jeanette Hall to suicide. He also talked about how financial incentives in Oregon's government health plan also steer patients to suicide. Dr. Stevens warned that if assisted suicide or euthanasia is legalized in Quebec, then the Quebec government health program could follow a similar pattern—that is, to pay for people to die, but not to live.

Dr. Paul Saba, a family physician and co-president of the Coalition of Physicians for Social Justice explained how Québec's proposed euthanasia law would encourage people, including young adults with treatable conditions, to agree to euthanasia and throw away their lives. The Coalition's position against euthanasia is supported by the World Medical Association representing nine million physicians.

For additional information and references including videos visit coalitionmd.org.

SOURCE Coalition of Physicians for Social Justice

Disability - a fate worse than death?

Thank you to Paul Russell and HOPE Australia for the link.

The day after the Tasmanian Euthanasia & Assisted Suicide bill was defeated, disability activist, author and editor of the ABC's Ramp Up website on disability, Stella Young shared her concerns about the Tasmanian euthanasia bill and euthanasia in general.

As Lives Worth Living made similar observations in their submission to the Tasmanian Parliament. They also noted that not every person living with disability would agree. This does not diminish the argument - it only enhances it in as much as it is a voice that needs to be heard.

Here's the opening few paragraphs of the story. I have provided a link at the bottom to the story on the Ramp Up site because I want to encourage readers to also read the comments left by others.

Disability - a fate worse than death?

Stella Young Ramp Up 18 Oct 2013

Relieved at the defeat of the Voluntary Assisted Dying Bill yesterday, ABC Ramp Up Editor Stella Young remains opposed to legalising assisted death in any form. Here she explains why.

Two and a half months ago, my grandfather died. He was 84. He was not unwell in any specific way. He had no cancer and had only spent short periods of time in hospital. He was just old, worn out and over it.

During his last week or so, he expressed a wish to die many times. He once asked his doctor, with no small amount of distress, how it was possible for a person's body to be dying but not their mind. He had reached a point where dying was what he wanted, and we wanted that for him too.

None of us, including his doctor, could do anything to assist him with his wishes because neither euthanasia nor assisted suicide are legal in Australia. With the Voluntary Assisted Dying Bill voted down by Tasmanian parliament this week, it doesn't look like that will change any time soon.

For many years now, I have been opposed to legalising assisted death in any form. My recent experience with my dear Pa Jack has not changed my mind.

What the Supreme Court said in the Rasouli decision

The following article was written by Mark Handelman. This article is an excellent summary of the Supreme Court - Rasouli decision. This article represent the position of Mark Handelman. 

Consent to Withdrawal of Life Support:
What the Supreme Court of Canada Said In Cuthbertson and Rubenfeld v. Rasouli.

Mark Handelman

By Mark Handelman, BA, LLb, MHSc bioethics) 1
Counsel, Whaley Estate Litigation
m.handelman@sympatico.ca

"It may be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the housebreaker the judges of that. If we did, then no neck would be safe and no house stable."

George Bernard Shaw The Doctor's Dilemma

Introduction

When Mr. Shaw wrote that a hundred years ago, it would not have occurred to him that his precise question would be before Canada’s Supreme Court, with a life [or death] hanging in the balance. Those were the stakes when the Court heard Cuthbertson and Rubenfeld v. Rasouli 2 on December 10, 2012. The Judgment was released October 18th, 2013.

Background

As a result of contracting meningitis following surgery to remove a brain tumour, Mr. Rasouli suffered severe brain damage. He was first diagnosed as being in a persistent vegetative state, but later “upgraded” to being minimally conscious. He remains at Sunnybrook to this day, with limited improvement, dependant on his health practitioners for everything. The intensive care physicians treating him do not think his life worth living and have taken the position that the decision to discontinue life support is theirs alone.

Mr. Rasouli’s wife, Dr. Salasar, trained as a physician in Iran, disagrees. She and their children say he is aware and responsive and, in any event, his religious beliefs require that all things be done to keep him alive in spite of his condition. She therefore began court proceedings to prevent the discontinuation of life support. She contended that, if that was what the physicians wanted to do, they were obliged to take the matter to The Consent and Capacity Board [“CCB”] pursuant to s.37 of Ontario’s Health Care Consent Act [“HCCA”].

The Application pursuant to s.37, known as a “Form G” Application, is to determine whether the patient’s substitute decision maker [“SDM”] complied with the principles for giving or refusing substitute consent when he, she or they gave or refused consent to a treatment proposed by a health practitioner. The CCB, unique to Ontario, has heard about 25 such cases over the past decade, more than all the courts in the country combined.

But, Mr. Rasouli’s physicians argued that this was not a “treatment” decision and therefore the CCB had no jurisdiction. In both Superior Court and the Court of Appeal, although for different reasons, the Judges sided with Dr. Salasal. They held that the unique wording in the HCCA that defined “treatment” to include the withholding or withdrawing of a treatment, covered what the doctors wanted to do, which was discontinue life support by withdrawing existing treatments that kept Mr. Rasouli alive and treating him palliatively in the expectation he would die.

No Second Chances: International experience shows legal euthanasia is never just for exceptional cases.

By Derek Miedema, researcher IMFC Canada. Published on October 22, 2013.

Derek Miedema

Executive Summary 

“Most people want palliative care, but for the exceptional cases, we need to have an answer.”¹ These were the words of Véronique Hivon, Quebec’s Minister for Social Services and Youth Protection on June 12, 2013 as she introduced a bill to legalize euthanasia in Quebec. Though Minister Hivon took great pains to call it “medical aid in dying,” the practice is not part of medicine as Canada has understood it to date, neither does it “aid patients in dying.” Quebec’s proposed legislation allows doctors to kill patients who request death, purportedly only in “exceptional cases.”

The problem with Minister Hivon’s statement is (at least) twofold. Firstly, the proposed law is not in itself limited to cases of exceptional suffering. Secondly, international evidence shows that once assisted suicide or euthanasia are legalized, the once-selective criteria expand to include more and more people. This is as true in the Netherlands, where euthanasia has been legal since 2002, as it is in Oregon and Washington State, where assisted suicide was legalized in 1997 and 2009, respectively.

In Oregon, the number of deaths by assisted suicide has doubled since 2005.² Prescriptions for a poisonous cocktail to kill patients have grown by 76% over the same time frame.³ The population of Oregon grew by seven percent during this time frame.⁴

In Washington, between 2009 and 2012, the number of deaths by assisted suicide grew 130%.⁵ Over the same period, Washington’s population grew only 18%.⁶

In the Netherlands, the number of deaths by euthanasia has increased by 64% between 2005 and 2010.⁷ In comparison, the Dutch population grew by less that two percent over the same interval.⁸

This paper will briefly examine Quebec’s proposal and compare it with the situations in Oregon, Washington State, and the Netherlands.

Download PDF: 

No second chances: International experience shows legal euthanasia is never just for “exceptional” cases

ENDNOTES: 

1. CBC News, Montreal. (2013, June 12). Quebec tables bill on medically assisted death. Retrieved fromhttp://www.cbc.ca/news/canada/montreal/story/2013/06/12/montrealquebec-
   palliative-sedation-assisted-suicide-dying-with-dignity-legislation.html
2. Oregon Public Health Division. (2012). Oregon’s death with dignity act (1999 to 2012). Retrieved fromhttp://public.health.oregon.gov/ProviderPartnerResources/
   EvaluationResearch/DeathwithDignityAct/Pages/ar-index.aspx.With author’s calculations.
3. Ibid. With author’s calculations.
4. Portland State University. (2013). 2012 Annual population report tables. Retrieved fromhttp://www.pdx.edu/prc/sites/www.pdx.edu.prc/files/Annual Pop Report Tables2012_
   web97Excel.xls. With author’s calculations.
5. 2009 to 2012 reports: Washington State Department of Health. (2012). 2009 to 2012
   Death with dignity act reports. Retrieved from www.doh.wa.gov/YouandYourFamily/
   IllnessandDisease/DeathwithDignityAct.aspx. With author’s calculations.
6. 2009 population: Washington State Office of Financial Management. (2002). April 1
   intercensal estimates of population and housing: 1990-2000. Table retrieved from http://
   www.ofm.wa.gov/pop/april1/hseries/ofm_april1_intercensal_estimates_1990-2000.xlsx
   2012 population: (2012). April 1 post censal estimates of population: 1960-present. Table
   retrieved from http://www.ofm.wa.gov/pop/april1/hseries/ofm_april1_postcensal_estimates_
   pop_1960-present.xlsx. With author’s calculations.
7. Onwuteaka-Philipsen, B.D., Brinkman-Stoppelenburg, A., Penning, C., de Jong-Krul, G.J.F, van Delden, J.J.M., and van der Heide, A. (2012, September). Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. The Lancet, Vol. 380, Issue 9845, Pages 908-915. See Table 1, p. 912. (With author’s calculations.)
8. 2005 and 2010 population: Statistics Netherlands. (2013). Population and population dynamics; month, quarter and year. Retrieved from http://statline.cbs.nl/StatWeb/publication/?DM=SLEN&PA=37943eng&D1=7&D2=186,299-315&LA=EN&HDR=T&STB=G1&VW=T. With author’s calculations.

DiManno: Court stays off euthanasia.

The following article was written by Toronto Star columnist, Rosie DiManno, and published on October 21, 2013 in the Toronto Star.

Rosie DiManno

By Rosie DiManno, Toronto Star - October 22, 2013

It was a bad week for the “Death With Dignity” shills.

Unlike what they so ardently advocate for others, do not expect this faction to pull the plug on itself. They will continue to pound on the courtroom door in an unending quest to legalize doctor-assisted suicide in Canada and all the other euphemistic versions of rationalized killing.

On Oct. 10, the British Columbia Court of Appeal overturned a B.C. Court ruling which had found the criminal ban against doctor-assisted suicide to be unconstitutional. In other words, it upheld the existing ban. The majority view in the split decision concluded that, while Charter of Rights and Freedoms law has evolved since 1993 — when last the issue of assisted suicide was visited — still not sufficiently so that the landmark decision should be set aside.

Then, on Friday, in a case that might seem to have little in common with the B.C. matter, the Supreme Court of Canada ruled 5-2 against two Sunnybrook Hospital doctors who had stubbornly sought to remove a severely brain-damaged patient from life support, over the objections of his family. The decision applies only to cases in Ontario and does not address the broader ethical questions.

This legal wrangle was particularly deplorable because it turned on the God-complex of a couple of doctors who’ve been fighting to bypass a dispute resolution system that has been in place for nearly two decades: Ontario’s Consent and Capacity Board, which deals on a case-to-case basis where there is disagreement between physicians and families making decisions on behalf of loved ones who can’t express their own wishes.

Rasouli family

The fate of 61-year-old Hassan Rasouli — on a ventilator and feeding tube since catastrophic complications following brain surgery three years ago — may yet come before the Consent and Capacity Board; that remains unclear. But for the moment, his wife and children are immensely pleased and relieved. While the two doctors continue to maintain that treatment for Rasouli is futile, the family has seen evidence that he is in fact responsive to stimuli — he smiles, he follows them with his eyes, he squeezes his fingers, he has even, as the family stated Friday, made thumbs-up and peace-sign gestures.

Even a layperson with no medical degree — unlike Rasouli’s wife, who was a physician in her native Iran — could see the man is not in a vegetative state. Indeed, neurologists have upgraded his condition to “minimally conscious.” There is brain activity and he might indeed still make a marked recovery. He is, at some level, a sentient being.

So, two cases coming at the conundrum of colossal enfeeblement from different angles but still in pursuit of the same outcome: death by choice, whether of the suffering individual or by treatment providers.

On both counts, it must have come as a rude wake-up for the death acolytes to discover they do not have the sympathetic ear of top courts in this country. “Bloody but unbowed,” vowed one of the lawyers in the B.C. case.

Perhaps they’ve been reading too many of their own editorial clippings, or misunderstanding public opinion polls that provide a blurry snapshot of prevailing attitudes because they exist in a vacuum bereft of nuance. It’s one thing for a person enjoying good health to peer into the future and decide that a life of severely limited faculties, of acute pain, of incurable illness, must surely be unendurable. It’s quite another thing when actually confronted by that reality, whether for oneself or on behalf of family members, as society chips away at the most fundamental of societal concepts: Thou shall not kill.

That’s not a faith-based proscription, lest anyone jump to the mistaken assumption that I’m thumping you over the head with a cross, as some were quick to assert the last time I wrote on this subject. At best, I am a lapsed Catholic who disagrees with the church on just about every social issue, from celibacy for priests to the denial of sacraments to divorced couples to abortion to homosexual unions — though I will say the church got it right on liberation theology, which has been a disaster.

No mainstream faith, however, has come out in favour of assisted suicide.

And, while death huggers pretend that it’s only a matter of time before governments catch up with the learning curve, as if Canada is somehow on the reactionary end of the spectrum, I would remind that out of 196 countries on the planet in 2013, only three allow assisted suicide: Belgium, Switzerland and the Netherlands. In America, three states have passed laws permitting limited euthanasia: Oregon, Washington and Vermont.

This is not a vanguard movement and Canada is hardly out of step with global attitudes, though proponents of euthanasia — which is the correct term, rather than the deceptive tautology of “Death with Dignity” — would have us believe otherwise.

Quebec seems intent, as usual, on marching to its own drummer, having recently tabled a bill to legalize mercy killing — another repugnant, pacifying term. Legally, it’s unclear whether Quebec has the authority to unilaterally implement such a law but it’s charging ahead anyway. Under the Criminal Code, assisted suicide in all its permutations is clearly illegal and unambiguous. While the law is federal, however, the decision to prosecute physicians assisting in suicide is provincial.

Clearly, this is an issue headed for the Supreme Court of Canada. While assisted suicide, euthanasia, mercy-killing, however you frame it, is steeped in deep-rooted precepts of morality and ethics, I will put my faith in that highest court in the land to render a decision that cleaves to matters of law rather than emotionalism.

But once you open that door, there’s no slamming it shut again, regardless of reassurances to the contrary.

In the Netherlands, deaths by euthanasia jumped 64 per cent between 2005 to 2010, and “terminal sedation” — defined in Canadian guidelines as “sedation with continuous IV narcotics and/or sedatives until the patient becomes unconscious and death ensues from the underlying illness,” thus not technically euthanasia — spiked from 11,000 to 17,000 in the same period. Not euthanasia, so no documenting paperwork required.

The Dutch even have mobile euthanasia units so doctors can kill patients in their own homes, including people with Alzheimer’s who obviously can’t form cogent intent.

Once that taboo is breached, the parameters keep expanding. That’s why advocates for the most vulnerable among us are so appalled, as children born with spina bifida are put to death (in the Netherlands, with parental consent) and the criteria for “exceptional circumstances” inevitably widen. In Quebec, Bill 52 is unacceptably vague in defining criteria, permitting doctors to assist in suicide when a patient “suffers from an incurable illness” or “from an advanced state of irreversible decline in capability.” That could just as easily define old age.

It’s not just about you, the “my right to die” chorus, as if any of us can opt out.

Beware the lulling croon of the death whisperers.