Assisted dying report goes beyond scope, ignores evidence

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

On February 25, the Special Committee on Physician-Assisted Dying released its report advising the government on euthanasia legislation in Canada.

The Supreme Court struck down Canada's assisted suicide law (February 6, 2015) and have given parliament until June 6, 2016 to implement a new law.

Similar to the Provincial-Territorial panel report that was loaded with pro-euthanasia activists, the federal committee recommended euthanasia for people with dementia, for minors, for people with psychiatric conditions and without effective oversight.

EPC legal counsel and constitutional expert, Hugh Scher, called the committee proposal "a dangerous social policy experiment."

David Baker

On Saturday, February 27; the Globe Mail published an excellent commentary by constitutional lawyer, David Baker, who represented national disability groups in the assisted suicide case at the Supreme Court and Trudo Lemmens, University of Toronto Professor in health law and policy at the Faculty of Law.

Baker and Lemmens argue that the Assisted Dying report goes beyond the scope of the Supreme Court decision, and that they also ignored evidence. According to the article:

The court foresaw it (the government) enacting a “complex regulatory regime” of “carefully designed and monitored safeguards.” Unfortunately, the federal report released yesterday recommends exactly the opposite, and proposes the world’s most open-ended regime with arguably the lowest safeguards.

Trudo Lemmens

The article continues by defining what the Committee on Assisted Dying recommended:

the parliamentary committee seeks to expand the criteria for physician-assisted death way beyond what was required by Carter or Bill 52. It includes mental-health conditions and all other disabilities, including developmental disabilities, autism, acquired brain injuries, fetal alcohol syndrome, not to mention blindness and deafness. 

Essentially all disabilities can be included in the open-ended criteria for access, extending the law beyond the persons with irreversibly declining capacities at the end-of-life that the Supreme Court ruled upon, and disregarding the court’s determination that “psychiatric disorders” were expressly excluded, as well as children, even if children would only have access three years after the new legislation is introduced. The committee further recommends access by advanced directive for people suffering from dementia, which most agree would create a practical and ethical minefield.

The article documents some of the evidence that the Committee had received but ignored:

The committee disregarded strong evidence (detailed analyses as well as various case reports) from Belgium and the Netherlands, that confirms vulnerable people are put at risk when vague and expanding access criteria are employed. The risk worsens when the regulatory system relies on individual physicians for determining access and for assessing competency of patients. 

Physician-assisted death in those countries is increasingly being performed on people who are lonely and are concerned about becoming dependent on others, people who are tired of life, and people suffering from mental-health conditions, including depression, anxiety, schizophrenia, eating disorders, autism, post-traumatic stress, and even complicated grief. In many analyzed euthanasia cases, treatment options were available but not used. Reports from those countries raise questions about how some physicians assess competency, and about how vulnerable patients have been able to shop around until they find a physician who, having had no prior therapeutic relationship with them, are willing to end their life. 

In many reported euthanasia cases, treatment options were available but not used. The report raises questions about how some physicians assess competency, and about how vulnerable patients have been able to shop around until they find a physician who, having had no prior therapeutic relationship with them, are willing to end their life.

The article concludes by stating that experts and political commentators in the Netherlands and Belgium are now calling for an end to the open-ended, after the death review system that exists in their countries, and yet the Committee suggested we go in that direction. Baker and Lemmens state:

Imagine that Canada would become a country where people, including children, receive a physician-assisted death for lack of access to appropriate palliative or other health care.

It is time for Canadians to rise up and say NO.

Assisted dying proposal a 'dangerous social policy experiment'

The following article was published by Advocate Daily on February 26, 2016

Hugh Scher

A parliamentary committee is endorsing a "dangerous experiment" in what would be the most wide-ranging assisted dying regime in the world without judicial oversight, says Toronto human rights and constitutional lawyer Hugh Scher.

“The suggestion of endorsing euthanasia for people with psychiatric conditions, for people who are depressed, for children, for people with psychological suffering — and doing it with absolutely no independent, objective, before-the-fact oversight by a court or tribunal to ensure powers are not abused — is extremely troubling,” says Scher, principal of Scher Law. 

“Effectively the government is suggesting the fox should be ruling the chicken coop and this notion is an extremely dangerous one,” Scher tells AdvocateDaily.com.

The special parliamentary committee introduced the long-awaited recommendations on Thursdayas the federal government prepares to draft new legislation governing medical assistance in dying.

In Carter v. Canada (Attorney General), 2015 SCC 5, the Supreme Court struck down the ban on doctor-assisted death last year. The government has until June to come up with a new law that recognizes the ability of clearly consenting adults who are enduring intolerable physical or mental suffering to seek medical help in ending their lives.

Contrary to the Supreme Court ruling in Carter, the committee suggests that people diagnosed with incurable conditions likely to cause loss of competence, such as dementia, should be able to make advance requests for medical assistance in dying, the report says.

The committee says physician-assisted dying should be immediately available to competent adults 18 years or older and — after further consultations — should be expanded to include "mature minors'' within three years, something Scher and many suicide prevention experts find alarming.

“The notion that children who aren’t able to drive and vote should somehow be able to access a needle in their arm to kill themselves when they are experiencing profound depression and feelings of hopelessness turns suicide prevention into a fallacy,” says Scher, counsel for the Euthanasia Prevention Coalition, the leading national and international association of doctors, nurses, people with disabilities and of leading experts on euthanasia and assisted suicide practices in foreign jurisdictions.

In a CityNews panel, Scher says there are not enough safeguards preventing misuse of the law that could find people dying unnecessarily.

“Stephen Hawking, Steven Fletcher (former Conservative MP), any person with a disability is now going to be subject to the risks of lacking any safe space in any health-care setting in our country,” Scher says on the TV news station’s panel discussion. 

“Every health-care setting is effectively required to implement and give effect to the terms and requirements of euthanasia that are being set out by this committee report — even those in hospices and palliative care environments who significantly oppose implementation of these measures because it undermines the essence of the work they’re trying to do.”

In an interview with AdvocateDaily.com, Scher says he fears the Liberal government may whip a vote in Parliament to pass the legislation, negating further debate or discussion, because it is considered a “Charter issue.”

“The Supreme Court of Canada did not establish the right to die as part of the Charter of Rights and Freedoms in Canada,” Scher says. “What they did was look at existing Criminal Code prohibitions and found they were overly broad relative to their purposes and, as such, they suggested it be struck down subject to Parliament’s right to reintroduce those measures necessary in order to minimally restrict the rights of a certain class of Canadians.”

He says the wide-ranging recommendations may be a “political ploy” so if the government decides to pull back on elements of the assisted dying regime it is considered to be more reasoned and measured.

“But the reality is this represents a dangerous experiment in social policy that is taking Canada into uncharted territory.”

Link to previous articles by Hugh Scher.

Schadenberg: Deep concerns generated by assisted death recommendations.

The following story was written by Renee Bernard and published by News 1130 on February 25.

Assisted death legislation is taking shape, as MPs mull over recommendations made by a parliamentary committee.

Among the recommendations: allowing “mature” minors and the mentally ill the right to seek physician-assisted death.

Alex Schadenberg

The report, however, is generating deep concerns.

Alex Schadenberg of the Euthanasia Prevention Coalition says the recommendations would make assisted death easier to access in Canada than in European countries offering physician-assisted suicide.

“They are talking about minors, we’re talking about people with psychological issues. These recommendations take us further than Belgium and the Netherlands, even before the legislation has passed,” says Schadenberg.

The coalition had intervener status in the original Supreme Court of Canada case, which brought down its ruling a year ago.

Schadenberg says the committee report contains no protection for physicians.

“Doctors who have no interest in performing euthanasia are being told ‘You don’t have to do it, but you’re going to have to refer the matter to a doctor who does. You’re going to have to be complicit in this in some way, even if you don’t agree.'”

He feels the report also falls short of providing oversight to make sure doctors are following the rules. He says, as it’s proposed, the two doctors who sign-off on the procedure will simply send a report once the patient is dead. Schadenberg says a third-party is needed to monitor that everything has gone by the guidelines.

The federal government has until June to enact legislation governing physician-assisted death. Cabinet is expected to begin discussions within weeks.

Recommendations Contained in Report of Joint Committee on Physician-Assisted Dying Pose Significant Risk to Vulnerable Canadians

For Immediate Release - February 25, 2016 - Toronto

The Council of Canadians with Disabilities (CCD) and the Canadian Association for Community Living (CACL) are extremely dismayed that the recommendations contained in the report released today by Parliament’s Special Joint Committee on Physician-Assisted Dying will jeopardize the lives of vulnerable Canadians. They do not follow the Supreme Court’s call for “stringent limits that are scrupulously monitored and enforced.”

“We are concerned that the Committee’s permissive approach would put vulnerable people at risk. Their recommendations exceed guidance from the Supreme Court, as well as UN Conventions to which Canada is a signatory” states Tony Dolan, CCD Chair. 

“We appreciate that members of the Joint Committee were alert to concerns about vulnerable persons,” says Michael Bach, Executive Vice-President of the Canadian Association for Community Living. “Nevertheless, we are alarmed by the committee’s conclusions. We believe the recommendations contained in the Committee Report fall well short of the minimum safeguards we believe are essential to protecting vulnerable Canadians. Clearly there is a lot of work still to be done.”

Together CACL and CCD represent the concerns of Canadians with disabilities. Both organizations believe that their members will be harmed if the government adopts the committee’s recommendations. They have four principle concerns.

First, both organizations believe the committee has erred by not accepting the trial judge’s definition of “grievous and irremediable medical conditions” to exclude psychosocial suffering as an eligible condition, and meaning an advanced state of weakening capacities with no chance of improvement.

Second, the Committee suggests that concerns about vulnerability can be addressed within the context of physician assessments of decision making capacity. The evidence does not support this claim. Physicians are not generally trained or have expertise in the kinds of vulnerabilities that are known to motivate requests for assisted death. For example, a survey of U.S. physicians found that only 2% had training, experience or expertise in identifying signs of elder abuse in their patients, despite this growing demographic. “The Committee’s recommendation, which instructs decision makers to pay attention to vulnerability does nothing to assuage our concerns,” states Rhonda Wiebe, Co-Chairperson of CCD’s Ending of Life Ethics Committee.

Third, the Committee recommends allowing for advance directives. This is not consistent with the Supreme Court decision which clearly stated that a person has to be capable in the actual circumstances of taking the intervention intended to cause death. Advance directives would empower substitute decision makers to determine when someone should die. This should be explicitly prohibited in federal legislation. The risks to the most vulnerable in society are obvious.

Fourth, the Committee rejected proposals that requests be authorized through an independent prior review, instead relying on two physicians to make the assessment and authorize the intervention to terminate a person’s life. These are fundamentally irreconcilable roles, and combining them exposes physicians and patients to conflicts of interest and increases risk of abuse. A check and balance of prior review is essential.

CCD and CACL will be urging the government to adopt a stronger system of safeguards, and to adopt a clear standard for protecting vulnerable persons. Canadians requesting assistance from physicians to end their life should be able to do so without jeopardizing the lives of vulnerable persons who may be subject to coercion, inducement and abuse.

Report recommends euthanasia for: dementia, minors, psychiatric conditions and without effective oversight.

By Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

The Report of the Special Joint Committee on Physician-Assisted Dying (Committee) was released today under the veneer of a “Patient-Centred Approach.”

This report is not patient centred but rather it is oriented to how medical professionals will cause the death of their patients.

The report contains 21 recommendations that ensure access to euthanasia and assisted suicide, under the term “Assisted Dying” for people who seek to be killed by a medical professional, based on physical or psychological suffering.

The report recommendations go beyond the Carter Supreme Court decision that stated that a person must be: 

“a competent adult person who clearly consents to the termination of life.”

The report recommends assisted death, by lethal injection (also known as euthanasia), be done, without effective oversight (recommendations 12 & 15) for people who are not terminally ill (recommendation 2), who may be unable to clearly consent due to dementia (recommendation 7), or mature minors (recommendation 6), and for people with psychiatric conditions (recommendation 3), including treatable depression (recommendation 4).

The report also demands that medical professionals, who refuse to kill their patients, must refer those patients to a physician who will kill (recommendation 10) and that medical institutions must permit killing on their premises (recommendation 11)

Analysis of the recommendations:

Recommendation 1 states that the terminology does not require definitions.

One of the many problems with the Supreme Court decision was that the language of the decision was not defined. Definitions are important to ensure clarity of the law.

If parliament does not clearly define the law, it will lead to future court cases designed to define or expand the excepted definitions of the law.

Recommendation 2 states that assisted dying not be limited to people with a terminal illness.

Recommendation 3 states that assisted dying can apply to persons with psychiatric conditions. Based on Recommendation 4, recommendation 3 opens the door to people who have treatable psychiatric conditions being approved for death by lethal injection.

Recommendation 4 states that the reason for assisted death should be based on what is intolerable to the individual. Objective criteria are not required to determine who will live and who should die.

Recommendation 5 requires an assessment for capacity to provide informed consent.

This recommendation appears to ensure capacity to consent. The report states several times that safeguards and oversight will strike the balance between vulnerability and a clear request to die, and yet, the report rejects the necessary safeguards and oversight to accomplish that task.

Recommendation 6 states that the federal government should implement euthanasia in a two-stage process, whereby the first stage would limit euthanasia to competent adults, with euthanasia being extended to “mature minors” within three years of implementing stage 1.

Recommendation 7 states that an incompetent person could be approved for euthanasia, so long as the person made the request after receiving the diagnosis, while the person is still competent.

Assisted death based on advanced directives can lead to misuse of the law. If a person states in their advanced directive that they want to die by euthanasia, often the euthanasia will occur when the person cannot change their mind since, at that moment, the person may be incompetent. How can this be defined as clearly consenting?

Recommendation 8 states that the person who died must be eligible for publicly funded healthcare services in Canada. This recommendation will not prevent death tourism.

Recommendation 9 suggests that the request for assisted death should be made in writing and witnessed by two people who have no conflict of interest.

Recommendation 9 does not permit a request for assisted death by a substitute decision maker, and yet recommendation 7 will require the substitute decision maker to make the request.

Recommendation 10 requires health care practitioners, who object to killing their patients, to effectively refer their patients to someone who will kill their patient or arrange it. This report provides no conscience protection for medical professionals.

Recommendation 11 requires all publicly funded health care facilities to permit euthanasia and assisted suicide. This would requires all religiously affiliated health care facilities to kill patients.

Recommendation 12 requires two independent physicians to assess a person who requests assisted death.

In all jurisdictions, where assisted death is legal, the law allows two doctors to determine who lives and who dies. Recommendation 12 does not provide effective oversight since recommendation 15 rejects a prior review and approval process and recommendation 16 requires the doctor who causes the death to submit a report. Doctors do not self-report misuse of the law.

Recommendation 13 permits nurse practitioners and registered nurses to lethally inject patients under the direction of a physician and it protects pharmacists and other health care practitioners from possible prosecution for participating in killing people.

Recommendation 13 is worded as providing protection for nurses, but in fact it is based on ensuring that there is a sufficient number of medical professionals who are willing to kill.

Recommendation 14 discourages a “cooling off” period even though the Oregon and Washington State assisted suicide acts require a 15 day waiting or “cooling off” period.

Recommendation 15 rejects a before-the-death approval or review system to ensure that the requirements of the law are followed.

A before-the-death approval system enables effective oversight of the law. The report rejects a system of effective oversight for a system where doctors self-police and self-report compliance with the law.

Recommendation 16 mandates a system of data collection and reporting to be published on a yearly basis.

The data will come from the reports that physicians will be required to submit, after-the-death of the person. This system provides no effective oversight, because the person is dead when the report is submitted. Little or no information concerning inappropriate deaths will be uncovered since doctors do not self-report misuse of the law.

Recommendation 17 requires a mandatory review of the law, by the House of Commons and Senate, every four years.

Recommendation 18 recognizes that indigenous patients require culturally and spiritually appropriate care, including palliative care.

Recommendation 19 urges the federal, provincial and territorial governments to re-establish a Secretariat on Palliative Care and End-of-Life Care.

Recommendation 20 urges the federal, provincial and territorial governments to support the Changing Directions, Changing Lives Mental Health commission.

Recommendation 21 urges the federal, provincial and territorial governments to develop a pan-Canadian strategy for individuals living with dementia.

The report of the Special Joint Committee on Physician-Assisted Dying is very similar to the one-sided Provincial/Territorial report. 

The recommendations would permit a wider regime for euthanasia that exists in Belgium, where the law has grown out of control. 

The report allows assisted death without effective oversight (recommendations 12 & 15) for people who are not terminally ill (recommendation 2), who may be unable to clearly consent (recommendation 7), or for mature minors (recommendation 6), and for people with psychiatric conditions (recommendation 3), including treatable depression (recommendation 4). The report demands that medical professionals, who refuse to kill their patients, must refer those patients to the executioner (recommendation 10).

Canadian government Assisted Dying recommendations will not protect people.

For Immediate Release - February 25, 2016

The Euthanasia Prevention Coalition (EPC) is a national organization representing groups and individuals representing medical, personal and disability perspectives since 1999 with the purpose of protecting people from euthanasia and assisted suicide.

Research proves that the misuse of Assisted Dying in jurisdictions where it is legal has resulted in deaths without an explicit request, assisted deaths of people with a wrong diagnosis, the under reporting of assisted deaths, and assisted death of people with treatable psychiatric conditions including depression.

EPC urges the federal government to:

• devise guidelines with clear oversight that cannot be abused.
• reject the concept that assisted dying is a form of medical treatment.
• reject assisted death for people who are incompetent to make decisions.
• devise clear guidelines to ensure that people, who are experiencing a vulnerable time of their life, will not die an assisted death, based on situational depression.
• protect the conscience rights of healthcare institutions.
• protect the conscience rights of medical professionals who reject that killing patients is an acceptable medical act. Medical professionals must not be forced, in any manner to participate in killing their patients.
• increase support for palliative care, home care for people with disabilities, mental health services and suicide prevention.

For interviews contact:

Alex Schadenberg (London ON) EPC Executive Director, (519) 851-1434 (cell) info@epcc.ca

Hugh Scher (Toronto ON) EPC Legal Counsel, (416) 816-6115 (cell) hugh@sdlaw.ca

Amy Hasbrouck (Montreal QC) Toujours Vivant Not Dead Yet, (450) 921-3057, tigrlily61@gmail.com

Dr. Will Johnston (Vancouver BC) EPC – BC Chair, (604) 220-2042.

Euthanasia Prevention Coalition, 1-877-439-3348, info@epcc.ca, www.epcc.ca

Physician Assisted Suicide Proponents Will Say Anything to Pass the Assisted Suicide Bill.

This article was published on February 22, 2016 by Maryland Against Physician Assisted Suicide.

• Requiring a professional mental health evaluation would “unnecessarily slow down” patient’s access to physician assisted suicide.
• Terminal patients are in pain so this bill must be passed. 
• [Including] too many regulatory requirements [in this bill] would make it impossible for a dying person to access death with dignity. 
• It’s not falsifying the death certificate [by only listing the underlying terminal diagnosis instead of listing assisted suicide as reason for death] because that’s the way it is done in Oregon and Washington. 

It goes on and on like this. The list of false and misleading statements that physician assisted suicide proponents said at the House hearing on HB 404 last Friday is hard to believe. But let’s take them at their word and address each of these assertions one by one:

   1. Medical studies show that terminal patients have high rates of depression: according to this study “best estimates are that between 15% and 50% of cancer patients experience depressive symptoms, and 5% to 20% will meet various diagnostic criteria for major depressive disorder.” These depressed, terminal patients have a poorer quality of life and a higher likelihood of having suicidal thoughts.

Proponents of physician assisted suicide and HB 404 are blatantly ignoring these data and argue that nothing should slow down a terminal patient’s quest to commit suicide, even if they are seriously depressed.

The 2015 data from Oregon show that an optional psychiatric evaluation does not work! Only 5 out of 132 patients receiving an assisted suicide prescription were referred for a professional mental health evaluation. That’s 3.8%. Far lower than the 15%-50% of cancer patients estimated to have depression (where 72% of OR residents receiving assisted suicide in 2015 had cancer!) 

   2. Pain isn’t even in the top 5 reasons why patients in Oregon chose assisted suicide. The 2015 Oregon “Death with Dignity” annual report shows that pain was the sixth highest reason stated for requesting assisted suicide – far behind “less ability to engage in activities that make life enjoyable”; “losing autonomy”; and “loss of dignity.”

   3. More regulatory requirements are exactly what an issue like physician assisted suicide demands and what legislators should seek in issues that are literally life and death. It’s insulting for assisted suicide proponents to argue that receiving a prescription to commit suicide should be as simple as possible.

   4. Just because Oregon and Washington “death with dignity” laws allow for the falsifying of a death certificate doesn’t mean it is OK to do in Maryland.

Contact Maryland Against Physician Assisted Suicide.

It is impossible to support euthanasia of any kind.

By Charles Lewis:

A good friend of mine, asked me tonight via email about what she should pray for in current euthanasia battle in Canada. She wondered whether we should pray for the most restrictive legislation possible or should we pray that the very notion of legalized killing should vanish — in other words, a miracle.

Of course, a miracle would be great. Even more miraculous would be to see all pro-euthanasia politicians, some real enthusiasts for medicalized death, suddenly change their minds.

I have become entrenched in my own position against euthanasia. Not because I am stubborn but I find it impossible to support euthanasia of any kind. It goes against everything I believe in. To try to help craft a "safe" bill, or even pray for a safe bill, would haunt me forever. I may not be able to stop the inevitable but I can ease my own conscience by not going along.

So here is roughly what I told her:

We should keep praying and working towards its destruction. Cardinal Thomas Collins appeared before the parliamentary committee that is attempting to craft a safe law. He refused to help them. He kept repeating euthanasia is wrong. The committee members were frustrated. But who cares. They are acting as the agents of death.

To my mind, you cannot oppose euthanasia and at the same time help craft a safe law. It would be like being against the death penalty but seeing nothing wrong in designing a painless noose or a quicker, more efficient poison to send a prisoner on his way to the next world.

Besides, what is a safe law?

The Supreme Court ruling of last year left things wide open. That means if the government is too narrow in its legislation, it will likely end up back in court.

Even excluding further involvement by the courts, the likelihood of a safe law remaining restrictive is slim. This is what happened in Holland and Belgium, to the shame of both those countries. As demand grew for pre-natural death more and more ailments and conditions, many not lethal, were approved for state-sanctioned killing.

It is strange for me that Allied soldiers, like my father, fought in those countries to get rid of the Nazis, the biggest promoters of death as a response to so-called imperfection. Did these countries learn nothing from the Occupation?

Senator Betty Unger: Palliative care should be the priority, not physician-assisted dying

This article was published by Senator Unger on February 22, 2016 on her website.

"Palliative care should be the priority, not physician-assisted dying.

There is something terribly wrong when a government

does more to guarantee that the living can die,

than to ensure that the dying can live."

- Betty Unger, Alberta Senator 

Senator Betty Unger

February 22, 2016

Last year, the Supreme Court of Canada ruled that the Criminal Code sections prohibiting physician-assisted suicide violate our Charter rights. After declaring those sections to be invalid, the Court paved the way for assisted suicide and euthanasia to become legal in Canada on June 6, 2016.

This short article does not allow us to list all the concerns raised by the Court’s decision. But the experience of countries with legalized euthanasia clearly demonstrates that the road is fraught with great danger, including hundreds of cases a year where people are euthanized without their consent. Even the Supreme Court itself admitted that the risk of abuse cannot be eliminated. They stated that such risks should be identified and minimized, “through a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced”.

It is this “carefully-designed system” which the Government of Canada is supposed to be in the process of crafting. A joint committee, including both Members of Parliament and Senators, was created last December. It held 12 public meetings, heard from 62 witnesses, and received a multitude of written submissions. From this evidence, the Committee is to “make recommendations on the framework of a federal response on physician-assisted dying that respects the Constitution, the Charter of Rights and Freedoms, and the priorities of Canadians.”

The Committee’s report is due on February 26th, at which time we will discover what their recommendations are. But from the multitude of statements made and questions asked during public meetings, it appears that the majority of Committee members have little regard for safeguards which might limit access to assisted suicide. Rather than crafting a system that imposes “stringent limits” they seem to be preoccupied with how wide the doors can be flung open. Their primary concern appears not to be safeguards, but guaranteed access.

It might come as a surprise to some, but the Supreme Court’s judgment in Carter v. Canada did not make physician-assisted suicide a Charter right. If you read the Charter of Rights and Freedoms you will see that assisted suicide is never mentioned. What the Charter does guarantee is “the right to life, liberty and security of the person.” The Supreme Court determined that in some very select, narrow and unusual circumstances, forbidding access to assisted suicide is a violation of this right. The duty of the government is to grant access in these cases. It is under no obligation, however, to guarantee access.

At first glance, a distinction between granting access and guaranteeing access may appear subtle. But a failure to understand the critical difference launches us down a very dangerous path. Guaranteed access means government must make the way, not simply get out of the way. Which, in turn, creates a strong bias towards diluting safeguards as much as possible, in order to provide access which is as broad as possible.

For example, the Supreme Court said that only competent adults can request physician-assisted death. But the Committee is clearly wrestling with whether to grant access to minors as well. The Court said that nothing should “compel physicians to provide assistance in dying”. Yet the Committee is contemplating whether to force dissenting doctors to refer patients to a physician who will agree to kill them. Even faith-based hospitals might not be safe from the Committee’s zeal. They too, contrary to their community values, could be obligated by law to participate in administering treatments designed to terminate life.

The determination to guarantee access for assisted suicide, when such access doesn’t even exist for palliative care, exposes a warped understanding of compassion. By separating compassion from a belief in the sanctity of life, you are left with a twisted concept of what is right and what is wrong. While masquerading as kindness, this view actually fosters a creeping devaluation of human life.

Access to palliative care is as much a Charter right as access to physician-assisted dying. And while the Committee seems oblivious to this, most people will acknowledge that there is something terribly wrong when a government does more to guarantee that the living can die, than to ensure that the dying can live.

Betty E. Unger, Alberta Senator

Senator Unger worked as a Registered Nurse for several years, then founded and operated an Alberta nursing services company with offices located in Edmonton, Red Deer and Calgary. Services were provided across the province, to national and Alberta life insurance companies, as well as occupational health services to industry.

Betty sold her company after twenty-five years and then engaged actively in politics, with a strong focus on Senate reform.

Interview with Alex Schadenberg was banned by Youtube.

Alex Schadenberg

By Alex Schadenberg

Executive Director and International Chair

Euthanasia Prevention Coalition

On Thursday, February 18, 2016; I was interviewed by Vicki Travis of Tropic Wave Radio. This was my first interview with Vicki Travis.

The audio of the interview is online here: (Link).

Within two hours of posting the interview on YouTube, the interview was banned by YouTube.

Consider donating to the Euthanasia Prevention Coalition (Link).

The message from YouTube stated:

Hi TWR RADIO,

The YouTube community flagged one or more of your videos as inappropriate. After reviewing the content, we’ve determined that the videos violate our Community Guidelines. As a result, we removed the following videos from YouTube:

Schadenberg 1 VickieTravis

Please note that this removal has not resulted in a strike.

- The YouTube Team

Therefore YouTube claims that the interview violates their Community Guidelines (Link). 

After listening to the interview, I cannot understand how the interview violated the Community Guidelines. 

Is the assisted suicide lobby trying to silence opposition?

Watch Alex Schadenberg on February 4, present to the Southern Alberta Council of Public Affairs (Link).

Further information on assisted suicide in the USA:

• Oregon 2015 assisted suicide report - another 26% increase in assisted suicide deaths.
• Washington State (2014) assisted suicide report: no information on 27 deaths.
• California's Assisted Suicide Law: Whose Choice Will it Be?

Diane Coleman: Opposing New York's assisted suicide bill.

This article represents one side of the debate between Diane Coleman, the founder of the disability rights group, Not Dead Yet and Dr Timothy Quill, a long-time supporter of assisted suicide that was published in the Democrat and Chronicle on February 18, 2016.

Diane Coleman: Opposing the aid in dying bill

“I think there is a very strong alliance of different segments of society that are really concerned about the danger of legalizing assisted suicide from the culture we have today,” Coleman said. “Policy makers have to really consider not only the idealized case that proponents put forward on assisted suicide but the real danger that affects so many elderly, ill and disabled people in this society and be sure that the protection that current law offers are still in place to benefit everyone.”

What are the main concerns of people who are opposed to aid-in-dying legislation?

I don’t think I speak for all (opponents), but the disability community's core message is that if assisted suicide is legal, some people’s lives will be lost due to mistakes, coercion and abuse, and that’s an outcome that can never be undone. 

There’s inherent discrimination in assisted-suicide laws. Most suicidal people receive suicide prevention. Assisted suicide laws would carve out an exception to that, and that exception would apply to people who are elderly, ill, disabled, and those are devalued groups in society. ... Assisted-suicide laws would say, 'these certain people, we’ll not only agree with their suicide but give them the means to carry it out.' We’re saying it comes down to social justice. Equal rights means equal suicide prevention.

Isn’t this a matter of the individual’s right to choose?

We agree that people have the right to refuse life-sustaining treatment. We do think it’s important that that be based on informed consent, that there be protections against health care providers that overrule people who want treatment. We’re also concerned about (a health care proxy) decision being based on the choice of what the person would want if the person were able to speak for themselves. 

You should have the choice to get all the pain relief that you need in order to not have any physical pain. You should have the choice to get all the home care you need so you don’t have to feel like a burden on your family or friends. 

People do have the choice to commit suicide because suicide and assisted suicide are not exactly the same. It’s the discrimination that’s inherent in assisted suicide that is our concern. But assisted suicide needs to remain illegal because of all the dangers the public policy of assisted-suicide creates of mistake, coercion and abuse. We think everyone deserves suicide prevention no matter how old, no matter how ill, no matter how disabled.

What’s the difference between stopping or never starting treatment and asking for help in dying?

With withholding and withdrawal of treatment, you still have to die from an actual condition that is currently diagnosed. With assisted suicide, the person will die whether it’s an accurate prognosis or not. 

I can see why it seems similar, but the intent of the health care system cooperating in your refusal of treatment, the system still is trying to provide palliative care, to make you comfortable to do the best they can within that parameter. When it’s facilitating your suicide, that’s an intent to kill.

Can you see any benefit to terminally ill people who believe they are ready to die being able to ask their doctor for help?

The way the law is written, it’s based on an idealized view that everybody has a good doctor who understands palliative care and that everybody has a loving family and that neither the health care system nor family would ever steer the person in the direction of assisted-suicide. But that’s not reality. There are cost-cutting pressures that prevent them from getting the health care they need. One in 10 elders experience abuse. So the risks of mistake, coercion and abuse when assisted suicide is legal are simply too great.

What about the issue of severe pain?

Nobody should be in pain, we agree with that. Palliative care can take care of all pain. 

It’s really not about physical pain. If you look at Oregon reports, about reasons people want to commit suicide, the reasons are things like feeling like the person has lost their autonomy, they’ve lost their dignity, they can’t do the things they used to do. They feel like a burden on their families. Those are psycho-social reasons that relate to the disability that people have when they have an advanced stage or chronic condition.

You’re saying assisted suicide. Proponents use aid in dying. Are they the same terms?

Assisted suicide includes physician assisted or other. Physician-assisted suicide is the term in the bioethics arena and it’s in the literature. Aid in dying is the public relations term to make it sound more palatable and make it easy to conflate with palliative care and other support given to terminally ill people. 

Our society has a feeling about suicide and most important a commitment to suicide prevention as a concept. Yes, people commit suicide but if someone comes forward and says I want to commit suicide, then as a society we respond by saying, ‘How can we help you? We want to support you.’

Go to the Not Dead Yet website for more information about their opposition to assisted suicide.

Liberal Members of Parliament may be ordered to vote for euthanasia bill.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

The Liberal Party has ordered Liberal Members of Parliament to support their upcoming euthanasia bill, even though many of them may object to the language of the bill.

The Euthanasia Prevention Coalition (EPC), which was not given the opportunity to present to the parliamentary committee, recognizes that the Supreme Court of Canada struck down the assisted suicide law, but the design and language of the future law will determine who qualifies for and how likely it is that the law will be misused.

In all jurisdictions where euthanasia and assisted suicide are legal, the system requires two doctors to  approve the death, and then the doctor who assists the death, must send in a report, after the person has died without before-the-death third-party oversight. An after-the-death reporting system allows doctors to self police and self report leading to misuse of the law, under-reporting, and falsified reports.

One of the issues that is being debated is whether euthanasia should be permitted for psychiatric reasons. Canada's euthanasia lobby is pushing for euthanasia for people who cannot consent. Ambiguous definitions could enable a person who requires treatment for depression to die an assisted death.

Last week the Globe and Mail reported that Liberal House Leader Dominic LeBlanc confirmed that the Liberal vote will be whipped to support the euthanasia bill. The Liberals have a majority government in the House of Commons. LeBlanc justified this decision by defining assisted dying as a "Charter of Rights" issue.

As much as LeBlanc, and the Liberal leadership have defined euthanasia as a Charter issue, it simply is not. The Supreme Court struck down Canada's assisted suicide act, but it did not declare that there is a "right to die."

Hon John McKay

Long term Liberal MP John McKay told the Globe and Mail:

“It’s not core to the government’s mandate; it’s a response to the Supreme Court,” he said. “I don’t see this as a Charter issue.”

Robyn Urback, from the National Post challenged the Liberals to be honest with why they are whipping the vote. Urback wrote:

"In claiming the issue is about the charter, rather than how the government meets the requirements of the court, LeBlanc is being both misleading and dishonest... In using the charter as a cape to deflect queries and justify dictating the vote to parliamentarians, no matter what their consciences may tell them, Trudeau is treating Parliament as a rubber stamp for the leadership."

After publishing this article, the Globe and Mail published a new article stating that the Liberals may not order Liberal MP's to support the euthanasia bill. The new article quoted Liberal House leader, Dominic LeBlanc, as stating:

“We decided to delay the decision about whether or not it’s a whipped vote. It’s premature to come to a final conclusion like that,” 

“We’re going to discuss the bill and the committee report in our caucus, and we will make the decision as to how the bill will be handled once the bill is introduced in the House.”

EPC recognizes that by whipping the vote, the Liberals will also control the consideration of amendments to the bill. The Liberal decision to snub democracy will likely impose on Canada an irresponsible and dangerous euthanasia law.

The Conservative and NDP Members of Parliament have been given a free-vote in parliament.

Senator Denise Batters opposes euthanasia for psychiatric reasons

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Senator Denise Batters

Canadian Senator Denise Batters, who became a widow after her husband David Batters, a former Member of Parliament, died by suicide. Batters, who is a mental health advocate, is speaking out about her opposition to euthanasia for psychological suffering.

Senator Batters, who was interviewed by Kristy Kirkup for the Canadian Press, opposes euthanasia for psychological suffering based on her personal experience with suicide and as a mental health advocate. The Canadian Press reported:

Batters said she unfortunately has insight into how a suicidal mind works because her husband took his own life in 2009 after a battle with severe anxiety and depression. 

"I have seen ... the devastating impact, not only for the individual that goes through that pain themselves ... but at the same time ... I've seen the devastating consequences that it can have on the immediate family members,"

Batters recognizes the reality that assisted death has been imposed by the Supreme Court of Canada, but she also recognizes that Canadians want a tightly worded law.

"Canadians may support assisted suicide, but they want extremely strong safeguards and I think that when I talk to people about the possibility of psychological suffering being included as ... sole grounds for having access to physician-assisted suicide, they are horrified and stunned that could be a possibility," 

"Unfortunately, my situation with my husband, did not have a good ending ... however, that doesn't mean there aren't many, many thousands of people in this country who have lived through a period of severe anxiety and depression and come out the other side."

Senator Batters also opposes the Liberal governments imposing a party line vote on Liberal MP's on this issue.

"I urge the Liberal caucus to think twice about that and give their members of Parliament the opportunity to vote with their conscience,"

Senator Batter is a lawyer who worked as the chief of staff for Saskatchwan's Minister of Justice (2007 - 2012) became a mental health advocate to help others.

"It really helps me to know that I might be helping somebody by something I'm saying and if I can prevent somebody else from being in the situation I'm in, basically an unwilling family survivor of suicide,"

Euthanasia for psychiatric reasons, including depression, is being debated in Canada. A recent study determined that euthanasia for psychiatric reasons, in the Netherlands, is not being tightly controlled.

Study uncovers problems with euthanasia for psychiatric reasons in the Netherlands.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The journal JAMA Psychiatry recently published a study on February 10, 2016 examining euthanasia for psychiatric reasons in the Netherlands by researchers Scott Y. H. Kim, MD, PhD; Raymond G. De Vries, PhD; John R. Peteet, MD.

The study examined 66 cases of euthanasia for psychiatric reasons between 2011 and 2014. The data for this study was provided by the Netherlands Regional Review Committee.

It should be noted that the euthanasia reports are submitted by the doctor who causes the death, after the person dies by lethal injection. Therefore the data, as bad as it may appear, may not uncover all of the problems since doctors are self-reporting the euthanasia deaths, a system that enables physicians to hide information that may be controversial.

The Netherlands 2014 euthanasia report stated that there were 41 euthanasia deaths for psychiatric reasons and 81 people with dementia died by euthanasia.

The CTV news report by Marlene Leung and Michael Shulman, indicated that the study uncovered some controversial data. According to the report, of the 66 people who died by euthanasia:

70 per cent were women;
52 per cent had attempted suicide;
80 per cent had been hospitalized for psychiatric reasons;

Further to that, CTV news indicated that there were several controversial cases:

However, in one EAS case, a woman in her 70s without health problems had decided, with her husband, that they would not live without each other. After her husband died, she lived a life described as a "living hell" that was "meaningless." 

A consultant reported that this woman "did not feel depressed at all. She ate, drank and slept well. She followed the news and undertook activities." 

The review found that 21 patients had been refused EAS at some point, but in three cases the physicians later changed their mind and performed EAS. The remaining 18 patients had physicians who were new to them perform EAS. 

In 41 per cent of the cases the physician performing EAS was a psychiatrist, but in the rest of the cases it was usually a general practitioner, the review found. 

Consultation with other doctors were "extensive, but in 11 per cent of the cases, there was no independent psychiatric input. In 24 per cent of the cases, there were disagreements among the physicians.

Dr. Scott Kim

Dr Kim expressed several concerns. According to CTV news Kim stated:

while the assessment of most terminal illnesses does not involve a lot of "physician discretion," and doctors can be "fairly sure" what the eventual outcome for the patient will be, psychiatric conditions are less clear. 

"Physicians must make tricky clinical determinations … without the help of a robust evidence base," 

"There is no evidence base to operationalize 'unbearable suffering,' there are no prospective studies of decision-making capacity in persons seeking EAS for psychiatric reasons, and the prognosis of patients labeled as 'treatment-resistant depression' varies considerably, depending on the population and the kind of treatments they receive."

Tara Brousseau-Snider

Canada is currently debating euthanasia for psychiatric reasons. Tara Brousseau-Snider, executive direct of the Mood Disorders Association of Manitoba, said she is concerned about the potential of Canada offering doctor-assisted suicide to those with mental illness.

According to CTV news, she said a woman with severe depression came into the Winnipeg centre just months ago and told a counsellor that she wanted to end her life.

"I find this is very alarming, very worrisome because people, through different avenues, find a different way of life and nobody needs to sit with depression and be miserable all through their lives. There are options; there are supports available," said Brousseau-Snider.

The Canadian government should heed the results of this study and ensure that if euthanasia becomes legal, that it is not permitted for psychiatric reasons.