Protecting patients in the shadows of euthanasia.

This article was published on the Cardus website on October 12, 2016.

Dr Margaret Cottle.

Co-authored by Dr Margaret Cottle & Faye Sonier.

Bill C-14, which sets out the legal framework for decriminalized euthanasia, satisfies no one. Some feel it is too restrictive. Others of us continue to have serious concerns about its implications.

We will all be vulnerable at some time in our lives and this legislation does not and cannot protect us. Even Justice Lynn Smith, the original Carter trial judge, foresaw the inevitability of wrongful deaths when the healthcare system provides state-sanctioned euthanasia. She suggested strong safeguards that should be “scrupulously enforced.” This bill does little toward establishing concrete guidelines, and life-ending decisions will be made for some patients against their explicit wishes as a result.

Here are some measures that may help to provide somewhat better protection for vulnerable patients.

First, proper care for patients with serious conditions is a basic human right and sufficient funding is essential. Currently, 70% of Canadians do not have access to adequate palliative care. This is a dismal failure for our healthcare system and an unacceptable tragedy. Canadians deserve better care — focused, excellent care that provides all the necessary supports to live life to the full, instead of a cold analysis that the person’s life is “not worth living” and a state-sanctioned system to deliver death instead of support.

Faye Sonier

Next, we must protect the conscience rights of physicians and other healthcare professionals. Thousands of citizens, who pay into our healthcare systems, want nothing to do with any form of hastened death. They have the right to be treated by professionals and in facilities where caring never includes killing. Real patient choice, “patient-centered care” and cultural diversity should mandate that our system accommodates many different demographic groups, including completely euthanasia-free healthcare facilities for those who need such settings to feel and to be safe. The assertion that it is “cruel” to move a patient to a different ward within a hospital or an outside facility that has special expertise in providing euthanasia or assisted suicide is a complete red herring. Patients who are extremely sick are moved all the time without major discomfort — within the hospital, from hospital to home or hospice, or from one hospital to another for specialized imaging or daily radiotherapy treatments. How ludicrous that there is an outcry against moving someone in a scheduled, safe way to a site with expertise in the procedure and yet no similar indignation when patients who are in far worse condition languish in the hallways of emergency departments for days.

The provincial governments and physician regulatory bodies must take a strong stance in support of physician conscience rights. Unfortunately, the College of Physicians and Surgeons of Ontario released two anti-conscience rights policies which violate physician conscience rights. The policies are currently being challenged in court, and the Ontario government has intervened in support of the College. These policies are not only Draconian, but unnecessary. Patients should be able to self-refer to specialized agencies for any of these controversial procedures. Eliminating the requirement for a physician referral provides greater patient autonomy and privacy and streamlines the process. This agency could provide a team of expert assessors who would screen patients with a wish for euthanasia or assisted suicide, to offer help for any untreated symptoms and who would address deficits in the social determinants of health such as inadequate support or loneliness. This system would be better for patients and obviate the need for any physician with conscientious objections to participate.

In addition, we must ensure robust data collection and oversight of euthanasia and assisted suicide reporting procedures. In the jurisdictions that have decriminalized these procedures, including Canada, not a single country has instituted an independent body to oversee those performing the acts. The physicians who write the prescription for assisted suicide drugs or administer the euthanasia drugs themselves are the ones who fill out the death certificates.

Studies have shown that means other than proper euthanasia protocols are used when doctors cannot be bothered to fill out the paperwork. In Belgium, where the legal framework is strikingly similar to Canada’s, studies have documented that up to 32% of all euthanasia procedures have been performed without the patient’s express consent. Another study found that around 47% of euthanasia deaths in a given year went unreported. In Quebec, which passed a voluntary euthanasia law in December 2015, physicians who perform euthanasia cannot record “medical assistance to die” as the cause of death on the death certificate, but must list instead the name of the condition affecting the patient that led the patient to request euthanasia.

Those in favour of these procedures continue to assure Canadians that these measures will only be for “hard cases,” and the public has believed this. However, there are already very credible reports of cases that fall well outside the legislation’s mandate that should cause concern and trigger more careful surveillance. We owe it to ourselves to keep careful, detailed records about the type of patients who are having their deaths hastened and for what reasons. Our strong support of suicide prevention must extend to this vulnerable population as well.

Wrongful and unnecessary deaths will occur. We can and should institute these basic measures to try to limit the damage, to begin to protect patients and to preserve real choice.

Margaret Cottle, MD, CCFP (Palliative Care) is a palliative care physician in Vancouver, BC, a Clinical Assistant Professor at the University of BC and the former VP of the Euthanasia Prevention Coalition. Faye Sonier is Canadian Physicians for Life’s Executive Director and General Legal Counsel.