Thursday, December 13, 2018

Canadian euthanasia reports offer useful information but little direction.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


The Council of Canadian Academies recently published three reports concerning the possible expansion of euthanasia in Canada. Those reports concerned child euthanasia, euthanasia for incompetent people who made an advanced request and euthanasia for psychiatric reasons alone.

Last night I published the following three articles on the report.

  1. Canadian report offers no clear direction on child euthanasia.
  2. Canadian report suggests that more research is needed on euthanasia for incompetent people.
  3. Canadian report is negative to the concept of euthanasia for psychiatric reasons alone.
Today, Andre Picard, the strongly pro-euthanasia writer for the Globe and Mail published an article titled: Expert panel on assisted dying has left us with many questions, but no solutions. Picard states:
The experts spent 18 months studying three issues related to assisted death: whether mature minors should have the same right to end their life as adults; how to handle advance requests for medical assistance in dying (MAiD), particularly from people with dementia; and how to legislate MAiD for people suffering from mental illness. 
Now we have the result: 798 pages of thoughtful and mercilessly detailed analysis of these legal and ethical quandaries, but no solutions.
Picard responds by stating that Canada needs to expand the scope of its euthanasia law. He wrote:
Today, two-and-half-years after the medical assistance in dying law took effect, a fundamental problem remains: Certain people, because of their age, their underlying condition and the uncertainty about how their illness will evolve, are being denied a right to choose assisted death.
Unlike Picard, I found the report as providing ample evidence against expanding euthanasia, in fact the report provides ample evidence as to why euthanasia cannot be controlled.


The report provided no directions concerning child euthanasia but it expressed an understanding that children experience a different level of vulnerability than adults.
The concept of child euthanasia is unpopular in Canada. Previous polls indicate that Canadians oppose child euthanasia and the recent response to the Hospital for Sick Children (Toronto) proposed child euthanasia policy shows how uncomfortable Canadians are with killing children.
The report suggests that more research was needed concerning the issue of euthanasia for incompetent people who made an "advanced request" for euthanasia injection. The report also stated that:
However, removing a requirement for express consent immediately prior to the MAID procedure raises the possibility that a person might receive MAID against their wishes.
Canada’s euthanasia lobby is pushing hard to extend euthanasia based on advanced requests. The Audrey Parker campaign was designed to pressure the government to approve advanced request.
The report is negative to the concept of euthanasia for psychiatric reasons alone. This report exhibits proof that a real divide existed among the working group examining this issue. The report stated:
A particular challenge for some people who request MAID MD-SUMC is that their desire to die could be a symptom of their mental disorder. Suicidal ideation is a common symptom of some mental disorders, and some mental disorders can distort a person’s thoughts and emotions, leading to a desire to die, hopelessness, and a negative view of the future, even when a person retains decision-making capacity. It may be difficult for a clinician to distinguish between a capable person who is making an autonomous decision for MAID and a person whose pathological desire to die is a symptom of their mental disorder that impairs their decision-making. 
Having a mental disorder is one of the most strongly associated risk factors for suicide. Systematic reviews and meta-analyses have found that up to 90% of those who die by suicide may have had a diagnosable psychiatric disorder (as determined by a retrospective psychological autopsy). Furthermore, there is some evidence that some people who have sought psychiatric euthanasia and assisted suicide (psychiatric EAS) in jurisdictions that permit it share certain characteristics with people who attempt suicide.
The committee also recognized that extending euthanasia for psychiatric reasons alone would cause Canada to have the most permissive euthanasia law in the world. They stated:
MAID law in Canada explicitly defines intolerable suffering in subjective terms. While a healthcare practitioner must “be of the opinion that” these conditions are met, if a patient truly believes their suffering is intolerable, and believes that existing means to relieve their suffering are not acceptable to them, they thereby meet the criteria for intolerable suffering set out in the legislation. No other country permits MAID MD-SUMC where one of the eligibility criteria is based on an individual’s personal assessment of what conditions for relief of their intolerable suffering they consider acceptable. If Canada were to expand MAID MD-SUMC using this criterion, it could become the most permissive jurisdiction in the world with respect to how relief of suffering is evaluated.
The Euthanasia Prevention Coalition was concerned with the composition of the committee members since each committee had a majority with a pro-euthanasia bias. Nonetheless, since the report was not based on a consensus model, those who oppose euthanasia or simply oppose the expansion of euthanasia, were given an opportunity to express themselves.

Unlike Picard I am thankful that the report only provided information without a clear direction. Some of this information is helpful for opposing the legalization of euthanasia in other jurisdictions.

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