Thursday, May 23, 2019

Québec palliative care physicians continue to resist euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Montreal Gazette published a pro-euthanasia article by health reporter Aaron Derfel arguing that palliative care physicians continue to resist euthanasia in Québec.

Based on data from the recent Québec euthanasia report, Derfel reports that the rate of euthanasia varies based on where the patient is located. Derfel states:

In Montreal, the number of cases of physician-assisted dying is seven times higher in the east end than on the West Island, suggesting possible resistance by some doctors who are opposed to the practice for ideological or religious reasons.
Derfel reports Dr. Georges L’Espérance, president of the Association québécoise pour le droit de mourir dans la dignité, as blaming mostly palliative-care specialists for the opposition to euthanasia. L’Espérance reportedly said:
“Certain palliative-care specialists do perform assisted dying, especially in the regions, as well as some in Montreal. However, a majority — especially at the MUHC, McGill and CHUM — are rather opposed to assisted dying.”

Dr. Balfour Mount is credited with pioneering palliative care in North America, founding a unit in 1973 at the former Royal Victoria Hospital (now part of the MUHC) that was dedicated to easing the pain and suffering of the terminally ill. Today, some palliative-care specialists argue that administering a lethal infusion at the patient’s request is against their medical ethics.
L’Espérance, who is a promoter of euthanasia, considers euthanasia to be part of a continuum that starts with palliative care.

Derfel completes the article by quoting Dr Michel Bureau, the Chair of the Québec euthanasia commission, stating that the number of euthanasia deaths continue to rise and the resistance will fade.

Derfel's pro-euthanasia article negates the truth that where patients receive good pain and symptom management, they don't seek death by lethal injection. Derfel also negates the fact that, according to the aims of palliative care, it focuses on caring for people not killing people.

Petition supporting Bill C-418 to protect conscience rights for medical professionals.

Link to sign the English language petition. 
Link to sign the French language petition.

Petition to the Government of Canada

  • The fundamental freedoms of conscience and religion are guaranteed to all Canadians in the Charter of Rights and Freedoms;
  • Bill C-14 (Medical Assistance in Dying) prohibits the compelling of health care providers or institutions to provide medical assistance in dying, to refer or transfer a patient to another health care provider, or to take other actions which could impact on health care providers’ freedom of conscience or religion;
  • Bill C-14 lacks clarity for effective enforcement;
  • Bill C-418 aims to protect the fundamental freedom of conscience guaranteed to all Canadians; and
  • Bill C-418 makes it an offence to intimidate a health care professional for the purpose of compelling them to take part, directly or indirectly, in the provision of euthanasia and assisted suicide. Bill C-418 also makes it an offence to dismiss from employment or to refuse to employ a health care professional for the reason only that they refuse to take part, directly or indirectly, in the provision of medical assistance in dying.

We, the undersigned, residents of Canada, call upon the Government of Canada to ensure that the conscience rights of medical personnel are protected, by passing Bill C-418.

Link to sign the English language petition.

Wednesday, May 22, 2019

Euthanasia by Organ Donation - Doctors debate the dead donor rule.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Several weeks ago I wrote about the experience Dr Wes Ely has had while attending conferences on organ donation. Ely explains that the topic of euthanasia by organ donation was regularly being discussed at organ donation conferences. Ely, who opposes euthanasia, stated:
At each meeting, the conversation unexpectedly shifted to an emerging question of “death by donation” — in other words, ending a people’s lives with their informed consent by taking them to the operating room and, under general anesthesia, opening their chest and abdomen surgically while they are still alive to remove vital organs for transplantation into other people. 
The big deal here is that death by donation would bypass the long-honored dead donor rule, which forbids removal of vital organs until the donor is declared dead. Death by donation would, at present, be considered homicide to end a life by taking organs.
Sharon Kirkey published an article in the National Post (today) concerning the debate that has grown concerning euthanasia by organ donation. Kirkey explains:
Under this scenario, people granted an assisted death would, with their full knowledge and consent, be transported to an operating room, put to sleep under general anaesthesia and their organs removed, including the heart and lungs. Death would follow removal of the beating heart. Under so-called “euthanasia by organ donation,” the act of organ donation itself — not a lethal injection or a doctor-prescribed, life-ending dose of barbiturates — would be the mode of death.
According to Kirkey organ donation after euthanasia has already occurred at least 30 times in Canada, since euthanasia was legalized.

Kirkey points out that the dead donor rule prevents euthanasia by organ donation. 

An article published in the New England Journal of Medicine (NEJM) last September argues that eliminating the dead donor rule provides "benefits" by providing healthier organs for donation. Ian Ball, the lead author of the article explains the scenario:
The dead donor rule isn’t a law, but more an “ethical convention,” said Ball. It’s being questioned more, especially in the advent of assisted dying. “Prior to MAID it was absolutely unacceptable for physicians to intentionally and directly cause the death of a patient,” he said. 
“The extreme perspective — and I’m not taking this, I’m not advocating for this and it’s certainly against current MAID legislation, but some people do — is that, in the case of MAID, why wouldn’t you go to the operating room, get a general anaesthetic and why couldn’t they retrieve your beating heart? Because that would provide your heart in the best possible condition to a recipient.”
It's important to point out that Robert Troug, a long-time proponent of euthanasia by organ donation was also involved with the publishing of the article in the NEJM.

Kirkey finishes the article by asking Jennifer Chandler who works with Organ and Tissue donation at the University of Ottawa. Chandler suggests that many people would be uncomfortable with the idea of euthanasia by organ donation and it would lead to a grave risk to public trust.

Dr Ely stated in his article published in USA today that:
When physicians are participating in a procedure designed to take a person’s life, will patients feel 100% certain that their physician is firmly on the side of healing? What message does it send about the value of every human life when physicians endorse the exchange of one life for another? What affect has it already had on physicians complicit in such death-causing procedures?
The problem begins when society permits doctors, or others, to kill people. If euthanasia by organ donation becomes an accepted way to kill, then sadly, euthanasia will be promoted as a benefit to society creating another pressure to die.

Dr Kate Baddock: 'euthanasia goes against the ethics of our profession.'

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Kate Braddock
r Kate Baddock, the chair of the New Zealand Medical Association told TVNZ news that euthanasia goes against the ethics of their profession. According to TVNZ1's Breakfast Baddock stated:
under the new bill doctors would still be the ones administering the injection... 
"Doctors are still the ones that would be involved in assisting people to die. It goes against what a doctors role is,"
Baddock then told TVNZ that euthanasia does not address the social needs of patients:
"Particulary those of coersion, competence and vulnerability. It doesn't protect the vulnerable, the weak, the lonely, those in pain and those that are suffering. It doesn't protect them from a wrongful death."

She says elder abuse is happening and this Bill only encourages it.
Dr Baddock then stated that many people die by euthanasia in the Netherlands based on feelings of obligation:
"Apparently approximately 50 per cent of those who choose euthanasia in the Netherlands do so because they feel obligated to die. They feel their continued existence is a burden either financial or emotional to their families and to society at large. They choose euthanasia even though they don't want to die,"
The New Zealand Medical Association has remained steadfast in its opposition to lethally injecting their patients. The New Zealand legislators should listen to their doctors.

Psychiatrists—we prevent suicide, not provide it!

Text from the debate between Dr Mark Komrad, Faculty of Psychiatry Johns Hopkins and the University of Maryland and Dr David Pollack, Department of Psychiatry, Oregon Health and Sciences University sponsored by the American Psychiatric Association (APA). Dr Komrad believes that doctors should care for their patients and never kill.

Mark Komrad
The 2300-year-old history of medical ethics is grounded in a covenant-based set of values that our profession “professes.” The Hippocratic Oath originally captured those covenantal values. It says: “I will give no one a poison, nor counsel any others to do so.” This is the root of the mighty tree from which the House of Medicine was built—forbidding killing—persisting as societies and their demands have come and gone. Hippocratic ethics have not been relegated to the trashbin of history. On the contrary, to this day, the WMA, the AMA, the APA, and many major medical organizations worldwide continue this ethical stance, without any Orwellian redefinitions of the word “suicide” which defy common sense.

The profound changes to a civilized society produced by even limited suicide-on-demand, are unnecessary and undesirable. Suffering and dying should have more access to the latest, state-of-the art palliative care, without being economically or morally short-circuited by institutional killing, promoted as a seductive virtue — referring to it as “dying with dignity.” It is unjust and impossible, in a democratic society, to permit suicide for some — like the terminally ill — but refuse it to others — like those with chronic physical and psychiatric disabilities. The signal that there are “lives not worth living,” is a dangerous one. Autonomy is precious, but shouldn’t crush other values that are necessary for the common good. Medicalizing suicide out-sources to physicians the moral responsibility for transgressing a taboo about taking one’s own life, reducing the moral deterrence to suicide, lowering the threshold of acceptability for all suicide. These practices overturn our Covenant to be providers of hope and healing, preventers of suicide. After two millennia of getting out of death’s way, providing palliative comforts— we now become providers of death? No.

Opening Statement

Thank you to Drs. Winchell and Bernanke and the APA for inviting me to participate in this critical debate in which we are considering profound changes to the ethical momentum, established over 2 millennia, regarding what it means to be a physician, especially a psychiatrist. Changing that venerable ethos is neither good medical ethics, nor desirable public policy.

This afternoon, please expect me to use language that reveals the nature of these activities, employing the ordinary use of English words. Suicide, for example, is defined by the CDC and well understood by psychiatrists as— “death caused by self directed behavior with an intent to die.” Also, “Killing,” defined by Websters as “actively terminating the life of a living creature.” Orwell described the consequences of hijacking ordinary language: 

“if thought can corrupt language, language can corrupt thought.”
Rather than using this opening statement to make arguments from principle, I want to share information with you about facts-on-the-ground, data from the living laboratories where assisted suicide and medical euthanasia have actually been deployed. Let’s see what happens when physicians are legally permitted to have a chemical gun with which to shoot eligible patients on demand, or give to patients to shoot themselves.

Let’s start with Oregon, the first to legalize assisted suicide for the terminally Ill in 1998. Several U.S. states have modeled their laws on Oregon’s With the exception of Hawaii, no state mandates any formal mental health evaluation or treatment to become eligible. In legalized states, though evaluators can refer if they suspect psychiatric problems, they are mostly non-psychiatrists, and we know the extensive research on the low pickup rate of mental disorders by non-psychiatrists. [ In Hawaii, the mandated psychological evaluation can be done by any mental health professional, not just psychiatrists]. Patients have to be competent. However, capacity assessment is a special skill set, not even possessed by all psychiatrists, yet no special training in those skills is required by evaluators. Second opinions are required, but they can be by any physician, and there are no criteria for independence—even a doc in the same practice is OK. No palliative care evaluation or treatment is required. Potential heirs to the soon-to-be deceased can be witnesses to signing consent forms. Although, coercion is forbidden, there is no statutory definition of coercion, and no way to distinguish the subtle differences between supportive encouragement and coercion. Nor are any witnesses required to ensure there isn’t coercion when the lethal pills are taken,. There is no required minimal length of a doctor-patient relationship for the evaluation. In the 2018 report of activities in Oregon, one new encounter was as brief as 4 days. Nothing in the law prevents a patient from converting a well maintained chronic illness into a terminal illness; for example, a diabetic deciding to stop insulin. Also, once the lethal meds are dispensed, there is no tracking what happens to them. They could be stored indefinitely in a shoebox, unless a suicidal relative finds them first! In Oregon, one batch of meds sat for over 800 days before being used.

This slide shows the growth of the practice in Oregon since 1998. Note about 1/3 of the scripts aren’t used. Nobody knows what happened to them! Most of the time, physicians are not present to prevent complications; and they do occur: 6 failed to die, 1 took 4 days to die. Worldwide experience, demonstrates that there is an inevitable evolution of these laws, so too in Oregon. What began as assisted suicide for the terminally ill, is now expanding via 2 current bills: one, to permit IV methods, taking a step towards euthanasia, and the other to be more like the Canadian euthanasia law: rather than terminal illness, “death at some point in the future.”

In 2002 the Netherlands and Belgium passed laws permitting euthanasia, untethering it from terminal illness . Eligible there is any condition that a patient finds“unbearable” and is considered “untreatable” (which is partially defined by what treatments a patient will accept). Also, respecting parity, any distinction was removed between physical and mental suffering. This paradigm allowed some with psychiatric disorders to have euthanasia, even those with dementia. Netherlands has had a growth in the number of psychiatric-only euthanasias, shown split here into those with dementia, and non-dementia. The latter have included a wide range of psychiatric diagnoses, mostly depression and borderline disorder. BTW, Scott Kim recently published that 28% of those euthanatized with personality disorders never had any psychotherapy.

In Belgium, you can see an exponential rise in psychiatric euthanasia, 22% between 2015 and 16. In a series of 100 psychiatric cases, you can see the wide range of diagnoses, again mostly depression and personality disorders, half of which were borderline; even some were psychotic but considered competent.

In Benelux the euthanasia is sometimes administered by the treating psychiatrist— the same one previously working to prevent the patient’s suicide, who then succumbs to providing it. Medical and psychiatric societies support it; even publish how-to manuals.

A “slippery slope” is not just theoretical, but demonstrated in the living laboratories of the U.S., Canada and Benelux These are actual developments! It always starts with the terminally ill but progresses to the non-terminal. Then the parity of mental suffering is embraced. Then, the laws have expanded to include children, and allow advance directives, including for dementia. Then, as we see in Canada—affirmed by a high court just last week—even conscientious objectors are legally mandated to discuss these options and refer. Then, our psychiatric patients are included, first the major mental illnesses, then conditions like personality disorders, alcoholism, and gender dysphoria. Then, prisoners with life sentences become eligible for euthanasia. Then proxy consent becomes possible for those who are not competent, and, legal constraints not withstanding, doctors start euthanizing incompetent end stage patients where family can’t be found. Finally, legislators push to de-medicalize the criteria as in the Netherlands, where now proposals are afoot to allow those who are simply “tired of living” or feel their life is “complete” to have access to euthanasia, possibly through self-administered, over the counter means. In Orwellian newspeak: “rational suicide.”

Colleagues, There are other ways to be compassionate and minister to our suffering and dying patients.

To this way, I personally believe we must stand up— as a profession. 

Caring not killing belongs in the House of Medicine. Let us sustain our core ethos, especially as psychiatrists—we prevent suicide, not provide it!

Tuesday, May 21, 2019

What’s Cruel for the Incarcerated is Cruel for the Terminally Ill: The Connection between Lethal Injection and Assisted Suicide

This article was originally published on May 21 by Consistent Life.

by Jacqueline H. Abernathy, Ph.D., MSSW

Jacqueline Abernathy
In a recent episode of HBO’s Last Week Tonight, comedian and host John Oliver offered a scathing (albeit profane) rebuke of lethal injection as a means of execution in U.S. states with capital punishment. He detailed the issues with the drugs employed and how ineffective they are at killing: essentially torturing the condemned with a prolonged death intended to make the process appear more palatable for everyone else. With each point he made, he always came back to his premise: the lethal means are irrelevant because capital punishment is simply wrong.

I agree completely.

But then he said something quite disturbing: He claimed that assisted suicide is somehow different because terminally ill people are easier to kill.

I’ll give you a moment to try to reconcile that with his larger point. That moment is over, because it doesn’t matter how much time you have. One simply cannot reconcile the two.

Lethal injection supplies the same class of drugs as assisted suicide does. It uses the same means toward the same end: premature and imposed death. How then is killing an ill person any different from killing anyone else?

Since he brought it up, let’s clear up the confusion about how assisted suicide works. He detailed how lethal injections are inhumane, but what distinguishes assisted suicide from traditional euthanasia is that traditional euthanasia is a lethal injection whereas assisted suicide is self-administered oral ingestion of these same drugs. Hence the drugs used in assisted suicide — which have included pentobarbital, the same one that has been used in lethal injection — are an okay option when self-administered by someone who’s dying; just not for those sentenced to death. Because it’s faster or more effective at killing, says Oliver. Only there is one big problem: it’s not.

Oliver mentioned assisted suicide only to demonstrate that it supposedly offers a more humane alternative to lethal injection, which he decried as barbaric and cruel. The show presented harrowing details about how the condemned may remain conscious during their executions since the drug responsible for inducing a coma can often fail. He explained how limited availability of certain lethal drugs can inspire the use of creative alternatives with horrific consequences. Finally, he lamented how long and torturous the process was, lasting not just a few minutes as intended but in one case, nearly two hours.

What Oliver apparently does not know is that every one of his points also apply to assisted suicide.

John Oliver
I can concede the logic that ill people are more fragile than healthy ones, but it doesn’t take a medical degree to know that intravenous delivery of any drug is more effective than oral intake.

Reports indicate that some people who choose assisted suicide vomit their bitter lethal dose before it can be absorbed, which is why anti-nausea drugs often accompany the barbiturate overdose. People do sometimes regain consciousness just like during an execution. Just as drug makers don’t want to be involved in executions, many of them have also inflated their prices to discourage use in assisted suicide. This practice leads many people to choose cheaper drugs with consequences akin to those experienced when the state looks for more readily-available drugs for lethal injections. In both cases, death takes far longer. And while I cringe that executions have taken up to 2 hours, assisted suicide can take up to 4 days.

Oliver mentioned assisted suicide only to make his point, while failing to recognize assisted suicide’s own inhumanity. He also mentioned alternatives to lethal injection like opioid overdose and the problems associated with that. His goal was not to defend any means of killing in executions, as he always circled back to his premise: there is no right way to do a wrong thing. So how then is assisted suicide not also a very wrong thing?

Oliver’s obliviousness is typical of the mental gymnastics required for justifying other forms of legal violence: that the violence he supports is not comparable to what he condemns. So let’s make it comparable. Would he withdraw his opposition to lethal injection if the death row inmates were as ill as those who choose assisted suicide?

The answer is clearly no. It doesn’t become okay to kill a person simply because they’re sick and therefore easier to kill. This suggests a double standard between ill people and inmates, when we actually have mechanisms to treat terminally ill inmates with dignity. This is called compassionate release, and exists at the federal level and in most U.S. states.

There’s hope that the horror stories Oliver highlighted will result in judges ruling that lethal injection is unconstitutional on the grounds that it is cruel and unusual punishment. But explain this: how is what deemed to be inhumane for convicted murderers somehow acceptable for the ill and dying? It clearly isn’t. Oliver was right when he said humane society doesn’t purposefully kill. Yet medical fragility is an exception? If anything, a humane society treats those more vulnerable with greater care rather than using their illness to justify their violent and unnatural end.

Oliver said it best when he concluded: “there is no perfect way for the government to kill people.” What he fails to mention is that there’s also no perfect way for people to kill themselves. I hope John Oliver will rethink his defense of violence toward the terminally ill and extend to them the same concern he has for human beings sentenced to die by execution. Assisted suicide is just as macabre as lethal injection, but less effective at killing. Just as in capital punishment, the means are irrelevant. Killing humans is wrong even if the human is terminally ill. Even if that human is yourself.

Monday, May 20, 2019

Vincent Lambert is saved from death by dehydration for now

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Sign the petition: Protect Vincent Lambert's Life (Link).

Vincent Lambert
The case of Vincent Lambert has become an emotional roller coaster as one court orders him to be dehydrated to death while another court orders food and water to continue.

Two weeks ago the United Nations Committee on the Rights of People with Disabilities intervened stating that causing Lambert's death by dehydration contravened his rights as a person with disabilities. Section 25f of the United Nations Convention on the Rights of Persons with Disabilities  requires nations to:
25(f) Prevent discriminatory denial of health care or health services or food and fluids on the basis of disability.
Euro news reported, on May 20, that doctors, at a hospital in Reims France, were deeply sedating Lambert as part of the process to withdraw fluids and food, causing him to die by dehydration, as approved by a court order.

Vincent Lambert with his mother
Later, that day, Euro news reported that the Court of Appeal in Paris ordered that Lambert be fed and hydrated. The decision was in response to the UN Disability Rights Commission appeal. BBC news reported Lambert's mother as stating:

"They are going to restore nutrition and give him drink. For once I am proud of the courts," she said.
The Lambert case has been winding through the French and European courts for several years.

Lambert was cognitively disabled from a motorcycle accident in 2008. In 2015, his wife petitioned the court to have treatment and care ceased including food and water. His parents wanted that their son transferred to a rehabilitation center. The legal battle concerning withdrawing water and food has continued.

Lambert is a disabled man who is not otherwise dying or nearing death. To directly and intentionally cause his death by withholding fluids is euthanasia by dehydration because he is not otherwise dying. His death would not be from his medical condition but rather, he would die by dehydration, a terrible death.

Sign the petition: Protect Vincent Lambert's Life (Link). 

Sunday, May 19, 2019

Belgian tug-of-war over euthanasia for mental illness and dementia

This article was published by Mercatornet on May 13, 2019

By Michael Cook:

Wim Distelmans
Belgium’s leading advocate for euthanasia liberalisation is campaigning vigorously for euthanasia for people with dementia. According to the current euthanasia law, patients are only eligible if they are fully aware and competent. This can lead to distressing situations and must change, says Professor Wim Distelmans.

Distelmans is chairman of Belgium’s chairman of the Federal Euthanasia Commission, the body which assesses whether euthanasia cases have been carried out legally. But he is also the chairman of LEIF (the Life End Information Forum), Belgium’s leading end-of-life lobby.

LEIF has organised an online petition which has been signed by scores of well-known academics, journalists and politicians as well as thousands of others. LEIF has also posted three heart-tugging videos of people with dementia putting the case for euthanasia.

Distelmans asks on the LEIF website:
“What are they waiting for to give priority to this basic human and patient right on the political agenda? After all, no one is obliged to euthanize or to implement it, not even in the proposed amendment to the law. But one can avoid a lot of situations that are considered 'degrading' by those involved by making the prior directive also applicable to those who suffer from dementia or other incapacity.”
However, at the same time and moving in the opposite direction, the Belgian medical association has implemented a far more restrictive policy on euthanasia for psychiatric patients. This is a very significant shift in policy. Some supporters of the country’s euthanasia law differ on the wisdom of making a liberal law even more liberal.

Belgium’s euthanasia law says that the treating doctor must seek advice from two other doctors, including at least one psychiatrist who is not the treating psychiatrist. But the new guidelines from the Orde van Artsen set down that the treating doctor should consult not just one but two independent psychiatrists who should meet face-to-face to discuss the case. This new standard is far more demanding. According to an April 29 directive:
the doctor considering euthanasia in psychiatric patients should go one step further and physically meet with the two psychiatrists. A physical meeting results in an interdisciplinary collaboration where every doctor explains his views as objectively as possible. The doctors should prepare a joint report and come to a joint decision, without being required to agree on everything. 
It is recommended that this physical consultation involves all healthcare providers who are in regular contact with the psychiatric patient. In addition to the nursing team, it is recommended that the psychologists and psychotherapists who help realize the care process are also involved in the consultation.
Theoretically, this implies that a doctor could be sanctioned by the Orde van Artsen over a euthanasia which was perfectly legal.

My feeling, for what it's worth, is that Belgium will keep relaxing its 2002 law until it becomes effectively euthanasia on demand. Doctors will end up becoming mere suicide enablers.

There may be one way to stop this juggernaut, or at least to slow it down. And that is to dismiss the chairman of the Federal Euthanasia Commission, Dr Wim Distelmans. This gentleman is not only the senior regulator of euthanasia in Belgium. He is also a media star as the chief spokesman for the right to die and one of the main practitioners of euthanasia (he also operates the euthanasia clinic). In other countries, this would be regarded as an egregious conflict of interest.

A new chairman who is not immersed in the world of Belgian euthanasia politics would be in a better position to identify abuses and refer doctors who fail to comply with the law to the public prosecutor.

Michael Cook is editor of MercatorNet

Key Messages: Palliative Care and Medical Assistance in Dying (MAiD) May 2019

The following was recently published by the Canadian Society of Palliative Care Physicians. 

The CSPCP supports conscience rights for physicians, they believe that (MAiD) euthanasia should not be the responsibility of individual physicians and they view (MAiD) euthanasia as separate from palliative care. The statement follows:

Key Messages: 
Palliative Care and Medical Assistance in Dying (MAiD) May 2019


In June 2016, the Federal Government enacted Bill C-14 legalizing assisted death under certain circumstances and adopted the term ‘Medical Assistance in Dying’. ‘Medical Assistance in Dying’ (MAiD) includes both euthanasia and assisted suicide, whereby under Canadian law eligible patients may have their lives intentionally ended through either the direct administration, typically injection (euthanasia), or self-ingestion (assisted suicide) of a lethal dose of drugs prescribed by a physician or nurse practitioner. The vast majority of MAiD procedures in Canada are provided through euthanasia. The term ‘Medical Assistance in Dying’ continues to cause confusion with respect to the role of palliative care. Palliative care provides medical assistance/aid in dying every day to patients and their families, to help them live as fully as possible until their natural death. The goal of this Key Messages document is to help clarify and define the role of palliative care within the Canadian context of legalized euthanasia and assisted suicide, these latter practices hereafter referred to as “MAiD”. 

Key Messages 
1. Patients with life threatening conditions have a right to high quality palliative care regardless of their end of life choices, including MAiD. 
2. Provision of MAiD is a practice distinct from palliative care. 
3. Palliative care strives to reduce suffering, not to intentionally end life. 
4. Requests for MAiD may be indications of suffering that could be ameliorated by high quality palliative care. No patient should choose MAiD because of lack of access to palliative care. 
5. The Canadian public must be able to continue to trust that the principles of palliative care remain focused on effective symptom management and psychological, social, and spiritual interventions to help people live as well as they can until their natural death. 
6. Physicians who do not wish to participate directly or indirectly in MAiD should have their integrity and fundamental freedoms, including freedom of conscience, protected. 
7. MAiD needs to be a healthcare system responsibility, rather than the responsibility of individual practitioners, with a separate and parallel system to provide awareness, information, counselling and linkages to the appropriate service(s) that can be directly accessed by patient, families, non-medical health care professionals and institutions without the requirement for a referral. (e.g. Alberta system). 
8. Given the nature and role of the physician-patient relationship, a mandatory non-patient initiated ‘duty to inform’ all those with serious illness about a right to access MAiD as an end of life option could exert undue pressure or cause subtle/overt coercion of patients. Clinicians should only be required to inform a patient that MAiD is a legal option in Canada if a patient makes an inquiry or request. 
Role of Palliative Care 

As a specialty, we see our contribution when patients with a life-threatening illness express a desire to die as the following: 
1. To explore the nature of a patient’s suffering and to address it through effective symptom management and psychological, social and spiritual support. 
2. To provide education and support to colleagues regarding the role of palliative care to help patients live as fully as possible until their natural death. 
3. To advocate for a high quality, accessible palliative approach to care with access to specialist palliative care services when needed for more complex cases. 
4. To prioritize and advocate for harm reduction, including: 
a. Potential harm to patients who choose MAiD because of inadequate support, including palliative care;  
b. Potential harm to any other person who may be negatively impacted, including those physicians that object to participating directly or indirectly in actions involving MAiD based on medical, moral or religious principles;  
c. Potential harm to the specialty of palliative care. 
The CSPCP strongly advocates for universal access to high quality palliative care to address the suffering experienced by patients with life-threatening illness and their families.

Friday, May 17, 2019

Canada euthanasia - The numbers game.

This article was published by Paul Schratz on his blog on May 17, 2019.

By Paul Schratz is editor of the BC Catholic

I’m indebted to Alex Schadenberg at Canada’s Euthanasia Prevention Coalition for this week’s column, since he not only did all the research but a fair chunk of the number crunching.

You may or may not know that it’s been frustratingly difficult to obtain information on euthanasia and assisted suicide since Canada legalized “medical assistance in dying” in June 2016. Trying to find out how many people are euthanized or “assisted” in dying is like trying to estimate how many traffic jams take place each day in Vancouver. It’s not at the top of anyone’s list of things to do.

News organizations have no interest in knowing how many Canadians are dying by assisted suicide. I wrote in March that the most recent data we had was from 2017 and it was still unclear how many people were legally killed in 2018.

So slow was the federal government in releasing data that the Euthanasia Prevention Coalition requested “Medical Aid in Dying” data from every province. Most of them refused to provide it.

So the EPC did its own investigative research. Based on a presentation for the Royal Society of Canada by Jocelyn Downie, an academic euthanasia activist, the EPC reported 4,235 “Medical Aid in Dying” euthanasia deaths in 2018, an increase of 50 per cent over 2017 and representing approximately 1.5 per cent of all deaths in Canada.

Schadenberg also examined data from Ontario and Alberta indicating a 78 per cent increase in Ontario euthanasia deaths and a 50 per cent increase in Alberta.

Finally, at the end of April, Health Canada released the Fourth Interim Report on Medical Assistance in Dying, which stated there were 2,614 assisted deaths in 2018.

Unfortunately, the data was short by two months (it only reported up to Oct. 31, 2018) and didn’t include four jurisdictions (Quebec and the three territories.) Based on that limited information, the report drew the conclusion that assisted deaths represented 1.12 per cent of all deaths in Canada.

Now it turns out Health Canada not only gave us inaccurate numbers, its analysis of them was wrong.

The Canadian data came under scrutiny by Richard Egan, a researcher with Australian Care Alliance, who said the report’s calculation of the percentage of deaths by euthanasia as 1.12 per cent was wrong and should have been quite a bit higher.

Egan explains: Health Canada used data for the total number of deaths in Canada, but only counted assisted suicide deaths in the jurisdictions it had data on … which excluded Quebec and the territories. An accurate percentage of deaths by euthanasia based only on reporting provinces is actually 1.47 per cent. That may not seem like much of a difference, but it’s a 30-per-cent error rate and represents hundreds of more dead people.

That figure also more closely matches the data reported by Jocelyn Downie, whose numbers put the euthanasia rate at 1.5 per cent.

Egan published further research on the data in an article published by Australian Care Alliance.

Among the provinces, euthanasia deaths as a percentage of all deaths varies widely, with British Columbia at 2.37 per cent of all deaths and as high as 3.6 per cent on Vancouver Island. That’s nearly three times as deadly as Saskatchewan (0.84 per cent of all deaths). But “Health Canada does not appear overly concerned about the quality of the Medical Aid in Dying report,” says Schadenberg.

And when some of its data is so wrong and outdated, how can we trust government to get its response – comprehensive palliative care – correct?

Thursday, May 16, 2019

Jacqui Dean: Why I oppose euthanasia.

I was reading through my google news and came across this article by Jacqui Dean, a Member of Parliament in New Zealand titled: Heartfelt Testimonies Strengthened My Resolve, published by the Otago Daily Times. 

This article effectively explains why Dean opposes euthanasia.
Jacqui Dean MP
MPs will again vote on David Seymour’s End of Life Choice Bill when it comes back before Parliament later this month. Waitaki MP Jacqui Dean outlines why she will vote against it.

I have decided to vote against the End of Life Choice Bill before Parliament.

I have lost family and friends over the years, I have listened to others, met those involved in palliative care and talked with those suffering a terminal illness.

In 2016, I sat on Parliament's Health Select Committee, which launched an inquiry in response to a petition calling for a law change to permit medically assisted dying in the event of terminal illness.

Over 20,000 submissions were made at that time, with analysis showing 77% were opposed to changing the law. While that inquiry won't influence this latest Bill, it did give me an insight into this sensitive issue.

I am opposed to euthanasia, with my resolve only strengthened after sitting on that committee and hearing the heartfelt testimony of hundreds of people who bravely faced death and the families who lost loved ones.

I heard some wonderful stories of love and tenderness, sad stories of heartbreak and loss, stories of great courage and inner strength, and through it all I had the utmost admiration for those who came before us to share their deepest fears and their greatest joys.

The Samoan grandmother who talked of the death of her father - a beautiful and moving family experience which she told us was gentle and loving and filled with prayer.

The woman whose husband was diagnosed with a brain tumour at 28, but who outlived three fatal prognoses and didn't actually pass away for fourteen years.

This woman pointed out that no-one can predict the final outcome of a terminal illness, and she and her daughter were grateful that they never gave up and that the family got to share those extra years together.

And the blind man who had fought against adversity all of his life and wanted to encourage people to live in hope and not give in to despair.

There were stories of courage and strength, which reflected the best of the human spirit.

Stories from those who made it their life's work to support the dying through palliative care, and submissions from groups motivated by strong beliefs around death and dying.

We also heard from those approaching the end of their lives.

This included a man, in his 40s who was dying of prostate cancer, who spoke with anger about his life being robbed. And others who said they feared death and wanted to take the pain away as quickly as possible when their time came.

There's no doubt decisions made at the end of life are emotionally charged, highly personal and reflect circumstances and timing that vary from individual to individual.

The care that people get at this time can make a fundamental difference to people's experiences.

For that reason, I support the power of good that hospice and palliative care services provide.

Dedicated and diligent guidance from these providers can assist terminally ill people to die peacefully and with dignity.

They believe that if people can come to a place where they can accept their end of life, it can have a huge impact on them and a lasting positive effect on their families.

I was deeply affected by the impassioned testimony the committee also heard from groups representing the disabled, elderly and the mentally ill.

Many of these people genuinely fear for the future if they become a physical or a financial burden on their families. They also questioned whether there could be circumstances where they may be manipulated or pressured into ending their lives.

This worries me deeply. If we legislate for the right to die, the negative impact on vulnerable groups will be huge.

In my heart I simply cannot accept that a law can be developed which will completely protect the vulnerable.

One of the most moving moments of the select committee process came when we heard from a Wellington man who said in the past he had been suicidal.

He recognised the grave consequences if euthanasia was made legal in this country. The option of taking one's life would become much more normalised and he believed vulnerable people might make a decision that could never be reversed.

Our suicide rates are already too high - we don't need death by choice as another signal that ending one's life is OK. I am mindful that there are many differing views around legalising euthanasia and I acknowledge that my voice is just one of many.

As politicians we are now faced with a difficult choice around this issue, but it is one that we do not make without the greatest thought and consideration.