Monday, September 21, 2020

Assisted suicide death may not be quick or peaceful.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

When debating assisted suicide, legislators and voters (New Zealand referendum) assume that an assisted death is quick and peaceful. This is important because people often support assisted suicide based on fear of a painful death.

The theory is not the same as the reality.

What is not known is that assisted suicide activists have been experimenting for several years with lethal drug cocktails on people approved for assisted suicide.

According to an article by Lisa Krieger published by the Medical Xpress:

When Californians passed the medical aid-in-dying law - inspired by Oakland's Brittany Maynard, San Mateo's Jennifer Glass and others who sought to end their suffering from cancer - voters assumed it promised them a neat Shakespearean-styled ending, like Romeo's quick poisoning in Verona. That was the goal, but it didn't always happen.

A little-known secret, not publicized by advocates of aid-in-dying, was that while most deaths were speedy, others were very slow. Some patients lingered for six or nine hours; a few, more than three days. No one knew why, or what needed to change.

"The public thinks that you take a pill and you're done," said Dr. Gary Pasternak, chief medical officer of Mission Hospice in San Mateo. "But it's more complicated than that."
But what is not said in the article is that assisted suicide promoters and practitioners developed lethal drug cocktails through human trials rather than animal trials. The human experimentation is ethically questionable and should be investigated by the Food and Drug Administration.

Furthermore, the doctors may have consent to assist a person's death but have they obtained consent to use experimental drug cocktails in the process? 

Krieger explains that these experiments are not new:

When aid-in-dying was first passed in Oregon in 1997, patients were given secobarbital, sold under the brand name Seconal. It induces deep sleep, then a coma that is so deep that the brain no longer drives respiration.

But that drug wasn't consistently quick. Then it became prohibitively expensive, finally unavailable.

To replace Seconal, the doctors invented a three-drug cocktail - a painkiller, sedative and a heart-slowing agent - based on their experiences with overdose deaths. They later added another cardiac drug. But problems remained.
The assisted suicide lobby is not honest about the fact that many assisted suicide deaths are slow and painful. The design of the law enables doctors to cover-up the reality.

A Daily Mail article by Vanessa Chalmers titled - Assisted Dying can cause inhumane deaths examined an article, by Professor Jaideep Pandit, as reported in the British Medical Journal. The article explains how death by assisted suicide is often inhumane. 

Chalmers reported:
Patients are usually given barbiturates – strong sedatives – which knock them out and eventually cause the lungs and heart to stop. 
But the report found complications including difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing. 
Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said.  
'This raises a concern that some deaths may be inhumane,' the researchers reported in the journal Anaesthesia
After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer. 
Death occurs within 90 min in two thirds of cases. 
But in a third of cases, death can take up to 30 hours, and some deaths took as many as seven days to occur (four per cent).

Before legalizing assisted suicide, legislators and voters need to know how it is done, the negative consequences associated with these drugs and the ethics related to the development and use of these drugs.

Assisted suicide deaths can be slow and painful.

More articles on this topic:

Who really wants to die? Part V: The absence of suicidal desire amongst the survivors of catastrophic injury.

Gordon Friesen

A fundamental truth

Cutting directly to the chase: survivors of catastrophic injury (such as those suffering from paralysis due to spinal cord injury), have no greater desire to die than anybody else. There is, therefore, no rationale for facilitating access to assisted death on their account.

In crude figures: only somewhat less than one percent of the victims of spinal chord injuries will despair, renounce, and end their lives during the first crucial five years of recovery (and after that time, their specific suicide rates become statistically identical to those of the general population). That is, of course, a huge number of individual suicides (and roughly twenty times the normal expectation). But it remains, none-the-less, only one percent of the whole.

These facts may come as a surprise to many. But such is the incontrovertible truth.

Once again, as with celebrity suicide, and with the general euthanasia rates observed around the world: we see that the “service” of euthanasia has been grossly oversold in proportion to the scale of voluntary organic demand on the part of its’ intended clientele. And even more importantly, this demand has been energetically misrepresented over the years, by suggesting that certain specific categories of ill and disabled individuals, including (especially) major injury survivors, people with AIDS or persons experiencing progressive neurological decline, and those diagnosed with terminal cancer, do indeed wish to die, when, by the dispassionate measure of statistical evidence: such is clearly not the case.

To what, then, do we owe this false, dangerous, and all too popular misconception?

At the heart of pro-euthanasia messaging: the ideal notion of “suffering”

Fully -- and confidently -- imbued with the early twentieth century spirit of progressive scientific utilitarianism, the Voluntary Euthanasia Society (UK) was formed in 1935 (four years before the onset of war), dedicated to the following principle: 

“incurable sufferers should have the right to choose a Merciful Death”
Ten years later, however, when the Second World War had ended the fascist dream of a “new social order” (and faced at Nuremberg with the appalling evidence of what can really happen when the medical profession is instrumentalized in the pursuit of utilitarian public policy), support for euthanasia virtually disappeared.

As a result, those few creative and powerful personalities who, for whatever reason, remained deeply attached to this ideology, found themselves in a similar situation to that of anti-euthanasia activists today, which is to say, firmly on the back foot and comprehensively obliged to reinvent their goals and methods.

In this extremity (and at the price of a deep fracturing within the Society itself), the immediate goal of access to euthanasia was abandoned; and what was left of the movement transitioned (in the post-fascist period) to a more modest set of objectives, beginning with the first and most basic patient prerogative on the road to full access euthanasia: the right to refuse treatment.

Refusal of treatment, and the original slippery slope

Today, of course this principle is universally accepted. We should, however, frankly realize that refusal of treatment has crucial suicidal implications: that by accepting refusal of treatment we are also deemed to have credited the idea that suicide need not be, by definition, a wrongful act; that we do not have an unconditional duty to prevent suicide; that suicide is not necessarily “bad”; that suicide can, in fact, be “good”; and ultimately, that we might be morally required to provide assistance in suicide. In other words, from the first formal acceptance of “refusal of treatment” (and with far greater effect from the later refusal of “care”), the road became clearly laid out -- through the logical falling of successive legal dominoes -- to that situation in which we find ourselves today.

For clearly: categorical interdictions can not be (formally) breached without inviting far-reaching consequences.

A required moral consensus on the desirability of (at least) some suicides

Perhaps the most brilliant and effective aspect of the strategy outlined above lies in this fact: that the entire collective and utilitarian justification for euthanasia -- previously quite obvious but now unavowable -- had been displaced by this one remaining principle of unfettered individual choice.

And yet there still remained a crucial obstacle to this plan. We must understand, I believe, how difficult it was for people, at that time, to openly promote the idea of suicidal choice. It was not enough, three quarters of a century ago, to simply fall back (as one might today) on the sovereign personal right of capricious subjective desire. Those who wished to enable suicide, assisted suicide, and ultimately euthanasia itself, faced the very real challenge of convincing a democratic majority that suicide can be (and is in fact), objectively “good” (in specific instances).

In practical terms, of course, this would mean convincing the common man that there were situations in which, he -- or anyone else -- would naturally wish to die. And to achieve this goal, euthansia promoters began with a truly ingenious linguistic tool, for soliciting agreement with their underlying thesis. This involved a minute, almost invisible change, introducing the notion, no longer of merely “incurable” suffering, but that of a suffering which was incurable and “unbearable”! For in this case, IF we accept at the outset that there is (in fact) such a thing as “unbearable suffering”, THEN by definition, anybody so afflicted would automatically wish to die, and the argument is carried without further demonstration.

The only task remaining, therefore, was to sow this treacherous conceptual seed in collective consciousness (appealing, also, to pre-existing popular prejudice), by presenting ideal images of people “suffering” in seemingly “unbearable” circumstances. Unfortunately, as we shall see, this challenge was actually undertaken with great success over a period of fifty years (in spite of clear statistical proof to the contrary), by mere literary representations of fictional suffering, involving notably (among others) the paralysed survivors of spinal cord injury.

An outstandingly successful instance of fictional misrepresentation : spinal cord injury

As early as 1972, a television drama championing the right to die, intitled “Whose Life is it Anyway”, by author Brian Clark (1932 - ), appeared in UK (once again), which was subsequently brought out on the stage (London 1978, Broadway 1979) and was ultimately produced as a Hollywood film starring Richard Dreyfuss (MGM 1981).

The subject of this film concerned the suicidal desires of a young man (Dreyfuss) who was rendered quadriplegic in a car accident. The point of the film however -- it’s purpose -- was to convince the average sympathetic spectator, that a life of paralysis is objectively unworthy of living; or at least, that if he or she were to find themselves in such a case, that they would not wish to live. The fundamental goal, therefore, lies in soliciting the spectator’s agreement with that essential euthanistic premise identified above: that there do indeed exist extraordinary instances of “suffering” which are objectively “unbearable” (and for which the act of suicide -- and indeed of homicide also -- must be postulated as a positive “good”).

Unfortunately however – incidentally and unforgivably -- it was also grossly (and falsely) intimated through this fictional imagery, that the typical paralysed survivors of spinal cord injury are indeed “suffering” in that mythically “unbearable” fashion so artfully evoked, and naturally desire death in consequence!

Never mind that this is a bald-faced lie. Never mind that ninety-nine percent of catastrophic injury survivors will show no more suicidal tendency than anybody else! People of the author’s ilk have no interest in such distractions: In fact, it would surprise me greatly to learn that Brian Clark actually cared if real spinal cord injuries wished to die. He might easily have discovered that they do not (And perhaps knew this perfectly well)!

Even the spinal cord issue, itself, (as choice of subject) was probably a mere happenstance. Apparently, Clark simply picked the worst infirmity he could think of (while still getting aesthetically photogenic shots). His one simple goal, for whatever reason, was to convince “normal” people that their “suffering” neighbors should be allowed to die. And if that demonstration depended on a completely fallacious description of reality, advanced unselfconsciously through a work of political fiction, then so be it.

A personal, indignant resentment, evoked at the view of this film

The reader may have detected a particularly warm tone in my treatment of this particular subject. And the reason for that “warmth”, is because, coincidentally, “Whose Life is it Anyway” appeared as a film only two years after I myself became paralysed in circumstances very similar to those depicted in the movie.

The terrible nature of such literary assault

Without the will to live, even the strongest man, in the most favorable circumstances, will soon disappear. For that is the inflexible rule of all life, which has governed evolution from the very start: Life must be desired; life must be nurtured; life must be defended; life must be striven after. Among humans, indeed, the capacity for adaptation is virtually limitless, and the will to live, therefore, is not a secondary, but the first and determining predictor of outcome: for almost any situation is livable to the person who desires life; but no situation will suffice for the one who does not.

Generally speaking, then: How could anyone fail to understand the mortal danger posed by such a work, to people at grips with these intimate and personal adjustments? In those first crucial four, or five years? In that first devastating year? How could anyone ignore the terrible implications of telling such people (at that most delicate of times), that their lives were (objectively) not worthy of life?

As concerns myself personally: forty years ago, my survival teetered on the knife’s edge. My life depended, quite simply, on the confidence required to make positive choices; and the suggestive force of Clark’s propaganda, with its nihilistic view of disabled life (whether wittingly or no) posed a direct threat to my existence.

I do not hesitate to affirm, therefore: that the production and distribution of this film (and the still very popular stage-play from which it sprang) were (and remain) acts of criminal assault upon real people; some of whom, sadly, will not succeed in repulsing this poisonous ideation.

And yet most happily: the human powers of recuperation (from psychic no less than from physical assault), are much greater than we might intuitively expect (and certainly much greater than the shameless pornographers of “unbearable” suffering would have us believe).

A more faithful portrait of real life

People who have lived through these sorts of difficult adaptations, and those also, who have been the intimate witnesses to such feats, naturally see them as unique, heroic, victories over misfortune. And they definitely are. But the superb level and intensity of the efforts made – and of the satisfaction achieved -- does not change their equally ordinary nature. It is simply a lie (albeit a nearly universally credited lie) that only a very few superior individuals can possibly overcome the challenges of catastrophic injury. In reality – and this is a truth which cannot possibly be over-stated: this kind of amazing adaptive power reveals itself as a standard characteristic of humanity. Especially where it is expected and embraced.

A conclusion of infantile simplicity

Once again, let us remember the main thesis of this present series of articles: that observed demand for euthanasia is wildly below what we would expect as a justification for the scale of the service offered (and for the sacrifices demanded of both typical patients and typical doctors) in the satisfaction of what little demand there is.

What is the reason for that? Why is this dishonest (and clearly false) nihilistic messaging (epitomized by the film “Whose Life is it Anyway”), still allowed to stand? Where are the ninety-nine other films logically required to faithfully portray observed proportional reality? Where are the popular commentators, eager to “set the record straight”?

Whatever answers might be found for these intriguing questions, something has clearly gone wrong with the scenario imagined seventy-five years ago by post-fascist euthanasia apologists suddenly recycled as apostles of personal choice: Doors to the “service” have been thrown wide open. Doctors are now instructed to be on the lookout and to recruit as many clients as possible. Yet to their enduring frustration (and, I believe, entirely predictably): As long as euthanasia depends on choice it can never prevail over the normal human instinct of survival. Or to recall the familiar Children’s Tale:

Then said the Little Red Hen:
“I have convinced the general population that “suffering” is worse than death;

I have changed the law to allow doctors to kill their patients;

I have transformed the public healthcare system along utilitarian lines in order to maximize access to euthanasia;

And now, who wishes to die?”

“Not I”, said the Pig.

“Not I”, said the Cow.

“Not I”, said the survivors of catastrophic injury...
How long will it take (and how much damage will be done to our medical establishment) before judges, administrators and opinion-makers realize that they are attempting to force a “product” upon us, for which there is no corresponding market organically expressed?

And how long will we – patients and taxpayers – allow this abuse of our trust?

This article is the fifth in a series of articles.

Friday, September 18, 2020

Netherlands euthanasia clinic: two year waiting list for euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On March 1, 2012; the Netherlands euthanasia lobby launched the euthanasia clinic with six mobile euthanasia teams. The euthanasia lobby anticipated that the mobile euthanasia teams would do 1000 euthanasia deaths per year.

The mobile euthanasia teams planned to fill "unmet" demand by focusing on euthanasia for people with chronic depression (mental pain), people with disabilities, people with dementia/ Alzheimer, loneliness, and those whose request for euthanasia is declined by their physician.

Janene Pieters reported for the NL Times that there is now a two year wait time for euthanasia for mental illness at the euthanasia clinic. According to Pieters last year the euthanasia clinic received 3122 requests for euthanasia representing a 22% increase over the previous year.

Pieters reports that Paulan Starcke of the Expertise Center said:
While the coronavirus pandemic is an easy thing to blame for the increasing waiting times, the crisis was really only part of the problem... According to her, the pandemic caused a maximum delay of two months. 
"Our waiting list is primarily a signal that regular mental health care still does not often seriously respond to a request for euthanasia. We are referred to too often," 
Patients are referred to the Euthanasia Expertise Center if their regular doctor considers their request too complex to handle themselves. The Expertise Center provided euthanasia to over 60 people with mental health problems last year. Doctors who are not affiliated with the center only did so six times.
The Netherlands euthanasia clinic temporarily shut-down during the Coronavirus crisis. The euthanasia clinic which specializes in euthanasia for mental illness and euthanasia for people with dementia or questionable competency, reported that euthanasia deaths, increased to 898 in 2019 up from 727 in 2018.

The 2018 euthanasia report indicates that there were 6126 reported euthanasia deaths in the Netherlands in 2018. According to the news:
Of the cases reported to the committee last year, 146 concerned people with dementia and 67 people had severe psychiatric problems. In 205 cases, patients had multiple problems derived from the ageing process.

I am concerned that in 2018 205 people were placed into a new category off euthanasia for people who have multiple problems derived from the aging process. This sounds very similar to "the completed life.

I contend that very few psychiatrists, in the Netherlands, are willing to do euthanasia because it is counter to the role of a psychiatrist who is trained to prevent suicide not provide it.

Thursday, September 17, 2020

Book: Made To Live. A personal and professional story. Purchase today.

Dr Saba is a Canadian hero. During the euthanasia debate, in Québec and nationally in Canada, Dr Saba not only spoke up and wrote briefs that were submitted to the committees, Dr Saba also launched a court case challenging the validity of the law.

Dr Paul Saba launched his book Made To Live on Sept 15, 2020 (Link to the book launch webinar).

Made To Live tells some of that story, but most of all Made To Live focuses on personal stories and experiences in his family and professional life.

Purchase Made To Live from the Euthanasia Prevention Coalition for $25 + GST ($26.25)(includes shipping) (Link).

The book starts with the story of his youngest daughter, Jessica, who was identified in-utero with significant heart issues. Many specialists told them that their child would not survive or if she survived her life or health would be significantly compromised.

Dr Saba and his wife believe in life and decided that they would do everything to help their daughter.

The Made To Live trailer video focuses on Jessica's story: (Link).

Dr Saba also writes about other medical experiences in his professional life. A patient who came to him who had been misdiagnosed and believed he was dying of cancer, a woman who had tried several treatments for cancer and was giving up, but is alive today because Dr Saba helped give her hope and more.

I personally found the book to be profound as Dr Saba shares stories and experiences in a well written human fashion. This book gives personal experiences as to why we must oppose killing.

We are Made to Live.

Nancy Elliott
Euthanasia Prevention Coalition USA
"Dr. Paul Saba’s personal journey to save life demonstrates his caring heart not only for his family but all those around him in the world whom he considers part of his extended family. He recognizes assisted suicide and euthanasia are neither caring nor compassionate. "
— Dr. Gordon Macdonald
CEO, Care Not Killing, London, UK
"In Made to Live, Dr. Paul Saba has provided a timely reminder of the underlying principles of medicine, which are to heal, promote health, and alleviate suffering, and to resist the temptation of killing the patient. Outlining his personal, family, and professional struggles to resist pressure coming from within the medical profession to take human life rather than preserve and cherish it, he provides valuable insight into the dangers posed to true medicine by the corrupting influence of the spread of euthanasia and assisted suicide. With reference to the history of the euthanasia movement, he shows that it is fundamentally opposed to the principles of medicine."
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
"I consider Dr. Paul Saba to truly be a canary in the coal mine, alerting the world about the fatal flaws associated with euthanasia and assisted suicide.... This book is an incredible addition to the arsenal of data and stories upholding the value of human life and enunciating why killing people is not only bad public policy but simply wrong."
Purchase Made To Live from the Euthanasia Prevention Coalition for $25 + GST ($26.25)(includes shipping) (Link).

Tuesday, September 15, 2020

A retrial is ordered in the belgian euthanasia death of Tine Nys, who was diagnosed as autistic.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Tine Nys (center) with sisters.
Belgium news is reporting that a retrial has been ordered into the euthanasia death of Tine Nys who died in 2010. HLN news reported:
The Court of Cassation has decided that a new trial will be brought against the doctor who performed the euthanasia on Tine Nys. The Court has ruled that the acquittal of doctor Joris van Hove was not sufficiently motivated. There will be no retrial for the two other doctors who were also acquitted.
Joris van Hove
On January 31, 2020 a 
Belgian court cleared three doctors in the euthanasia death of Tine Nys (38). The Nys family of continue to argue that Tine didn't qualify for euthanasia and that she was falsely diagnosed as autistic to qualify for euthanasia.

A BBC news article from January reported:
Nys's family argue that her reason for seeking to end her life was because of a failed relationship, far short of the "serious and incurable disorder" as required under Belgian law.
Michael Cook reported for Mercatornet during the first trial that:
Dr Joris van Hove’s seamy background was highlighted in the media coverage. He has been in court before over offenses like drink driving and forgery. In 2017 he was convicted of molesting young male patients. Was his troubled background the reason why he had turned his hand to euthanasia? (On that fateful evening he had to rush off to do another euthanasia after Tine Nys.) Perhaps more testimony will shed light on this. The Dutch medical council has begun disciplinary proceedings against him.

Dr van Hove admitted that he had never done a euthanasia for psychological suffering before and that he had been clumsy. He had not completed his “end of life” training and he failed to administer the lethal injection properly. He did not have a stand for the infusion and the bag plopped onto Tine’s face as she was saying goodbye to her family. He neglected to bring a blank death certificate.
With respect to van Hove, HLN news reported:
Van Hove continues to work as a general practitioner. He was finally convicted in 2017 for indecency assault of patients, but the Order of Doctors only started a disciplinary investigation after a report by the prosecution in connection with the euthanasia process. “I have not heard from the Order of doctors anymore. I am currently at work and have no additional stress for a retrial. I have nothing more to say about the other case (the moral case, ed.). ”

Van Hove's new trial will probably be brought before a civil court early next year, but if it is concluded extensively, the case could drag on for a long time.
Tom Mortier's case concerning the euthanasia death of his depressed mother in Belgium also continues.

The family of Tine Nys have battled the Belgian legal system for 10 years.

Similar to Canada, when a euthanasia is approved by the doctors, even if the assessments are wrong, the death is considered lawful.

Hopefully justice will be done.

Analysis of Canada's 2019 MAiD Annual Report

This article was published by Toujours Vivant - Not Dead Yet on Sept 8, 2020.

By Amy Hasbrouck, Director Toujours Vivant - Not Dead Yet.

Does the MAiD Program shown in the first annual report meet the Supreme Court’s requirements?

In July of 2020, Health Canada issued the first annual report on Medical Assistance in Dying (MAiD) using data drawn from the monitoring system that went into effect in November of 2018. The report covers MAiD provided throughout Canada during the 2019 calendar year.

Before we talk about the substance of the report, it’s important to remember that, in the 2015 Carter decision, the Supreme Court of Canada said that protecting vulnerable people required “a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced.” Yet as Alex Schadenberg of the Euthanasia Prevention Coalition has pointed out, the law has no method for families to appeal a determination of eligibility they believe is wrong.

Further, Health Canada has denied any responsibility to ensure compliance with the MAiD law’s safeguards. In the final regulation, Health Canada says: “[Monitoring] is fundamentally distinct from a process that seeks to assess individual medical or nurse practitioners’ compliance with the Criminal Code exemptions. Investigating instances of non-compliance with the eligibility criteria and procedural safeguards set out in the Criminal Code falls outside of the scope of the federal monitoring regime, and is under the purview of local law enforcement.” If Health Canada offloads compliance onto local law enforcement, how does Health Canada propose to ensure that the law is “scrupulously monitored and enforced”?

On page 17 of the report, Health Canada says that “all cases of MAiD are captured.” But that’s not the same thing as saying that all euthanasia deaths were reported. The report doesn’t include deaths by Continuous Palliative Sedation (CPS), euthanasia that doctors didn’t declare, or other life-ending acts without explicit request. There are no eligibility criteria, approval process or safeguards to be met for continuous palliative sedation. Studies in jurisdictions where euthanasia is legal which traced the cause of all deaths during a certain period of time have found that many euthanasia deaths were not reported, even when the doctors knew they were performing euthanasia. As well, Québec’s monitoring system, which has a two-track verification design, has consistently shown that doctors are not reporting all euthanasia procedures they perform. Nor does Health Canada discuss how many reports contained incomplete or inaccurate information, or how these were corrected. Thus, Health Canada may have reported all the MAiD declarations they received, but they didn’t count all euthanasia deaths.

At the same time, Health Canada admits there remain “data gaps.” They point out that, because an oral request can start the eligibility determination process, “many assessments for MAID are taking place with the written request only being completed once a finding of eligibility has been determined or a date for MAID has been established.” Thus the number of written requests reported in 2019 (7,336) is probably substantially lower than the real number of people who asked for euthanasia, because those who are determined ineligible upon making an oral request are not counted by the monitoring system. As well, not all requests that pass through MAiD case coordination or referral systems are captured because some employees of such services are not required to file MAiD reports. Nor does Health Canada document the role of euthanasia advocacy groups in facilitating MAiD approvals and procedures.

The report uses two different figures for the number of MAiD deaths being reported, which creates some confusion. In footnote 1, Health Canada says: “When all data sources are considered, there were a total of 5,631 MAID deaths in Canada in 2019. This includes 242 MAID deaths that were reported voluntarily by the provinces and territories. The detailed analysis on requests for MAID (7,336 written requests), and cases of MAID (5,389 provisions), are available only for the reports collected through the federal monitoring system (for requests received on or after November 1, 2018).” A clarification is provided on page 16. “[A]ggregate data for MAID deaths in 2019 is based on two data elements: MAID provisions in 2019 resulting from a written request prior to November 1, 2018, and data collected under the Regulations for the period January 1, 2019 to December 31, 2019.” So if a person asked to die before November 1, 2018, and was euthanized after January 1, 2019, their death was counted in 2019, but was not subject to the new monitoring system’s reporting requirements. This was the case for 242 people.

Of the 7,336 written requests for MAiD in 2019, 1,947 (26.5%) did not result in euthanasia.

  • 1,113 (15.2%) died before approval or euthanasia 
  • 571 (7.8%) were deemed ineligible due to:
    • lack of capacity – 184* (32.2%),  
    • natural death was not reasonably foreseeable – 159 (27.8%),  
    • not in an advanced state of irreversible decline – 134 (23.5%)
  • 263 (3.6%) requests were withdrawn.

There were 5,631 MAiD deaths in 2019 (including 242 requested before November 1, 2018)

  • Accounted for 2% of all deaths in Canada (ranging from .3% of deaths in NL to 3.3% in BC) 
  • All but a handful (< 7) were by euthanasia.  
  • Total since 2016 = 13,946

*These numbers are estimates based on the percentage of 571 people found ineligible. The report did not provide the exact figures.

The annual report reflects corrections and adjustments to the statistics given in the interim reports. The number of MAiD deaths has increased each year.

  • 1,015 in 2016 
  • 2,833 in 2017
  • 4,467 in 2018 = 58% increase over previous year,
  • 5,631 in 2019 = 26% increase over previous year.

On page 19, Health Canada explains the small number of assisted suicides by saying “providers are less comfortable with self-administration due to concerns around the ability of the patient to effectively self-administer the series of medications.” They do not talk about the individual’s choice, nor the apparent conflict between the idea of MAiD as a form of self-determination, and the small number who choose the more autonomous option of assisted suicide. This is important because, according to Statistics Canada, intentional self harm (suicide) was the 9th leading cause of death in Canada in 2018,** accounting for 3,811 deaths, whereas MAiD accounted for 4,467 deaths in 2018. But because MAiD isn’t counted either as suicide or as a separate “cause of death” it doesn’t take its place as the 9th leading cause of death in the country. In 2019, MAiD accounted for 2% of all Canadian deaths.

**The 2019 statistics are not available.

The monitoring system did not collect crucial demographic information that would show the impact of discrimination, economic and social pressures on requests to die. Health Canada is not tracking information about the person’s race, ethnic background, income, indigenous status, sexual orientation, disability status, first language, or other grounds of discrimination. Indigenous and racialized Canadians have been calling for accurate data collection to document racism in the health care system for decades, and we raised the issue in our comments on the draft monitoring regulations. As well, though the monitoring system collects data on where euthanasia was performed, it doesn’t ask about the person’s living situation when the request is made.

There are three “catch-all” categories in the section on underlying medical conditions (4.1) that total 19.8% (or 1,067) of all cases; “Multiple Comorbidities,” “Other Condition” and “Other Organ Failure.” An explanatory note says that: “other conditions” includes “a range of conditions, with frailty commonly cited.” When “miscellaneous” medical conditions make up 20% of cases, and include non-terminal conditions such as frailty, something smells fishy.

As we observed in our comments on the draft regulations, the monitoring system does not collect data on whether suicide prevention services were provided in response to requests for MAiD. The data in Section 4.3 regarding palliative care and disability support services gives no indication what services were provided, or whether the services met the person’s needs. Health Canada reports that 82% of people received palliative care, and 89% of those who needed them received disability support services. The authors conclude these findings: “seem to suggest that requests for MAiD are not necessarily being driven by a lack of access to palliative care services,” (p. 24) though they admit that “the data … [do] not speak to the adequacy of the services offered.”

Without suicide prevention intervention, or effective palliative care and disability support services, a person’s consent to euthanasia cannot be voluntary, capable, and free of external pressure.

A few items worth noting about who provided MAiD, and where it occurred:

  • The monitoring system doesn’t record the medical specialty of the practitioner who provides the written second opinion. 
  • While 20.6% of euthanasia were performed in “palliative care facilities” (p. 27) only 9% of MAiD practitioners were palliative care specialists. 
  • As Richard Egan pointed out in his analysis of the Canada report, “Despite two thirds of cases with cancer as the underlying condition, only 1.7% of clinicians administering euthanasia gave their specialty as oncology.” 
  • Mr. Egan also notes that even though euthanasia is not allowed for psychiatric conditions, 1.2% of euthanasia were administered by psychiatrists.

In its introduction to data on the kind of suffering reported by people asking to die (Section 6.1), Health Canada claims: “It is not the practitioner’s interpretation of the intolerability of an individual’s suffering; only the individual requesting MAID can determine whether their suffering is unbearable.” Yet there is ample evidence that medical professionals’ negative views of disability do affect how people value their disabled lives. This is why peer support is so essential to adapting to aging, chronic and degenerative illness and disability.

“Nature of suffering”

  • Loss of ability to engage in meaningful life activities – 82% 
  • Loss of ability to perform activities of daily living – 78% 
  • Inadequate control of symptoms other than pain (or concern about it) – 56%  
  • Inadequate control of pain (or concern about it) – 54%  
  • Loss of dignity – 53%  
  • Perceived burden on family, friends or caregivers – 34%  
  • Loss of control of bodily functions – 32%  
  • Isolation or loneliness – 14%  
  • Emotional distress/anxiety/fear/existential suffering – 5% 
  • Loss of control/autonomy/independence – 4% 
  • No/poor/loss of quality of life – 3%

The medical practitioner is responsible for ensuring compliance with the law’s safeguards; the only “proof” that safeguards were met is the clinician’s opinion and assurance to that effect. Of course, nearly all clinicians said they asked the person what they wanted, but did that conversation take place privately, away from the influence of family or others who might sway the decision? One telling statistic is that only 14% of practitioners based their determination of the voluntariness of the person’s request on prior knowledge of the person. This suggests that few providers had the deeper knowledge that comes of long-standing relationships with the people they were assessing for eligibility to die.

The questions and concerns raised by this first annual report lead us to believe that Canada has not met the Supreme Court’s mandate to create “a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced.” 

Amy Hasbrouck is the President of the Euthanasia Prevention Coalition

Monday, September 14, 2020

Book launch - Made To Live with Dr Paul Saba on September 15.

Dr Paul Saba is launching his book - Made To Live on September 15, 2020.

Alex Schadenberg is hosting the Zoom event featuring Dr Saba, who will speak about his new book.

Date: September 15, 2020

Time: 7:30 PM (Eastern Time).

Now that the event has happened. Here is a link to the video of the event (Link).

After registering, you will receive a confirmation email containing information about joining the meeting.
"Dr. Paul Saba’s personal journey to save life demonstrates his caring heart not only for his family but all those around him in the world whom he considers part of his extended family. He recognizes assisted suicide and euthanasia are neither caring nor compassionate. "
—Nancy Elliott
Euthanasia Prevention Coalition USA
"I consider Dr. Paul Saba to truly be a canary in the coal mine, alerting the world about the fatal flaws associated with euthanasia and assisted suicide.... This book is an incredible addition to the arsenal of data and stories upholding the value of human life and enunciating why killing people is not only bad public policy but simply wrong."
—Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
"In Made to Live, Dr. Paul Saba has provided a timely reminder of the underlying principles of medicine, which are to heal, promote health, and alleviate suffering, and to resist the temptation of killing the patient. Outlining his personal, family, and professional struggles to resist pressure coming from within the medical profession to take human life rather than preserve and cherish it, he provides valuable insight into the dangers posed to true medicine by the corrupting influence of the spread of euthanasia and assisted suicide. With reference to the history of the euthanasia movement, he shows that it is fundamentally opposed to the principles of medicine."
— Dr. Gordon Macdonald
CEO, Care Not Killing, London, UK

A euthanasia (MAiD) story. Who decides?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Why has assisted death become common so quickly in Canada?

I was visiting a friend, this weekend, who told me the story of how his neighbour died by (MAiD) euthanasia earlier this year.

He told me that he and his wife were helping their neighbour, who had cancer, by bringing him to the hospital for treatments and the doctors for appointments.

The man was considering a new round of treatment, but his family doctor urged him to "ask" for MAiD (euthanasia). The cancer had spread quickly and he was losing hope so he agreed to die by lethal injection. In case your wondering, finding a second doctor or nurse practitioner to agree is not difficult.

My friend then spoke about how the doctor, and his neighbour, kept the euthanasia decision a secret. His wife asked, how does my husband know that he is dying on that day? She became aware of the decision in the last minute. 

If there is nothing wrong with killing by euthanasia, then why keep it a secret?

She sat at his side holding his hand while he was injected and died. My friend looked at me and said, his wife was upset.

My friend did not question that his neighbour qualified for MAiD, he questioned the process that led to his neighbours death.

According to my friend, this man was not suffering, even though he probably feared possible future suffering.

This man was speaking to his doctor about another course of treatment, not euthanasia. I understand that the doctor thought that further treatment was futile, but why did killing become the answer? Was it compassionate?

Why didn't the doctor assure the man that he could be kept comfortable? Why was euthanasia brought up rather than caring options?

This appears to be a case of a doctor who has normalized killing within his medical practice. He has done it before and doing it again only rationalizes, for him that his other acts of euthanasia were good.

Killing justifies killing and normalizes the act.

Caring normalizes caring.

Killing is not caring. Killing is not dignified.

Legalising assisted dying can actually increase suicides

The Conservative Woman published an article on September 13 by Theo Boer analysing the suicide statistics in the Netherlands. Boer was a member of a Regional Euthanasia Review Committee in the Netherlands for 10 years and has done significant analysis of the experience with euthanasia in the Netherlands.

Here is what Professor Boer wrote:

Last week I addressed a group of Parliamentarians about assisted suicide and euthanasia. My talk, which coincided with World Suicide Prevention day, sought to address the unintended consequences of legalising assisted suicide and euthanasia in the Netherlands.

One of the arguments we hear is that assisted dying will bring down the numbers of violent suicides. It will provide a more peaceful death to patients in unbearable suffering who would otherwise have violently killed themselves. For other patients, the mere option of assisted dying (even if it will never be effectuated) is said to be a reassuring thought that will keep them from killing themselves.

I admit that these arguments may hold in individual cases. However, on the whole, the argument is mistaken. In the Netherlands, assisted dying gradually became available for patients commonly considered to be at risk of committing suicide: psychiatric patients, people with chronic illnesses, dementia patients, and elderly people without a terminal disease. But instead, the suicide numbers went up: from 1,353 in 2007, they went up to 1,811 in 2019, a rise of 33.8 per cent. In surrounding countries, most of which have no assisted dying practice, the suicide numbers went down. Germany, with a population much like the Dutch in terms of age, economy, and religion, saw its suicide numbers decrease by 10 per cent in the same period.

One hypothesis I increasingly accept as an academic and as someone who worked for almost ten years in monitoring and reviewing assisted dying cases for the Dutch authorities is the normalising effect that legalising assisted dying has had on the general population. We already know from the literature that when one person takes their own life, it can be a catalyst for others. Indeed, there are over 50 peer-reviewed studies reaching the same conclusion in what has been dubbed suicide contagion, copycat suicides or the Werther Effect. Not without reason, and based on advice from the World Health Organisation, the media go to great lengths to censor details that could trigger further suicides. Unfortunately, the same can’t be said about their carefulness when reporting assisted suicide stories, the great majority of which express an ill-informed and naïve sympathy for assisted dying.

The Netherlands should act as a cautionary tale to those in power in the UK. Like many of the current supporters of assisted dying, I used to believe that it was possible to regulate and restrict killing to terminally ill mentally competent adults with less than six months to live. I also thought that regulating suicide and death in this way would curtail those tragic cases where someone ends their own life. I was wrong. If there is one thing I learned in my country, it is that legalising assisted dying will not constrain the numbers. Deep down, many campaigners consider the legalisation of assisted dying for terminal patients merely as a stepping stone towards further liberalisation. Take Canada as an example. Soon after euthanasia was legalised in 2016, right-to-die lobbyists contested the limitation to the terminally ill. Not without success: in 2019, the Superior Court of Quebec ruled that such a limitation is ‘unconstitutional’ and that euthanasia should become available to any patient, whatever their life expectancy. As for the Netherlands, a Private Member’s Bill is making its way through The Hague that would extend killing to any person of 75 years and older.

Again, it may be reassuring to some that they will have access to an assisted death. But legalisation also conveys a cynical political signal: some people may be right if they no longer want to exist. In the Netherlands, I have witnessed a growing portrayal of death as the most effective and dignified remedy to unbearable suffering. Not only has this led to more assisted deaths, but it may well be one of the causes of the increased suicide numbers. This matters to the UK, because your number of suicides is roughly 3.5 times the Dutch level. According to your ONS, in 2018 there were just over 6,500 suicides. Even a modest percentage increase could add dozens if not hundreds to these figures, and this seems a risk too far.

Many of those campaigning for a change in the law have a genuine compassion for suffering people. However, be careful what you wish for. The legalisation of assisted dying will not only lead to tens of thousands of cases of assisted dying – the Netherlands, with 17 million inhabitants, has between 6,000 and 7,000 cases of assisted dying yearly – but may well contribute to more people, not fewer, taking their own lives.
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