Tuesday, June 30, 2020

Euthanasia (MAiD) for People with Psychiatric Disorders is dangerous.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In September 2019, Justice Christine Baudouin of the Quebec Superior Court struck down the section of Canada's euthanasia law limiting euthanasia to people whose natural death is reasonably foreseeable. The Truchon decision was not appealed by the federal or provincial governments creating a new debate concerning the limits for euthanasia (MAiD) in Canada.

In my commentary on the Truchon decision I stated:

A person didn't qualify for euthanasia based on psychological reasons alone since the law required that the person's "natural death be reasonably forseeable". Now the court has struck down this important safeguard
In other words, the Truchon decision opened the door to euthanasia for psychological reasons alone. A further problem is that Canada's euthanasia law does not define the term psychological suffering.

On March 10, the board of the Canadian Psychiatric Association (CPA) changed its position on euthanasia from negative to being supportive of MAiD (Link). The change in position happened without consulting the members of the CPA and without doing a review of the literature.

On May 26 the Canadian Journal of Psychiatry, published a research paper titled: The Lack of Adequate Scientific Evidence Regarding Physician Assisted Death for People with Psychiatric Disorders is a Danger to Patients by Mark Sinyor and Ayal Schaffer. 

Sinyor and Schaffer do an extensive literature review and conclude:
We cannot quantify, according to any of the usual scientific standards, whether PAD for PPD will benefit or harm patients and to what degree. ...We believe that the only rational approach is to insist on further study before expanding legislation.
They then state:
Earnest people may disagree philosophically in this area, but personal opinions cannot bypass the usual scientific process and, in this regard, those proposing expansion of the use of PAD have fallen woefully short. The fact that they have not been held to the usual requirements of medical science is absurd and even shameful. Sadly, no one in power seems to have noticed.
The conclusions by Sinyor and Schaffer are backed by their research. They state:
The problem with the limited and low quality scientific evidence available to date is compounded by imprecision and spurious reasoning within the conceptual articles which really should not have been called "studies."
The researchers examine many questions such as how permitting MAiD for psychiatric patients will affect the suicide rate for this patient group, especially since suicide is the most common cause of death for this patient group. They state:
Nevertheless, there have been no studies rigorously testing the impact of legalizing PAD for PPD on routine psychiatric care or suicidal patients.
Sinyor and Schaffer then examine the suicide contagion effect:
Furthermore, the Canadian Psychiatric Association (CPA) guidelines for responsible media reporting ask that journalists: "[avoid] portraying suicide as achieving results and solving problems." This is because of what is now robust literature on suicide contagion showing that messages of death result in more suicides across a population while stories of resilience and mastery of suicidal crisis can have the opposite impact. Whether legalization of PAD for PPD might lead to a similar social contagion phenomenon also remains unexplored... Whether legalizing PAD for PPD and associated media exposures in at-risk patients might result in a suicide contagion phenomenon is once more a testable yet unanswered question.
The researchers challenge the CPA's recent change in position on MAiD (euthanasia):
The CPA recently released a position statement which is agnostic to whether PAD should be allowed in PPD. This was most unfortunate. The CPA is not obliged to take a moral stand but it ought to advocate for adequate scientific evidence to inform public policy. Its position statement is an abdication of that responsibility.
Recently two CPA past Presidents published an Open Letter challenging the position of the CPA and the process that was followed to change the position.

If you consider the nature and condition of many psychiatric patients, Psychiatrists should never kill their patients. killing should be viewed as antithetical to their care.

I am concerned about the good psychiatrists who I have come to know who believe that killing is not a treatment for psychiatric conditions. Where is our country headed?

More articles on this topic: 

COVID-19 response in some areas amounts to 'elder abuse'

This article was published by OneNewsNow on June 30, 2020. 

Alex Schadenberg
An expert on assisted suicide is shedding light on the pandemic's impact on the elderly.

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition (EPC), tells OneNewsNow the one place where the elderly should fear contracting the coronavirus is in long-term care facilities.

"Recent reports are showing that 43 percent of all COVID-19 deaths were nursing home residents," he relays. "This is not just a problem in the U.S.; it's been a problem worldwide. Sweden was over 50 percent. Canada was even worse -- 81 percent of all COVID-19 deaths were long-term care residents."
Schadenberg says it is definitely not common practice to place people with a contagious disease in a facility with the elderly, but in too many cases, that is what happened. New York City is a good example of this.
"I would say that these types of situations really do amount to elder abuse, and investigations should be done," he submits. "You also should have some homicide charges when you're intentionally putting a sick person who has a disease that's easily spread, a condition that's easily spread, too, in a room with people who are healthy."
The EPC executive director fully expects lawsuits to be filed because of it.

He also points out that in states where assisted suicide is legal and a 15 day waiting period is required before a patient can attain the life-ending procedure, the pandemic has been used to try to roll back that requirement under the argument that it is an impediment to death with dignity.

ADAPT of Texas Protests Hospital Killing of Michael Hickson, A Black Disabled Man

This article was published by Not Dead Yet on June 29, 2020

ADAPT of Texas members protested on June 28th in front of St. David’s Hospital in Austin where they refused treatment and starved to death Michael Hickson, a black disabled man who died on June 11th, 2020.

ADAPT of Texas reported that Michael Hickson was a quadriplegic with a brain injury who was refused treatment for COVID 19 that he acquired in a local nursing home.

A pro-life media outlet reported on Mr. Hickson’s story, including a video of his recovery as he progressed over time, and an audio recording of a doctor explaining the hospital’s decision not to treat him for COVID-19.

. . . Hickson became a quadriplegic in May 2017 after going into sudden cardiac arrest while driving his wife Melissa to work. He received CPR but suffered an anoxic brain injury from the loss of oxygen to his brain. Since that time, he has been conscious and alert, responding to jokes, laughing, shaking his head, singing, and puckering his lips when his wife asked for a kiss over FaceTime. See the video below:

Then in 2020, he contracted COVID-19 from a staff member in his nursing home and developed pneumonia. He was hospitalized at St. David’s South Austin Medical Center, but doctors there refused to treat him, allowing him to die.

In a recorded conversation between the doctor and Melissa, she was told that he would not receive treatment due to his disability:

Doctor: So as of right now, his quality of life — he doesn’t have much of one.

Melissa: What do you mean? Because he’s paralyzed with a brain injury he doesn’t have quality of life?

Doctor: Correct.
A five-minute recording of the conversation is here:

The doctor seems to invoke the infamous Texas futility law, aka the “10-day-rule”, which allows doctors to involuntarily withdraw life-sustaining treatment after giving ten days notice. But it’s not clear how long Mr. Hickson was in the hospital. There’s no indication that even the minimal requirements of the futility law were met. Even if they used a hospital “ethics” committee, it’s highly unlikely that it included any disability rights advocates. (A problem we can all work to address – nothing about us without us!)

There’s also no indication that Austin hospitals had entered a period of shortages that would have triggered COVID-19 triage policies. Even if resource shortages existed in early June, the reasons given for withholding treatment are blatantly and illegally discriminatory under recent federal HHS Office of Civil Rights COVID triage rulings. The latest OCR settlement with the state of Tennessee makes it crystal clear that the Texas hospital’s decision leading to Mr. Hickson’s death violated federal standards.

Based on the information we have, it seems that the hospital used COVID triage and Texas futility policies in combination to try to “justify” a killing that neither policy could do alone. NDY questions the relative lack of media interest in this outrageous killing of a Black disabled man, and the hospital’s cold and cavalier dismissal of his life as unworthy of care. But for the video and audio recordings, this injustice would likely have remained hidden. Our hearts go out to his family for their terrible loss.

Monday, June 29, 2020

Past Canadian Psychiatric Association (CPA) Presidents urge the CPA to withdraw its support for MAiD euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On March 10, the board of the Canadian Psychiatric Association (CPA) changed its position on euthanasia from negative to being supportive of MAiD (Link).

An Open Letter from two CPA past Presidents challenges the position of the CPA and the process that was followed to change the position.

The Open Letter from Dr K. Sonu Gaind and Dr Fiona McGregor challenges the process that was followed. The letter states:

Dr K. Sonu Gaind
The CPA Position Statement was developed by the Professional Standards and Practice (PSP) Committee without the engagement or awareness of membership, without expert external consultation, and without internal consultation of groups like the CPA Research Committee. The Statement offers no evidence-based guidance on issues related to mental illness and makes no reference to any mental health or mental illness literature or evidence. Given the absence of any guidance, standards or mention of what irremediability means in the context of mental illness, the Statement has been criticized for how it could be ambiguously and even dangerously interpreted in the current politicized debate [May 22 Canadian Journal of Psychiatry piece on “What does ‘Irremediability’ in mental illness mean?”].
Dr Fiona McGregor
They continue by challenging the lack of membership input:

The lack of engagement of membership on this significant and complex issue, which has been evolving over at least 4 years and which members have expressed significant desire to have input in, failed to respect the role of members in a member association. The Statement itself is also highly problematic and potentially harmful. While we appreciate the CPA has since indicated it seeks to engage members in developing a discussion paper, this process should have taken place before development and release of the Position Statement. A Statement cannot be informed by a consultation process that occurs after its release.
They then outline the negative harmful effects with the current CPA position
..the government review of MAiD policy initially intended for June 2020 will occur soon, and that the extended deadline for complying with the Truchon ruling is July 2020, we are concerned the current CPA Position Statement will be harmful in influencing imminent policy changes in a way that does not reflect CPA membership input or views. Media interpretations of the Statement have already presented the CPA as supporting MAiD for mental illness without any further evidence-based guidance [May 26 Canadian Journal of Psychiatry piece on the “Lack of Scientific Evidence regarding MAiD in psychiatric disorders”]. The last time CPA members were surveyed, in 2016, only approximately 30% supported MAiD for mental illness, and even those expected standards and evidence-based guidelines that the CPA Statement lacks.
They urge the CPA board to temporarily withdraw its support for MAiD:
We are asking the CPA to revisit the Statement by temporarily withdrawing it, to allow for a proper engagement process and development of evidence-based recommendations to inform any future Position Statement on MAiD. The CPA has already expressed reluctance to do this, and this process will only occur if CPA members wish it to.
Psychiatrists should not be involved with killing their patients. If you consider the nature and condition of many psychiatric patients, killing should be viewed as antithetical to their care.

I am concerned about the good psychiatrists who I have come to know who believe that killing is not a treatment for psychiatric conditions. Where are we going?

More articles on this topic: 

Sunday, June 28, 2020

43% of US COVID-19 deaths were nursing home residents.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On June 25 I published the article - 81% of Canada's COVID-19 deaths were long-term care residents. I based my article on the June 25 report by Globe and Mail Health Reporter Kelly Grant, who wrote about the Canadian Institute for Health Information (CIHI) report: Pandemic Experience in Long-Term Care Sector.

A few days before I republished the article by Michael Cook concerning the abuse of palliative drug cocktails in Sweden, that led to higher percentages of COVID-19 deaths and at least 50% of the deaths being residents of nursing homes. 

In my article: Stealth euthanasia: How many Canadian Seniors with COVID-19 were killed? I suggest that the same abuse happened in Sweden and Canada.

Today I am writing a commentary on the article in the New York Times published on June 27 titled: 43% of US Coronavirus deaths are linked to nursing homes.

The data in the New York Times article is based on deaths up to June 26. The data in the article - 81% of Canadian COVID-19 deaths were linked to long-term care residents is based on deaths up to May 25. The percentage of Canadian long-term care resident deaths likely decreased between May 25 and June 26 as Canada's provincial governments began to focus on lowering the infection and death rates in nursing homes.

The New York Times article states that 43% of the Coronavirus deaths were linked to nursing homes while 11% of the known cases were nursing home residents. According to the article:

At least 54,000 residents and workers have died from the coronavirus at nursing homes and other long-term care facilities for older adults in the United States, according to a New York Times database. As of June 26, the virus has infected more than 282,000 people at some 12,000 facilities. 
While 11 percent of the country’s cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for more than 43 percent of the country’s pandemic fatalities. 
The share of deaths linked to long-term care facilities for older adults is even starker at the state level. In 24 states, the number of residents and workers who have died accounts for either half or more than half of all deaths from the virus.
This chart concerning percentage of deaths is from the New Times article.

Cases and deaths in long-term care facilities, by state

United States12,000282,00054,00043%
New Hampshire261,96729380%
Rhode Island642,74571577%
North Dakota655695664%

The New York Times conducted its own research:
In the absence of comprehensive data from some states and the federal government, The Times has been assembling its own database of coronavirus cases and deaths at long-term care facilities for older adults. These include nursing homes, assisted-living facilities, memory care facilities, retirement and senior communities and rehabilitation facilities.
The Canadian research was done by a government supported agency that had access to all of the data enabling them to determine if a death was related to a long-term care facility.

The data in the New York Times article is devastating and indicates that it is necessary to conduct a full inquiry into nursing homes which should lead to possible elder abuse and homicide charges.We need to rethink nursing homes and support community based care.

Friday, June 26, 2020

Stealth euthanasia. How many Canadian seniors with COVID-19 were killed?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On June 25 I published the article - 81% of Canada's COVID-19 deaths were long-term care residents. I based my article on the report by Globe and Mail Health Reporter Kelly Grant, who was writing about the Canadian Institute for Health Information (CIHI) report: Pandemic Experience in Long-Term Care Sector. This article focuses on the CIHI report.

Why is this important?

The data from the CIHI report indicates that up to May 25, 81% of all Canadian COVID-19 deaths were long-term care residents. This is tragic and criminal. How many Canadian seniors were killed rather than treated for COVID-19?

CIHI report: Pandemic Experience in Long-Term Care Sector.

The data in this report was collected up to May 25.
1. While Canada’s overall COVID-19 mortality rate was relatively low compared with the rates in other OECD countries, it had the highest proportion of deaths occurring in long-term care. LTC residents accounted for 81% of all reported COVID-19 deaths in Canada, compared with an average of 42% in other OECD countries (ranging from less than 10% in Slovenia and Hungary to 66% in Spain).
The total number COVID-19 deaths in Canada was similar to the OECD average, but there was a disproportionate number of seniors dying by COVID-19.
2. As a proportion of total COVID-19 cases in Canada, about 1 in 5 (18%) were among LTC residents. Internationally, this proportion ranged from under 1% of total cases in Australia to 51% in France and 73% in the U.K.
Therefore 81% of the COVID-19 deaths happened to 18% of the COVID-19 patients.
3. The mortality rate for those infected with COVID-19 in LTC was about 35% as of May 25. The number of LTC residents infected by COVID-19 and the percentage who died by COVID-19 varied from province to province in Canada.
I am convinced that the COVID-19 pandemic protocols and guidelines led to more elderly Canadian deaths. Decisions to cause death must have been made for Canada to have twice the percentage of seniors dying by COVID-19, than the OECD average and 15% worse than Spain, the second worst country.

I suggest that stealth euthanasia was the reason for number of elderly Canadians who died  from COVID-19. When I refer to stealth euthanasia I am referring to giving large doses of morphine "comfort care" to palliate symptoms and intentionally hasten death. 

It is true that many of these seniors may have died anyway, but based on the data, many of these seniors died who would have survived.

I commented on this issue early.

On March 30 I commented on the triage protocol that was developed for Ontario Health by Dr James Downar, the former chair of the physicians advisory committee for Dying with Dignity, a Canadian euthanasia lobby group. 

Downar's triage protocol was based on a utilitarian calculation as to when a patient would receive treatment. If the patient did not "qualify" for treatment, palliative care protocols were mandatory. This led to the abuse of palliative care.

On April 6 I further commented on Downar's Pandemic Palliative Care Protocol: Beyond Ventilators and Saving Lives that was published in the CMAJ. The authors of the protocol outlined the parameters for providing treatment and emphasized when treatment is not provided that palliative care protocols must be followed. Downar advocated for the improper use of palliative or terminal sedation.

In my commentary I stated that the proper use of palliative or terminal sedation is for a patient who has symptoms that cannot be effectively alleviated in any other way. For instance, a person who is living with neuropathic pain may only be relieved of pain by sedation. The protocol authors proposed the use of sedation as a means of causing death.

I then stated that the protocol changes palliative care. Proper palliative care provides pain and symptom relief but never to hasten death. The protocol allowed the use of palliative care  drugs to replace active treatment, even when treatment could lead to recovery. So palliative care becomes a way of providing a comfortable death when a person has been medically abandoned. I continued:
The protocol claims that it will lead to greater equity. The protocol acknowledges that people who live with mental illness or other conditions face substantial challenges to receiving healthcare and they conclude that: "Palliative care thus becomes the compassionate option to counterbalance this inequality." 
...but this protocol institutionalizes the inequality and injustice. The protocol states that you must be kept comfortable as we abandon you. But it doesn't stop there, the protocol advocates for the abuse of the use of "palliative sedation" meaning, we will not only palliative your symptoms, but in certain circumstances we will end your life without your explicit consent.
On April 9, I commented on the CMA approval of a Framework for Ethical Decision Making During the Coronavirus Pandemic that was based on the protocol by Ezekiel J Emanuel et al that was published in the NEJM on March 23, 2020 titled: Fair Allocation of Scarce Medical Resources in the Time of Covid-19

The utilitarian guidelines, such as the one's designed by Emanuel et al, and Downar ingrain negative and discriminatory attitudes towards vulnerable populations.

Medical decisions should be based on Justice and equality (non-maleficence) and not the elimination or abandonment of the weak.

Decisions to deny long-term care residents access to hospital care may have been based on a fear that hospitals would have be over-run with COVID-19 patients but it was also based on an ideology that these seniors were futile, even when treatment was not futile.

The pandemic protocols that were instituted in Canada led to many unnecessary intentional deaths of elderly persons with COVID-19. Decisions to live or to die were made by doctors and nurses who denied effective treatment to long-term care residents and then placed them on a "program" that nearly guaranteed their death. This is stealth euthanasia.

A better option is the pandemic decision making protocols developed by the disability community which represent a fair and equitable response to scarcity of resources. (Link to the protocol). The quality of life ethic, mixed with a utilitarian and discriminatory ethic towards people with disabilities and the elderly leads to ingraining decisions that results in the deaths of vulnerable persons.

Investigations must be done. These may have been criminal acts of elder abuse and intentional killing. Society must begin to recognize that the utilitarian ethic does not bring equality and justice but rather death and abandonment.

We need to rethink nursing homes and support community based care.

Thursday, June 25, 2020

81% of Canada's COVID-19 deaths were long-term care residents

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

We need to rethink nursing homes and support community based care

A few days ago I republished an article by Michael Cook concerning the abuse of "palliative drug" cocktails in Sweden, during the COVID-19 crisis, that led to higher percentages of deaths and at least 50% of the deaths being residents of nursing homes.

Kelly Grant, the Globe and Mail Health Reporter, published a report on June 25, 2020 confirming that 81% of Canadian COVID-19 deaths were long-term care residents.

I published several articles (listed below) warning that the COVID-19 triage guidelines and protocols  were leading to many seniors being denied admittance to hospital and many others receiving morphine and comfort care rather than effective treatment. I knew that many of the seniors may have died anyway, but others, who would have survived, were denied the option of recovery. This was a form of discrimination, elder abuse and even murder.

The horrific number of Canadian nursing home deaths is twice the OECD average and worse than any other OECD country . Grant reports:
Canada has done a far worse job of protecting nursing-home residents from the coronavirus than other wealthy countries, according to a new analysis that shows the places that fared best made sweeping changes at seniors’ facilities as soon as they shut their societies down. 
Just over 80 per cent of Canada’s known COVID-19 deaths were in residents of nursing or retirement homes as of May 25, nearly double the average for countries in the Organization for Economic Co-operation and Development, says a new report from Canada’s health care statistics agency. 
Spain was next, with 66 per cent of its total COVID-19 deaths in residents of seniors’ facilities, followed by Norway and Israel at 58 per cent and Ireland at 56 per cent. Some of the countries examined in the report, including Slovenia, Hungary and the Netherlands, had fewer than 20 per cent of their COVID-19 deaths in such homes.
Grant refers to the report from the Public Health Agency of Canada by stating:
The most recent in-depth report from the Public Health Agency of Canada (PHAC), released last Friday, shows Canada has logged coronavirus outbreaks in 971 nursing and retirement facilities, leading to nearly 6,000 deaths. PHAC reported 8,454 COVID-19 deaths overall as of Tuesday. 
The tragedy that unfolded inside Canada’s long-term care homes during the first wave of the coronavirus pandemic has prompted Quebec to call a public inquiry and Ontario to launch an independent commission.
Both provinces called in the military to help at the hardest hit homes.
Grant reported that Canada had fewer COVID-19 deaths in general but more nursing home deaths.
The flip side of the tragedy in long-term care is that Canada has done a better job of protecting people outside of seniors’ homes from the virus than many of its peer countries. 
As of May 25, Canada had recorded fewer COVID-19 deaths per million than the OECD average, better than Belgium, Spain, Britain, the U.S. and others, but worse than standouts such as Australia, Israel and Norway.
The Canadian Press report by Cassandra Szklarski interviewed Dr. Roger Wong, clinical professor of geriatric medicine at the University of British Columbia, says the numbers are “very concerning.” Wong told Szklarski that:
he recently spoke to a Senate standing committee on the topic, drawing on data from June 1 when reports of LTC deaths totaled 6,007, or 82 per cent of deaths.
Canadian triage protocols, during the COVID-19 crisis denied many elderly people and people with disabilities hospital admittance and often only offered these people morphine and comfort measures rather than effective treatment.

More articles on this topic: