Saturday, July 25, 2020

Canada's MAiD report: 26% increase in 2019 euthanasia deaths. The hidden story of abuse.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Health Canada released the first annual report on (MAiD) euthanasia and assisted suicide. The data was gathered from the reports submitted by the medical or nurse practitioners who caused the death. There is no requirement that a third party or neutral person submit the euthanasia reports to insure their accuracy.

Unlike the most recent Québec euthanasia report (October 2019), the data in this report does not attempt to uncover potential abuse of the law. The data in the Québec report indicated that at least 13 assisted deaths did not comply with the law.

The report concerns the 2019 Canadian MAiD deaths indicates that the number of assisted deaths is increasing:
  • In 2019, there were 5,631 MAID deaths reported in Canada, up from 4467 in 2018, accounting for 2.0% of all deaths.
  • The number of cases of MAID in 2019 represented an increase of 26.1% over 2018 with every province experiencing a steady growth in the number of cases of MAID since its introduction into law in 2016.
  • When all data sources are considered, the total of number of medically assisted deaths reported in Canada from legalization until December 31, 2019 is 13,946.
MAID is most often administered in a home or hospital setting.
  • The primary settings for the administration of MAID are hospitals (36.3%) (excluding palliative care beds/units) and patients’ private residences (35.2%). The remaining cases of MAID occurred in palliative care units (20.6%) and residential care (6.9%) or other settings (1.0%).
  • There were 1,271 unique practitioners who provided MAID in 2019. MAID was provided most frequently by a family medicine physician (65.0%), followed by palliative medicine specialist (9.1%) and anesthesiologists (5.0%).
Nature of suffering among MAID recipients
  • Practitioners reported that suffering among MAID recipients was closely tied to a loss of autonomy.
  • The most frequently reported reason for the patient's intolerable suffering was loss of ability to engage in meaningful life activities (82.1%) followed closely by loss of ability to perform activities of daily living (78.1%), and inadequate control of symptoms other than pain, or concern about it (56.4%).
One-quarter of written requests for MAID did not result in an assisted death
  • there were 7,336 written requests for MAID reported through the MAID in 2019. Of these requests, 26.5% (or 1,947) did not result in a MAID death, because the patients died before receiving MAID (57.2% or 1,113 cases), were deemed ineligible (29.3% or 571 cases), or they withdrew their request (13.5% or 263).
  • The most frequently reported reasons why a person was deemed ineligible for MAID (7.8% of written requests) were: lack of capacity to make health care decisions (32.2%); the individual’s natural death was not reasonably foreseeable (27.8%); and the individual was not in an advanced state of irreversible decline in capability (23.5%).
  • Of those persons who were assessed as eligible for MAID, but did not receive it, the majority died of another cause prior to administration (15.2%), while a small number (3.6%) of persons withdrew their request after having been deemed eligible.
The report acknowledges that many people start the MAiD process with an oral request, but the law only requires tracking once a written request has been made. Therefore some requests for MAiD are not reported.

The report indicates that 20.6% of the assisted deaths were done in a palliative care setting and 9.1% were done by a palliative care specialist. 

Palliative care and hospice professionals and organizations opposed the legalization of MAiD and are now being forced to participate. The Delta Hospice Society, which is an independent hospice charity, has is being forced by the British Columbia Health Minister to provide euthanasia or lose their funding.

The report indicates that the federal law does not force physicians or nurse practitioners to participate in MAiD, and yet some provinces are pressuring medical practitioners to participate. 

In May 2019, the Ontario Court of Appeal ruled that doctors, who oppose euthanasia, had to participate in the act by doing an effective referral. In March 2020, the Physicians Alliance Against Euthanasia reported that a growing number of physicians are being bullied to participate in MAiD.

Roger Foley
The report indicates that 41.2% of those who died by MAiD, in 2019, required disability support services, and 89.8% were receiving those services. The data doesn't provide information as to the level of services. There are people with disabilities who have been denied the level of support that they needed but instead offered MAiD. For instance, Roger Foley of London Ontario was turned down for self-directed home-care but offered euthanasia.

Candice Lewis
The report does not attempt to uncover abuse of the law and it didn't track stories that were negative to euthanasia. For instance, in August 2016, Candice Lewis (25) while receiving treatment at a Newfoundland hospital was pressured to "request" an assisted death.

No one questions that Candice was very sick, but as Candice's mother told CBC news, the doctor pressured her to request physician-assisted death, Candice never asked for it.

Alan Nichols (Center)
In August 2019, Alan Nichols died by euthanasia, even after his family insisted that Alan was not competent to make this decision and that he was living with chronic depression.

  • Do you have a story about euthanasia or assisted suicide (Link).
In September 2019, Justice Baudouin, struck down the requirement in Canada's euthanasia law that a person be terminally ill. The federal government did not appeal the decision.

I reported that striking down the "terminal illness" requirement in the law opened the door to euthanasia for psychiatric conditions (Link).

On February 24, Canada's federal government introduced Bill C-7 to expand the euthanasia law.

What does Bill C-7 do?

1. Bill C-7 removes the requirement in the law that a person’s natural death be reasonably foreseeable in order to qualify for assisted death. Therefore, people who are not terminally ill can die by euthanasia. The Quebec court decision only required this amendment to the law, but Bill C-7 went further.

2. Bill C-7 permits a doctor or nurse practitioner to lethally inject a person who is incapable of consenting, if that person was previously approved for assisted death. This contravenes the Supreme Court of Canada Carter decision which stated that only competent people could die by euthanasia.

3. Bill C-7 waives the ten-day waiting period if a person's natural death is deemed to be reasonably foreseeable. Thus a person could request death by euthanasia on a "bad day" and die the same day. Studies prove that the “will to live” fluctuates.

The report indicates that in 65.7% of MAID deaths, MAID was provided following the 10-day reflection period. In the 34.3% of MAID deaths where this period was shortened, most practitioners (84.4%) cited imminent loss of the patient’s capacity to consent as the primary reason, with imminent death cited in 45.4% of these cases.

Bill C-7 does not need to eliminate the 10 day waiting period because more than one-third of the deaths, the waiting period is already waved.

For instance, in November 2016 EPC reported the case of a woman who may only have had a bladder infection who died by euthanasia. Even in this case, soon after legalization, the doctor waved the 10 day waiting period.

4. Bill C-7 creates a two track law. A person whose natural death is deemed to be reasonably foreseeable has no waiting period while a person whose natural death is not deemed to be reasonably foreseeable would have a 90 day waiting period before being killed by lethal injection.

5. As stated earlier, Bill C-7 falsely claims to prevent euthanasia for people with mental illness. The euthanasia law permits MAiD for people who are physically or psychologically suffering that is intolerable to the person and that cannot be relieved in a way that the person considers acceptable. However, mental illness, which is not defined in the law, is considered a form of psychological suffering.

Bill C-7 goes much further than the Quebec Superior Court Truchon decision.
The Canadian government must reject Bill C-7 and begin the promised 5-year review of the euthanasia law with an open view to what is actually happening rather than continuing to expand euthanasia, making Canada the most permissive euthanasia regime in the world.
  • Five reasons to oppose euthanasia and assisted suicide (Link).
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