Monday, November 23, 2020

I hate to say that we were right but Canada’s law did not prevent euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alan Nichols died by euthanasia for mental illness in 2019
Parliament is currently debating Bill C-7, a bill to expand Canada’s euthanasia law.

During the debate on Bill C-14 (2016) we argued that the lack of definition in the bill would enable the law to be continuously expanded by doctors who support euthanasia.

Joan Bryden published an article for CP Press on November 22 titled: Exclusion of mental illness in assisted dying bill slammed by psychiatrists. In her article Bryden writes:

“Vancouver psychiatrist Dr. Derryck Smith, who has personally been involved in two cases where people suffering solely from severe mental disorders received medical help to end their lives. And he says he knows of other similar cases.”

One of the cases Smith took part in involved a woman of about 40 years old who suffered from a "severe, intractable eating disorder" and was intending to starve herself to death if she did not receive medical help to end her life.

"She was approved for assisted dying and received assisted dying just for a psychiatric illness, in this case anorexia nervosa."
When Smith admits to being involved with cases of euthanasia for mental illness alone, he is admitting that Bill C-14, in 2016, did not prevent euthanasia for mental illness or even prevent euthanasia for a person who was not terminally ill.

Since Bill C-14 did not define the phrase: natural death is reasonably foreseeable, and it did not define the term psychological suffering, therefore it did not prevent euthanasia for mental illness or limit it to terminally ill people.

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

Bill C-7, also does not define psychological suffering or the meaning of natural death is reasonaby foreseeable. Bill C-7 makes the situation worse because it also eliminates some key safeguards in the law.

If the government wants to exclude euthanasia for mental illness, Bill C-7 needs to define psychological suffering in a manner that excludes euthanasia for mental illness.

What does Bill C-7 do?

Bill C-7 removes the requirement in the law that a person’s natural death be reasonably foreseeable to qualify for MAiD. People who are not terminally ill can be killed by MAiD. The Quebec Truchon court decision, that led to Bill C-7, only required this amendment to the law, but Bill C-7 goes further.
1. Bill C-7 permits a medical practitioner to lethally inject a person who is not capable of consenting, if that person was previously approved for MAiD. The current law required consent at the time of death.

2. Bill C-7 waives the ten-day waiting period when a person is deemed to be “terminally ill.” A person could request death by euthanasia on a "bad day" and die the same day.

3. Bill C-7 creates a two track law. A person who is deemed to be terminally ill would have no waiting period while a person who is not terminally ill would have a 90 day waiting period.
If Bill C-7 is passed, a future court decision will strike down the 90 day waiting period for people whose natural death is not reasonably foreseeable because, this provision represents an inequality in the law.
4. Bill C-7 reduces the number of independent witness from two to one.

5. Bill C-7 falsely claims to prevent euthanasia for people with mental illness. The law permits MAiD for people who are physically or psychologically suffering in a manner that is intolerable to the person and that cannot be relieved in a way that the person considers acceptable. This is a completely subjective evaluation.
Since mental illness is already considered a form of psychological suffering, and since psychological suffering is not defined in the law, therefore Bill C-7 does not prevent euthanasia for mental illness.

Contact your Member of Parliament and tell them that Bill C-7 is a sham because it does not define the key terms, natural death is reasonably foreseeable and psychological suffering. The list of Members of Parliament:

Sunday, November 22, 2020

The Netherlands expands the rules for euthanasia of people with dementia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Euthanasia for people with dementia paves the way for non-voluntary euthanasia.

The Netherlands is quickly expanding the euthanasia rules The Netherlands government recently announced that they plan to extend euthanasia to children, they are also expanding euthanasia for people with dementia while, at the same time, the Netherlands government is debating euthanasia for healthy people who claim to have lived a "completed life."

The NL Times reported that the five regional euthanasia review committee's have agreed to expand euthanasia for people with dementia by loosening the requirements in four areas. The article stated:
The updated Euthanasia Code says that a dementia patient's statement requesting euthanasia does not have to be legally perfect. The statement, in which the patient describes the circumstances under which they want euthanasia, can sometimes be interpreted in multiple ways. Doctors will now have more room to interpret what the patient meant, for example by consulting family members.

Doctors will also be allowed to give a sedative to advanced dementia patients if they expect the patient will become aggressive or restless because they don't understand what's happening. The doctor also does not have to request a verbal confirmation from a patient with advanced dementia before the euthanasia procedure is performed. "Such a conversation is pointless, because such a patient lacks understanding of these topics," is stated in the code.

And it will be up to the doctor to assess whether a patient is suffering unbearably and hopelessly, the updated code reads. "The RTE should test that medical professional judgment with caution."
Not only do these new rules deny people with dementia the right to change their mind or consent at the time of death, but since they can be sedated, they will not even be aware that they are being killed.

The change in the rules for people with dementia is based on the decision by the Netherlands Supreme Court in April 2020, concerning the euthanasia death of an incompetent woman with dementia who resisted at the death.

According to the case, a woman with dementia stated in her advanced directive that she wanted euthanasia but when the doctor came to inject her she resisted. The doctor put drugs in her coffee to sedate her but the woman continued to resist so the doctor had the family hold her down while the doctor injected her.

The Netherlands euthanasia law which came into effect in 2002. In 2017 there were 6585 reported euthanasia (lethal injection) deaths representing almost 4.5% of all deaths.

According to the DutchNL news, the number of assisted deaths for dementia or psychiatric reasons also increased in 2017, with 169 people dying by euthanasia for dementia (3 were advanced dementia) and 83 people dying by euthanasia for psychiatric reasons. The new rules concerning euthanasia for dementia will likely lead to many more deaths.

When the Netherlands legalized euthanasia, they required the person to consent to their death. The Netherlands has now come full circle as they are now willing to kill people who cannot consent, whether they have dementia or are children.

Euthanasia for people with dementia paves the way to non-voluntary euthanasia.

Saturday, November 21, 2020

Canada’s claim to value seniors & disabled people rings false during COVID-19 pandemic

By Taylor Hyatt

Euthanasia Prevention Coalition board member & disability rights activist 

Canada's Maclean’s magazine has been running a series of articles on aspects of life turned upside down in the chaos of 2020. On their list of “14 things 2020 proved wrong” is the assumption that “Canada values its seniors” – not to mention younger disabled people who also live in congregate care settings.

Author Christina Frangiou’s piece begins on a jarring note, quoting a nurse in a Toronto-area hospital who called octogenarian Mary Wilton “a waste of space” while caring for her in the summer of 2019. Ms. Wilton’s daughter, Alison, says that her mother has been on the receiving end of many forms of age discrimination in the last decade as her needs changed. In addition to “callous comments, she condemns “unaffordable housing, insufficient home care, wait lists for long-term care and a lack of support for [caregivers].” As Alison Wilton notes, “[All of these problems] existed prior to the pandemic but worsened over 2020,” and it’s all dismissed as people in power say “Well, they’re old anyway.” In addition to the ageism the Wiltons observed, these problems stem from an apathy towards disability – both in younger people and as an effect of aging.

For nearly two decades, government officials have repeatedly promised to improve long-term care, and provide other services that older adults need to remain in their homes safely. Ms. Frangiou quotes former Ontario minister of health and long-term care George Smitherman; he said in 2004: “We need to change the culture of long-term care in this province…”.

Little has changed since then. The coronavirus pandemic has exposed authorities’ lack of action – and willpower – in this department. Ms. Frangiou quotes some sobering facts:
  • “[By] the summer, over 80 per cent of all COVID-19 deaths in Canada occurred in nursing and retirement home settings – nearly twice the Organisation for Economic Co-operation and Development (OECD) average, even though Canada’s total COVID-19 mortality rate was comparatively lower.”
  • “[The] military was called into long-term care homes in Quebec, [and] the Canadian Red Cross was summoned into some Ontario homes” when staff became overwhelmed with the number of sick residents, or homes faced staffing shortages when personnel themselves became ill. 
  • Finally, provincial leaders are dismissing the deaths of elderly, ill, and disabled people as acceptable losses. “In Manitoba, Minister of Health Cameron Friesen [has said] that deaths in personal care homes are ‘tragic’ but ‘unavoidable.’ In Alberta, Premier Jason Kenney noted this spring that many people dying from COVID had already surpassed their life expectancy.” 
I find that last point particularly revolting. To rephrase it: because a long-term care resident has already lived longer than estimated, their preventable death – from an illness that has devastating effects even on younger people who contract it – is suddenly something we should shrug our shoulders at? Of course, we can't and shouldn't expect to prolong life, especially with the use of painful and extraordinary measures. Yet why should age, or associated disabilities, make someone less worthy of treatment? 

Healthcare systems in Quebec and Ontario have already faced criticism for ableist triage protocols implemented earlier in the pandemic, and these politicians’ remarks are rooted in the same attitude. Last but not least – as I've written before, not everyone who lives in an institution is an elder at the end of life.

Ms. Frangiou continues: 
“Even before the pandemic…430,000 [Canadians] reported having unmet home care needs, according to the National Institute on Aging. Many lack the funds to pay out of pocket for care: in 2016, 14.5 per cent of older Canadians lived in low-income households, according to census data from Statistics Canada.” 
The idea that aging in place depends on how much a person can afford to save is – as Toronto geriatrician Dr. Amina Jabbar says –  “grossly inequitable.”

Euthanasia Prevention Coalition executive director Alex Schadenberg calls attempts to reform long-term care facilities “band-aids.” He hopes that, if sufficient supports are provided that “more family and community support would develop over time.” Although he “applauds” provincial governments who fund renovations to make houses more accessible, these programs are “too little, too late” compared to the much greater cost and ease of keeping someone in an institution.

Dr. Vivian Stamatopoulos, a teaching professor at Ontario Tech University, sums up the truth at the heart of the situation. 
“People don’t want to think about the elderly because it’s sad, [or] because they just don’t see them.” 
This is largely true of younger disabled people as well. Initiatives to help them live in their own homes – outside of institutions – began in earnest with Ed Roberts and other disabled American students in the 1960s. Although Canada likes to present itself as a defender of equality, we must remember that this movement only reached Canada a few decades ago. (I'm at the end of my twenties, and my parents were young children then!) Even today, advocates such as Daniel Pilote, Jonathan Marchand, Tyson Sylvester and Amy Hampton work to make a truly dignified life in the wider community possible. Unfortunately, it seems decades will pass before more Canadians realize the importance of their efforts and the thanks they are due.

Friday, November 20, 2020

A suicide prevention story from a Canadian psychiatrist.

I received the following message from a Canadian psychiatrist who gave permission to publish it.

From the diary, a lived experience of a psychiatrist:

“I spent over 4 hours on Tuesday night talking a chronically suicidal patient out of jumping off a bridge after multiple suicide attempts in the past two months, and convinced her to meet me at the hospital to get treatment that she needed to stay stable. A phone conversation that began with her at the bridge saying: “I just want to die”, ended 5 hours later, not with tragedy, but thankfully with a renewed sense of hope in the patient, and a desire to try again to work together toward a better path.

That critical conversation was a continuous see-saw, a battle between the will to live and the desire to die. The turning point arrived with the offer to accompany her to hospital. She needed someone trustworthy to be there for her, to be present with her, and to stand beside her in her darkest hour. It required a firm stance on the part of her doctor, a firm commitment to not give in to the deception of death, and a literally extended hand (albeit gloved during this pandemic) to pull someone back from the brink of death. Deeds of love and compassion, words of faith, hope, and affirmation offer dignity to broken souls, heals the body, eases the mind, and revives the spirit.

Are we our brother’s keeper? In today’s world, we must rise to the call to care for one another, especially for those who are most helpless. We must be the ones to stand in the gap and give hope and reason to pursue life again. When the medical system had nothing left to offer my patient (hospital admission was deemed ineffective and usually more harmful) after her more than 7th attempt in the last couple of months and a revolving door pattern in and out of hospital, she cried through her tears: “Doctor, thank you for not giving up on me.” And when I asked her after, as she contemplated ending her life after she had already called other supports and didn’t find them to be helpful, what stopped her from jumping? She looked directly into my eyes and exclaimed: “YOU! When you called me! THAT's what stopped me!”

Never underestimate the power of one’s words, the power of one's presence, the impact of love, genuine care and compassion, and the effect that one's willingness to go that extra mile in accompanying another in their pain can have in a moment of great darkness. Be a light, a firm sturdy hand to show the way. And never, never, give up.”
Celebrating more than 1025 signatures on the declaration!

90-year-old woman dies by (MAiD) euthanasia rather than go through another COVID-19 lockdown.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Canada's parliament is currently debating Bill C-7, a bill to expand (MAiD) euthanasia in Canada to people who are not dying.

Even though Bill C-7 is not yet passed,  CTV News Medical Correspondent, Avis Favaro, reported that Nancy Russell, a 90-year-old long-term care resident, who was not chronically ill or dying, died last month by euthanasia (MAiD) to avoid living through another COVID-19 lock-down. 

Favaro reports:
Across Canada, long-term care homes and retirement homes are seeing rising cases of COVID-19 and deaths yet again, a worrisome trend that is leading to more restrictions for the residents. 
But these lockdowns are taking another toll among those who don’t get COVID-19.

Residents eat meals in their rooms, have activities and social gatherings cancelled, family visits curtailed or eliminated. Sometimes they are in isolation in their small rooms for days. These measures, aimed at saving lives, can sometimes be detrimental enough to the overall health of residents that they find themselves looking into other options.

Russell, described by her family as exceptionally social and spry, was one such person. Her family says she chose a medically-assisted death (MAID) after she declined so sharply during lockdown that she didn’t want to go through more isolation this winter.
Nancy Russell
Russell, who was a supporter of euthanasia, when first requesting "MAiD" was turned down. The doctor told her that she had "too much to live for." But she was then approved after her second request. The report stated:
By the time she applied a second time, “more concrete medical health” issues had developed, her daughter said.

This time, doctors approved her. Russell would not have to go through another lockdown in her care home.

“She just truly did not believe that she wanted to try another one of those two-week confinements into her room,” her daughter said.
Doctor shopping is a clear concern with Canada's euthanasia law. Russell was probably sent, the second time, to a doctor who provides euthanasia. Canada's euthanasia law is based on subjective rules.

In August 2020, Rob Munro reported a similar story for the Kelowna Infonews. Shirley Turton (78), asked her family to arrange a "MAiD" death because she felt "locked into a long term care prison" due to COVID-19.

Munro reported that the daughter of Shirley Turton said that her mother is not terminally ill but she had become:

depressed, not interested in eating and can’t even put a glass of water to her lips but, most of all she is lonely.
Turton didn't die by euthanasia, but it is impossible to know how many Canadians have died by euthanasia based on the COVID-19 lock-down.

For instance, the Ontario data does not indicate how many MAiD deaths are based on similar reasons to Nancy Russell's death but recent Ontario MAiD statistics indicate that the number of euthanasia deaths is increasing.

From June 17, 2016 to October 31, 2020, there were 6266 reported assisted deaths in Ontario. There have been 1948 reported assisted deaths in 2020 representing 1127 in the first six months of 2020 and 821 in the last four months (now averaging more than 200 assisted deaths per month) in Ontario.

Canada's MAiD law permits euthanasia for people who are physically or psychologically suffering that is considered intolerable to the person and that cannot be relieved in a way that the person considers acceptable. 

Thursday, November 19, 2020

Who really wants to die? Part VII: The justification of Canadian-style euthanasia cannot be found in any rational dynamic of market economics

Gordon Friesen
Gordon Friesen, EPC board member

As a general principle, the means taken to address an issue should be proportional to the issue itself. We do not, for instance, use a baseball bat to swat a fly.

The specific point of this series of articles has been to demonstrate that there is very little organic consumer demand for euthanasia as compared to the scale as it is currently being developed and marketed in Canada.

Let us briefly resume our evidence:

A great deal of literary romance has been created around the idea that survivors of catastrophic injury, and particularly those paralysed by damage to their spinal cords would naturally rather die than live in such a diminished state. In actual fact, however, only about one percent of these people will really commit suicide (in the entire first critical five years following injury) and subsequent suicide rates for this group are statistically normal.

In the worst phase of the AIDS epidemic, that is in the late eighties and early nineties (before effective treatments were available), a literary romantic ideal of voluntary death arose within the homosexual community which sparked the most powerful suicide trend ever seen. Assisted suicide became a community ritual. Universal approval was shown throughout the literary class. However, in actual fact, only somewhat less than two percent of people living with AIDS died by suicide during that period, and following that time, suicide rates among this group have returned, essentially, to normal (when adjusted for other factors such as high suicide among intravenous drug users who also belong to this cohort).

In sum, spinal injury and AIDS were the two most important areas where it was claimed that assisted suicide must be provided in order to satisfy a genuine (and justified) demand. “Normal” people were universally groomed to believe that “they”, also, would wish to die should they be injured, or become ill, in such ways. But none of that literary work of idealized voluntary death was based upon reality.

More recently, we have been assailed with literary depictions of death in circumstances of excruciating and unmanageable suffering. Euthanasia, we are told is the only route to humane end-of-life care. Terminal cancer, in particular, was described as a condition which could only rationally end in euthanasia. “Normal” people, once again, were groomed to believe that they would, indeed, wish to be euthanatized at such a time.

(It is mysteriously omitted from this portrait that the control of discomfort is now infinitely superior to anything ever known before; that people had been dying in much worse circumstances since the beginning of time; and that, far from hastening death, the development of humane society had been characterized by a growing recognition of the need to protect the dying from the murderous instincts of their entourage).

In actual fact, however (once again), we noted that in the most euthanasia-prone area of the world (the Netherlands and Flemish Belgium), after twenty years of wide-spread access to legal euthanasia, only approximately ten percent of terminal cancer patients currently die in that manner.

And therefore, bringing all of this information together, we see that the maximum organic demand for euthanasia (absent the powers of suggestion and institutional normality) would be: one percent of catastrophic injury survivors (spinal cord paralysis, amputees, etc.); perhaps two percent of degenerative illness sufferers (AIDS, ALS); and ten percent of terminal cancer patients. While for clarity, the corresponding rates of euthanasia refusal would be: 99, 98, and 90 percent respectively.

On the other hand, in order to provide euthanasia service in Canada, it has been decided: that the practice of medicine should be fundamentally altered by declaring euthanasia as a benign form of medical care; that all patients possess a universal, state-guaranteed right to that care; that all doctors and other medical staff be granted a literal “licence to kill” in the institutional context; that euthanasia providers not even require individual selection or certification; that euthanasia be performed in all medical institutions; that, going forward, euthanasia be emphasized in training as a normal expectation of students and professionals; that the new culture of euthanasia attain institutional dominance through the suppression and replacement of euthanasia opposition in positions of medical leadership; and finally: that the imperative need for universal euthanasia access justifies the correspondingly inevitable development of therapeutic environments (hospitals and clinics) which will become increasingly (and predictably) more hostile to those patients (the vast statistical majority) who will still refuse to voluntarily receive the “assistance” in dying that has been so reasonably provided for them.

And all of this (the popular romantic literary pornography of “intolerable suffering” notwithstanding) done in order to address an organically expressed demand from one, two, or in some specialties, perhaps, a maximum of ten percent of the clientele.

In other words: conceived merely as a consumer-driven economic phenomenon, euthanasia (as currently provided through the Canadian public healthcare system) makes no sense whatsoever!

This is indeed an astonishing but largely unstated fact which is of the greatest importance for Canadian citizens; because nothing in the realm of public policy happens for nothing; and therefore: If the reason for maximizing euthanasia availability is NOT economic – is NOT meant to satisfy consumer demand -- then what on earth IS it for?

And with that question in mind, I now intend (with the reader’s permission), to begin a new series of articles entitled: What is the “Good” of Euthanasia? Which will examine exactly what place (if any) assisted death might more appropriately claim to occupy among us; in consideration of the various moral (and other) justifications currently offered for providing (or restraining) this practice.

This article is the seventh in a series of articles:
  1. Who really wants to die? Part 1: A brief quantative analysis of the purported "need" for euthanasia (Link). 
  2. Who really wants to die? Part 2: The popular impact of celebrity suicide (Link). 
  3. Who really wants to die? Part 3: Life choices of the common person (Link).
  4.  Who really wants to die? Part 4: The true scale of demand for euthanasia in Canada (Link). 
  5. Who really wants to die? Part 5: The absence of suicidal desire amongst the survivors of catastrophic injury. (Link).  
  6. Who really wants to die? Part 6: Aids in the Eighties and Nineties and the literary ritual of assisted suicide. (Link).

Gordon Friesen, November 19, 2020