Thursday, December 3, 2020

Bill C-7 should be put on hold until a thorough review of the euthanasia (MAiD) program is completed.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Jaro Kotalik, MD, MA, FRCPC, a professor at the Northern Ontario School of Medicine, Lakehead University wrote an excellent analysis of Canada's euthanasia (MAiD) law and concludes that Bill C-7, the bill to expand euthanasia in Canada, should be put on hold until the government has completed a thorough review of the MAiD program.

Kotalik explains:
Bill C-7, which proposes changes to medical assistance in dying (MAID) and is currently being debated by Parliament, must be rejected. This bill is dangerous because while it proposes to expand the criteria for determining who is eligible for MAID, it also eliminates certain existing safeguards.

The original MAID law (Bill C-14) holds that “robust safeguards, reflecting the irrevocable nature of ending a life, are essential to prevent errors and abuse in the provision of medical assistance in dying.” The new Bill C-7 has no such concerns.

Did society’s four-year experience with MAID show that errors and abuse do not happen? Not really. The reality is that governments (federal, provincial, territorial) have failed to provide sufficient, publicly accessible evidence to show that the MAID program is operating as mandated by the requirements of the law.
Kotalik examines the First Annual Report on MAiD that was released in July 2019. He states:
The First Annual Report on MAID was released by the federal government in July 2020. It provided the statistical data that some 13,000 persons have received assisted death and it contained anonymous profiles of MAID recipients and MAID providers. Regrettably, it did not systematically report on the adherence to eligibility criteria or safeguards that were prescribed by the law. In fact, for about 10,000 of these deaths, there is no publicly available evidence that the eligibility criteria and safeguards were ever respected, while for the other 3,000 deaths, only some information is available.

Astonishingly, the federal government, after having received data from MAID practitioners, does not consider it to be its responsibility to analyze and report on the issue of compliance with eligibility criteria.
Kotalik then explains that Canada's euthanasia law created an exemption in the criminal code for homicide, therefore transgression of the law remains homicide. He states:
Yet, these eligibility criteria and safeguards do not represent some bureaucratic red tape that can be easily ignored. Even when the MAID law is in force, the Criminal Code still holds that consent does not affect the criminal responsibility of any person who inflicts death on the person who gave consent, and that counselling or assisting in suicide remain indictable offences.

The section of the Criminal Code that we call MAID law just provides an exemption for physicians and nurse practitioners to terminate the life of a person if, and only if, these practitioners respect the eligibility criteria and safeguards as set out in the MAID law. If these conditions are not fulfilled, then the criminal law is transgressed. Given this situation, the responsible approach of the federal government would be to put on hold Bill C-7 until a thorough review of this program is completed. The MAID law of 2016 mandated that such a review by Parliament was to start in June 2020.
Kotalik then explains why he particularly opposes how Bill C-7 removes the ten day reflection period and the requirement of consent at the time of death. He states:
There are two changes proposed by Bill C-7 that I find particularly disturbing. The MAID law of 2016 stressed that “vulnerable persons must be protected from being induced, in moments of weakness, to end their lives.” For this reason, two safeguards were put in place. One was an obligatory 10-day reflective period between the request for death and actual provision of death; the second one was the requirement that the person be asked to verify their consent to death immediately before MAID was delivered. Both of those safeguards are being jettisoned by Bill C-7, which evokes in me a disturbing nightmare.

I imagine I am consulting Mr. Jay, a patient in hospital. I gently inform him that his cancer is metastatic carcinoma that can be treated and controlled, but not cured. He does not hear the rest of my message – that he can enjoy his remaining life of some months or even years – because he’s in shock after hearing the word “cancer.” I remain with him until he appears to have somewhat settled, and I promise to visit the next day. This is a common situation, and as an oncologist, I have dealt with it many times. Most patients who develop reactive depression gradually recover after the plans for care are made and they experience the support of their families and staff.

But in my nightmare, when I arrive the next day, Mr. Jay is gone. I then learn that shortly after my visit, he completed a form requesting MAID. A physician who had entered his room to discuss MAID with another patient was introduced to Mr. Jay, and because the information on his chart could be interpreted as him having “a grievous and irremediable medical condition,” a legal condition for eligibility, the MAID provider had a discussion with the patient, asked another doctor on the ward to co-sign the papers, and later fulfilled my patient’s request.

Kotalik clearly explains why Bill C-7 is dangerous because it proposes to expand the criteria for determining who is eligible for MAID, while eliminating certain existing safeguards in the law.


1 comment:

Unknown said...

What this doctor said is so, so true. I have two friends who died of cancer in their late 60s. One was diagnosed with inoperable colon cancer. She was told to handle it as a chronic illness, but one that would eventually take her life. She lived for four years after diagnosis. She taught crafting classes, enjoyed time at her community's senior center, and traveled with her husband. Another was diagnosed with ovarian cancer and was told that she would be fortunate to make for it two years. She pursued every treatment option available to her and lived for 4.5 years. She saw a granddaughter born and attended her baptism. She traveled much of the US in an RV with her partner. These two women were fortunate to live in the US with Medicare and supplemental health insurance. What would have happened if they had been Canadian citizens? Would they have been encouraged to give up on life much sooner and have doctor or nurse practitioner-hastened death by euthanasia? God forbid!