Care for People with Cognitive Impairment: Don’t Euthanize Them

By Dr Paul Saba is co-founder of Physicians for Social Justice and is the author of a book entitled “Made to Live.” 

The proposed Bill 38 being debated in the Québec National Assembly is dangerous. Cognitively impaired people will be allowed to decide by advanced directives the ending of their lives via lethal injection by euthanasia. This should not happen. Quebec parliamentarians must vote no to Bill 38. (Link to Bill 38).

Henriette is a woman in her 70s who has been experiencing slow cognitive decline and has been my patient.

Her daughter is a busy real estate agent who until recently was able to help care for her mother who lived downstairs in a duplex they shared. Now that the care required is more than the homecare services can offer, she was transferred to a nursing home. The memory loss has been slow and progressive but slowed down by adjusting her medications including medication for memory loss. The support that she received at home had been helpful but inadequate for Henriette to remain at home which had been her desire. Her daughter wants her mother to live with the best care possible rather than see her life prematurely ended by euthanasia.

Some of my patients have cognitive impairment for many different reasons. Most are elderly and have chronic health problems including arthritis, diabetes, lung, heart and kidney disease, anxiety and depression. The combination of physical and psychological conditions with the side effects of the medicines impact on their mental capabilities.

The challenges of cognitive decline

There are different stages of cognitive decline. These stages can be broadly categorized as mild, moderate, or severe. The decline can be variable in its progression. There are several factors that can slow the progression of the disease. Because dementia has many different causes, there are also many different treatments and ways to slow the decline. Chronic diseases such as diabetes, heart disease, B12 deficiency must be optimized. Medicines that impact on memory loss must be changed. When possible encouraging more physical and mental activity can slow down memory deterioration. Music and art can help.

There are healthy brain diets. There are psychological and social contributions; in addition, new drugs are continually coming to market that need to be administered at early stages of the condition to have the greatest impact. Having access to geriatricians and neurologists who specialize in cognitive decline is essential. Unfortunately, the wait times for access to specialists and memory assessment centers are long.

• The fragility of caregivers and external pressure on people with cognitive decline. 
• Fatigue and burnout take their toll on primary caregivers who feel overwhelmed and abandoned.  
• They often react emotionally at the request of their loved ones.
  

People who request Medical Aid in Dying (MAID) often do so because they do not want to be a burden on their loved ones and caregivers. It is common knowledge that people do not make the best decisions when they are depressed or exhausted. It is not a question of euthanizing their loved ones, but of bringing help and respite to these caregivers.

Conclusion

In Quebec, with significant investments in research, we can develop promising treatments that can not only slow disease progression, but reverse cognitive impairment. Quebec must become a society that provides the best care for people with cognitive impairment, including home care-not MAID. 

We need to care for people with cognitive impairment not euthanasia them.

Dr. Paul Saba is head of the Physicians Committee at Lachine Hospital and the founder and President of Physicians for Social Justice.

Disabled Canadian Woman Requests Euthanasia As She Waits For Surgery

This article was published by National Review online on May 28.

Wesley Smith

By Wesley Smith

A Canadian woman with a serious neuromuscular condition has been unable to obtain an appointment to see a neurosurgeon for four years. From the CTV story:

Ashcraft has something called Ehlers-Danlos syndrome, or EDS, a group of inherited disorders that affect connective tissue. “It’s bulldozed my life,” she said, adding that it took years to get an accurate diagnosis.

For her, it means wearing a brace to keep her neck stable. She also has constant joint pain and feels weak.“I’m in terrible chronic pain,” she said. “The pain is horrendous.”

On bad days, she said it “feels like an axe in the back of my head.” She can’t work, and spends most of her days in a medical bed at her home.

Despite pain medications, Ashcraft said her condition is getting worse. She wants surgery to stabilize her neck.“ Surgery, it can reduce my pain. It will also keep me much safer because it’s dangerous to have an unstable upper neck,” she explained.

She accepts that nothing will “cure” her EDS, but she believes surgery will make her more comfortable. But she said she’s been waiting almost four years to see a neurosurgeon, and still has not received an appointment.

The video above is the woman's story as posted on youtube.

She checked to see if she could be treated in the U.S. Yes, but at the cost of $100,000. She has asked the BC Provincial Government to pay for it. After all, free health care and all that. So far, she has not heard anything.

In desperation, she is now contemplating a lethal jab:

With nowhere to turn and little hope, a struggling Ashcraft has been contemplating MAiD. “I don’t want my family to watch me suffer like that for years on end,” she said. “Death still kind of scares me, but what fears me more is that I’m starting to lose my fear of death,” she added.

But, but, but euthanasia = Compassion! Ditto, single-payer health-care! Right?

Great news: 31-year-old woman who was approved for euthanasia based on MCS has found a clean place to live.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have great news.

A 31-year-old woman who was approved for (MAiD) euthanasia based on her condition that (MCS) that causes her to have strong allergic sensitivities to chemicals, has been helped by individual donors who have enabled her to move to a location that does not trigger her allergic sensitivities.

On April 30th, Avis Favaro, the CTV National News Medical Correspondent, reported that a 31-year-old Ontario woman was approved for (MAiD) euthanasia for chemical sensitivities. 

Favaro reported that Denise (not her real name) is diagnosed with Multiple Chemical Sensitivities (MCS), which triggers rashes, difficulty breathing, and blinding headaches called hemiplegic migraines that cause her temporary paralysis. Favaro reported:

She desperately wants to move to an apartment that’s wheelchair accessible and has cleaner air. But her only income is from Ontario’s Disability Support Program (ODSP). She receives a total of $1,169 a month plus $50 for a special diet. "I've applied for MAiD essentially...because of abject poverty," she said.

Favaro followed-up on this story and reported on May 28 that: 

She told CTV News at the time that she had spent months trying to secure housing with cleaner air and essentially gave up and was cleared by two doctors as qualifying for an assisted death.

But now she's found a temporary home, is no longer struggling for every breath and her extreme suffering has lessened, her application for MAID is on pause. However, Denise says she has not cancelled the MAID application outright as she still has several other pain-causing chronic health issues that haven't been properly addressed.

Favaro reported that:

After the story garnered worldwide attention, supporters set up a GoFundMe campaign that has now has amassed over $65,000 in donations from nearly 1,000 people along with countless emails of encouragement.

The Euthanasia Prevention Coalition promoted the GoFundMe campaign and helped to raise the $65,000. But we recognize that "Denise" has not yet decided to live, she has only temporarily put her death on hold. The problem remains, death is considered an answer to human problems.

We believe in a society that cares for people like "Denise" and does not abandon her to death.

Living with Dignity responds to Québec euthanasia expansion Bill 38

Living with Dignity's reaction to the tabling of Bill 38 in Quebec

Serious ethical issues on the horizon: how to adopt measures of such magnitude in three weeks?

Urgent need to reflect further on human dignity and its impact on our social choices

Montreal, May 28, 2022 – The Minister of Health and Social Services, Mr. Christian Dubé, tabled on May 25 a bill to amend the Act respecting end-of-life care and other legislative provisions.

You can read it here.

In addition to complying with the Federal Bill C-7 (withdrawal of end-of-life criteria) and extending access to medical aid in dying (by advance request) to persons who are incapable, as we had feared, this bill contains a very unpleasant surprise: the obligation for hospices to offer medical aid in dying, unless there is an exception - an item that was unfortunately not part of the press release (available in French only), and only briefly mentioned during the Minister's press conference.

We opposed all of these measures in our August 2021 brief to the Quebec Select Committee. We will actively participate in the upcoming consultations. We are particularly distressed to see that the Quebec government is giving in to the demands of the most militant groups and individuals in favour of an all-out expansion of MAiD by lifting the clause for conscience protection that hospice care teams have benefited from since the adoption of the provincial law in 2015. Of the 37 hospices in Quebec, 16 still refuse to offer medical aid in dying under their roof. Do we really want to impose on 43% of hospices a gesture that is in flagrant contradiction with the principles of their team members?

We urge the members of the Quebec National Assembly to refuse to adopt such a major bill in three short weeks. Whether one agrees or not with the provisions of the legislative project, it concerns very serious ethical issues. There is no justification for such a rush.

Media contact:

Jasmin Lemieux-Lefebvre
Coordinator
Living with Dignity
directionVDD@gmail.com

 

Québec debates bill to permit euthanasia for incompetent people.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Québec National Assembly has introduced Bill 38, a bill to expand Québec's euthanasia law. Bill 38 is Québec's response to Truchon court decision, the federal passage of Bill C-7 in March 2021 and the report of a Québec government committee that supported euthanasia for incompetent people but not for mental illness.

Article: Québec Committee supports euthanasia for incompetent people but not for mental illness (Link)

Bill 38 removes the requirement that a person needs to be at the "end of life" to die by euthanasia, it permits euthanasia for incompetent people who requested it in their advanced directive and it permits euthanasia to be done by nurse practitioners, among other changes. Bill 38 does not permit euthanasia for mental illness alone, as the federal legislation, Bill C-7 had done.

Bill 38 removes conscience protections that were in the original Québec regulations which will force all hospices to provide MAiD (euthanasia). Bill 38 is expanding the law in accord with the demands of the euthanasia lobby.

Bill 38 refers to euthanasia for incompetent people who had requested it in their advanced directive as a "contemporaneous request" where the “advance request for medical aid in dying” or “advance request” where it is made in anticipation of a person becoming incapable of giving consent with a view to an administration of such aid after the onset of that incapacity.

Permitting euthanasia by advanced consent creates several problems, even for people who believe in euthanasia. First, advanced request creates the problem of who will decide the time and place of the lethal injection. Secondly, since the person is deemed incapable of consenting, it denies the person the right to change their mind.

Further to the problems with advanced requests to be killed, Bill 38 will allow a "third" person to make the request in the presence of the person, when the person is unable to sign and date the request form.

To qualify for an advanced request for euthanasia the patient must:

29.2 With the assistance of that professional, the patient must describe in detail in the request the constant and unbearable physical or psychological suffering which cannot be relieved under conditions the patient considers tolerable that will determine, when the patient has become incapable and when a competent professional finds that the patient is experiencing such suffering due to their illness, the time from which the patient considers it appropriate to obtain medical aid in dying.

The reasoning for euthanasia is completely subjective. It states that the constant and unbearable physical or psychological suffering which cannot be relieved under conditions the patient considers tolerable. A person who is seeking death simply has to say that the suffering that they are experiencing is intolerable. People can be killed without objective criteria.

The medical professional in 29.3 only needs to:

(1) be of the opinion that the patient meets the criteria set out in section 29.1

A person is killed and the medical professional is only "of the opinion" that the person meets the criteria of the law.

Bill 38 is designed to protect medical professionals from being charged or sued for misconduct rather than ensure that the person who is being killed actually meets the criteria of the law.

The advanced request can one or two trusted "third persons" who would decide when the person, who has become incompetent, should die.

Once the advanced request for euthanasia is made the information will be maintained in a register of requests.

Section 29.9 allows a person to withdraw the advanced request at any time. The problem is that the person makes an advanced request because they anticipate that their condition will lead to becoming incompetent. Once a person is incompetent, they cannot legally change their mind.

Section 29.15 states that before administering medical aid in dying following an advance request, the competent professional must

(1) be of the opinion that the patient meets the following criteria:

It doesn't matter what the criteria states, the medical professional only needs to be of the opinion. To be of the opinion means that if someone complains that something wrong has happened, the medical professional is protected since they only need to be of the opinion...

At least the Québec government recognized that someone who changes their mind might resist and indicate that they don't want to die. Bill 38 states at the end of section 29.15:

Any refusal to receive medical aid in dying expressed by a patient must be respected and it is prohibited to disregard it in any manner.

The Euthanasia Prevention Coalition recognizes that Bill 38 does not extend euthanasia to people with mental illness alone, nonetheless, the federal government extended euthanasia to people with mental illness alone with the passage of Bill C-7.

It is interesting that Bill 38 describes the process that the committee examining the euthanasia reports must go through to determine that a euthanasia death did not fit the criteria of the law and yet the medical professional must only be of the opinion that the person who was killed fit the criteria of the law. Once again, the law is designed to appear to provide effective oversight of the law, whereas, in reality the law lacks any effective oversight.

Swiss Medical Association approves "tighter" assisted suicide guidelines.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Swiss Medical Association have published new guidelines concerning assisted suicide for healthy people. According to the Swiss Academy for Arts and Sciences the new guidelines state:

assisted suicide for healthy persons is not medically and ethically justifiable according to the guidelines. Assisted suicide is justifiable in the case of a patient with capacity if he or she is suffering unbearably from the symptoms of an illness and/or functional impairments, the severity of the suffering is substantiated by an appropriate diagnosis and prognosis, and other options have been unsuccessful or are rejected by the patient as unreasonable.

In order to ensure that the desire for suicide is well-considered and enduring, the guidelines now specify that the physician must – other than in justified exceptional cases – conduct at least two detailed discussions with the patient, separated by an interval of at least two weeks.

The patient’s desire not to continue living in this situation of intolerable suffering must be comprehensible to the physician on the basis of the previous history and repeated discussions. However, an objective determination of suffering is neither possible nor required by the guidelines. The guidelines also emphasize, however, that patients cannot claim to be entitled to assisted suicide, and that physicians are free to decide whether or not to consider this option.

The Swiss Medical Association appears to be wanting to curtail assisted suicide for people who are not sick or dying and yet the guidelines remain open to interpretation. Since the decision is based on "intolerable suffering" which they admit is not objective, therefore assisted suicide for healthy people will not be eliminated with these guidelines. The requirement that there be at least two discussions no less than two weeks apart will at least slow down the assisted suicide approval process.

Japanese dystopian euthanasia film "Plan 75"

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Jurgen Hecker wrote a film review of the Japanese dystopian euthanasia film "Plan 75" that was published by Japan Today on May 22. "Plan 75" reportedly shook audiences to the core at the Cannes film festival.

"Plan 75" responds to the aging demographic of Japan with a dystopian vision of a government program that would encourage people to die by euthanasia at the age of 75. Hecker wrote:

In the movie, anybody over 75 is encouraged to sign up for a deal with the government by which they receive a sum of money in return for agreeing to be euthanised. A collective funeral is thrown in for free.

Japan is the most rapidly aging population in the world. Japanese director and writer Chie Hayakawa stated:

"On the face of it, the government's Plan 75 is full of goodwill and friendliness and pragmatism, but in truth it is both very cruel and shameful,"

"I wanted the images to be aesthetic and beautiful, as well as cold and cruel, just like the plan itself,"

Hayakawa's first full-length feature film, is full of slow sequences with minimal camera movement. Hecker reported Hayakawa as stating:

"If such a plan was on the table today, I believe that many people would accept it, even welcome it as a viable solution,"

"Most young people worry already what the end of their life will look like. Will their basic needs be met? Can they survive once they live alone? Can they afford to age?"

"What worries me a lot is that we're in a social reality that would very much favor such a radical solution,"

"It's scary."

The Netherlands have been debating the concept of "completed life" for several years, whereby a person who is 75 could die by euthanasia. The Netherlands Council of State published a report from December 2020, explaining why they rejected a "completed life" bill that was sponsored by the D66 MP Pia Dijkstra.

 

Australian assisted dying law forces religiously affiliated medical institutions to provide euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

New South Wales is the final Australian state to legalize euthanasia with a catch, the Voluntary Assisted Dying bill forces religiously affiliated medical institutions to provide euthanasia.

As stated by Michael Cook, the editor of Bioedge:

The new law will allow patients to choose between assisted suicide and euthanasia. Its provisions are more or less the same as the other states, but it does not allow institutions to refuse to allow their residents to have VAD, to the consternation of Catholic healthcare officials.

“This law will force organisations that do not agree with assisted dying to allow doctors onto their premises to prescribe and even administer restricted drugs with the intention of terminating a resident’s life – without even informing the facility,” said Brigid Meney, of Catholic Health Australia. “These laws ignore the rights of staff and residents who may choose to work and live in a particular residential facility because of their opposition to assisted dying.”

It is one thing to give doctors the right in law to kill their patients it is another issue when you force people who oppose the killing to participate.

Greg Donnelly, a Labor Member of the Legislative Council, who had proposed amendments, including conscience rights, to the legislation stated:

it was “utterly repugnant and draconian” to force facilities with moral objections to assisted suicide or euthanasia to allow the practices. Such provisions are “essentially an authoritarian imposition on what are, in our civil society, associations of people coming together for a purpose.”

Canada's euthanasia lobby has also launched a campaign to force religiously affiliated health care institutions to provide euthanasia.

The legislation will come into effect in 18 months.

Netherlands report rejects proposed euthanasia for completed life.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The NL Times reported today that the Netherlands Council of State published a report from December 2020, explaining why they rejected a "completed life" bill that was sponsored by the D66 MP Pia Dijkstra.

According to the Council of State report:

it is important to establish that people really want to die, have thought about it thoroughly, no longer have any doubts, and that their wish for death is not related to other issues, like financial problems

The Completed Life bill proposed to permit assisted suicide for a person who is competent, at least 75 years-old, with a two month waiting period and the request must be voluntary and well considered.

The Council of State thought that the two month waiting period was insufficient, they questioned the 75 year-old limit and they decided that there must be "no reasonable other solution" available to alleviate the suffering and remove the wish to die.

The "Completed Life" bill was sponsored by former D66 MP Pia Dijkstra. The D66 political party stated that they will study the recommendations.

Suicide contagion

This article was published by First Things on May 19, 2022.

Wesley Smith examines three studies examining the possible co-relation between legalizing assisted suicide and rising suicide rates.

Wesley J Smith

By Wesley Smith

I have often argued that, as a matter of logic and intuition, the widespread legalization of assisted suicide will increase both the rate of assisted suicides and the rate of unassisted suicides. After all, many people conflate what is “legal” with what is “right.” Once a state gives its imprimatur to assisted suicide as a way of alleviating suffering and providing “medical aid in dying,” as it is euphemistically called, an ever-increasing number of people will resort to that means of ending their lives. And indeed, some recent studies suggest that in places where assisted suicide is legal, both assisted suicides and unassisted suicides increase.

Advocates of assisted suicide disagree, of course. One argument—which the media often parrots—holds that people with suicidal ideation not caused by terminal illness are unlikely to be influenced by legalization of assisted suicide because “medical aid in dying” is a treatment and not “suicide.” This argument has never rung true for me. That is simply not how the human mind works, particularly when we are in extremis. It has always seemed to me that suicidal people are likely to think that society’s approval of suicides for the terminally ill also applies to them, even if the cause of their existential crisis and misery falls outside the current parameters of legalization.

Even though overall suicide rates have risen considerably throughout the West in recent years, few studies have been conducted to determine whether the legalization of assisted suicide has had any effect on this concerning trend. That is slowly beginning to change. In 2015, a study published in the Southern Medical Law Journal applied CDC suicide data from states where assisted suicide was legal (Oregon, Washington, Vermont, and Montana, where legality remains a matter of dispute). The authors reported that “PAS [physician-assisted suicide] is associated with an 8.9% increase in total suicide rates” (including assisted suicides), and when “state-specific time trends” are included, “the estimated increase is 6.3%.” The authors concluded: “The introduction of PAS seemingly induces more self-inflicted deaths than it inhibits.”

This report, as is usual in professional discourse, was praised and criticized in a responsive paper published in 2017 in Journal of Ethics in Mental Health (JEMH). While the critics recognized some strengths in the earlier study, they noted that suicide rates in Washington and Montana had been increasing before legalization, that the work exhibited “methodological weaknesses” (such as not taking trends in nations such as the Netherlands and Belgium into account), and that “association does not prove causation.” Still, even these critics did not contend that legalizing assisted suicide had no effect on overall suicide rates. Rather, they argued that much more research needed to be conducted “before definitive claims about the effects of legalization of medical assistance in dying on non-assisted suicide can be made.”

Earlier this year, the original authors responded to this criticism in the JEMH. This time, they compared suicide rates in European countries that had legalized euthanasia with demographically similar countries that had not. Again, the authors found a “concerning pattern” where EAS (euthanasia/assisted suicide) is legal. They found, much to my expectation, that in the four jurisdictions they studied in which euthanasia and assisted suicide (EAS) are legal, “there have been very steep rises in suicide.” Moreover, “In none of the four jurisdictions did non-assisted suicide rates decrease after introduction of EAS.” In the Netherlands—which has recorded the highest number of deaths by EAS, “the rates of non-assisted suicide” increased since legalization. Even in Belgium, where “non-assisted suicide decreased in absolute terms, they increased relative to its most similar non EAS neighbor: France.”

A third study was just released also showing an increase in suicide rates associated with assisted suicide legalization, with a particularly adverse effect on women. Two professors, writing for the Centre for Economics Policy Research (CEPR), tested the hypothesis that legalizing assisted suicide would actually reduce suicide rates, and countered with their own hypothesis that doing so would “not only reduce practical barriers to committing suicide but may also lower societal taboos against suicide,” leading to “an increase of suicide rates overall.”

After reviewing data taken from U.S. states that legalized assisted suicide as of 2019, and referencing the studies described above, the authors concluded:

There is very strong evidence that the legalisation of assisted suicide is associated with a significant increase in total suicides. Further, the increase is observed most strongly for the over-64s and for women. To give an idea of the size of the effect, the event study estimates suggest assisted suicide laws increase total suicide rates by about 18% overall. For women, the estimated increase is 40%.

And what about the unassisted suicides in that increase in total suicides?

There is weaker evidence that assisted suicide is also associated with an increase in unassisted suicides. The effect is smaller (about a 6% increase overall, 13% increase for women). It is still statistically significant in the main estimates but not in all of the robustness checks, meaning we have less confidence in that result. However, we find no evidence that assisted suicide laws are associated with a reduction in either total or unassisted suicide rates.

What are we to make of all of this? There is evidence that suggests suicide begets suicide, and that legal assisted suicide has an effect on suicide rates overall. Obviously, we need to undertake more empirical studies and pointed analyses, but if we care as a society about preventing suicides generally—regardless of our beliefs about assisted suicide for the seriously ill—surely the question of assisted suicide contagion should become a pressing concern in fashioning public policy. Before any more states legalize doctor-assisted death, policymakers and the public should focus much more closely on this little-considered aspect of the debate. Human lives literally are at stake.

Wesley J. Smith is host of the podcast Humanize and chairman of the Discovery Institute’s Center on Human Exceptionalism.

More articles on this topic:

• Suicide rates in jurisdictions that have legalized assisted death are not decreasing (Link).
• Be careful what you wish for when you legalize active killing (Link).
• Legalizing assisted dying can actually increase suicides (Link).

Why euthanasia for children "mature minors" is wrong.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

• Sign the Petition: No to child euthanasia (Link).

Dr Ramona Coelho

Dr Ramona Coelho, a family physician in London Ontario and the Hon Graydon Nicholas, a member of the Wolastoqiyik Nation and a former Lieutenant Governor of New Brunswick wrote an insightful opinion article that was published in the Ottawa Citizen on May 11, 2022 on the issue of euthansia for children.

They begin by explaining that the government's Special Joint Committee on Medical Assistance in Dying (MAiD), is currently meeting and, among other issues, is considering MAiD for children. Briefs can be submitted to the committee until May 30.

Graydon Nicholas

Coelho and Nicholas express their concern with the current problems with euthanasia in Canada and state that the Special Joint Committee should be examining the problems not expanding access to the MAiD regime in Canada. They write:

In an increasing number of reported cases, MAiD is taking the place of medical treatment and government assistance for those with social, economic and psychiatric issues. An example is the case of Alan Nichols, who had recurrent episodes of depression. Nichols was picked up by the RCMP and admitted to hospital under the Mental Health Act. While in hospital, he received MAiD — to the utter dismay of his family, who wished he had received medical care instead. Similarly, a recent CTV story recounted how “Sophia,” unable to find affordable housing compatible with her chemical sensitivities, chose MAiD.

How can we keep MAiD from being used as a tool to absolve governments of their obligation to provide for those living in poverty, with disability, or with mental illness their equal rights as citizens to health, economic security, and life? That is the question the Special Joint Committee should be considering. But instead, expanding MAiD for children is on the agenda.

Coelho and Nicholas ask the question: What are the dangers with expanding euthanasia to children? They respond:

One is teenager suicide contagion. There is evidence that messages that promote suicide, and knowing someone who has engaged in self-harm or suicide, both raise the risk of teenage suicide contagion. Indigenous youth are particularly at risk because of an already high suicide rate resulting from longstanding injustice. Indigenous stakeholders have repeatedly demanded support from the federal government for the implementation of suicide prevention and mental wellness strategies in their communities. These demands have not been adequately met and in many cases, ignored, while the federal government instead focuses on making suicide access easier for youth, including Indigenous youth.

Coelho and Nicholas complete their article by stating:

The Council of Canadian Academies Expert Working Group on MAiD for Mature Minors notes that there is a lack of evidence on how MAiD for children will affect families. It noted there is no robust evidence that captures the voices of youth on this matter including views of minors with disabilities, Indigenous youth, and/or those in the child welfare system. It cites a paucity of international evidence on which to draw conclusions as well.

Given the lack of evidence to support safe practice and risk of suicide contagion in teenagers, and the gravity of MAiD as an option, a valid question is: why the rush to make MAiD available for children?

More articles on this topic:

• Responding to the Special Joint Committee on Medical Assistance in Dying (Link)
• Sign the Petition: No to child euthanasia (Link).

Euthanasia (MAiD) is out of control in Canada.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In April I wrote about the euthanasia death of a 51-year-old Ontario woman who had chemical sensitivities. The story was reported by CTV National News Medical Correspondent, Avis Favaro who reported that the woman was not terminally ill but living with chronic chemical sensitivities and environmental allergies. Favaro reported:

She died after a frantic effort by friends, supporters and even her doctors to get her safe and affordable housing in Toronto. She also left behind letters showing a desperate two-year search for help, in which she begs local, provincial and federal officials for assistance in finding a home away from the smoke and chemicals wafting through her apartment.

“This person begged for help for years, two years, wrote everywhere, called everywhere, asking for healthy housing,” said Rohini Peris, President of the Environmental Health Association of Québec (ASEQ-EHAQ).

“It’s not that she didn’t want to live,” Peris said from her home in Saint Sauveur, Que. “She couldn’t live that way.”

I stated that the CTV news story represented the ultimate form of abandonment whereby this woman died by MAiD, not because of "unremitting suffering" but because the government didn't help her find appropriate housing.

In late April, Favaro reported on a case of a 31-year-old Ontario woman who was approved for (MAiD) euthanasia for chemical sensitivities. Favaro stated that Denise (not her real name) was diagnosed with Multiple Chemical Sensitivities (MCS), which triggers rashes, difficulty breathing, and blinding headaches called hemiplegic migraines that cause her temporary paralysis. Favaro reported:

The chemicals that make her sick, are cigarette smoke, laundry chemicals, and air fresheners. She is at risk of anaphylactic shock and so has EpiPens at all times in case she has a life-threatening allergic attack.

Denise is also a wheelchair user after a spinal cord injury six years ago and has other chronic illnesses. In March 2021, the Canadian government passed Bill C-7 which permitted (MAiD) euthanasia for people who were not terminally ill, but living with chronic conditions. This has resulted in approvals to lethally inject (MAiD) people with treatable chronic conditions and it is exposing the reality that people with chronic conditions are often living in abject poverty and poor living conditions.

According to Favaro, Denise applied for MAiD based on poverty. Favaro stated:

She desperately wants to move to an apartment that’s wheelchair accessible and has cleaner air. But her only income is from Ontario’s Disability Support Program (ODSP). She receives a total of $1,169 a month plus $50 for a special diet. "I've applied for MAiD essentially...because of abject poverty,"

One of her physicians, Dr. Riina Bray, medical director of the Environmental Health Clinic at Women's College Hospital in Toronto, has been looking for better housing saying Denise requires “immediate relocation for her safety.”

The treatment for chemical sensitivities is to move the person into a home that doesn’t trigger sensitivities/allergic response. Therefore, medical practitioners are approving euthanasia and lethally injecting people who are not dying, who are not chronically ill, but rather require a clean place to live.

The reason these people live in unbearable social housing is because of poverty.

In April we received a call from a woman who was approved for euthanasia. She was speaking to one of our supporters about her decision to die by euthanasia. Our supporter gave her my contact information. This woman has cancer, she is nearly blind and she has debilitating arthritis.

After speaking with her we established that she wanted death by euthanasia because she couldn’t live the way she was living. Yes, she has cancer and yes she has debilitating arthritis, nonetheless, the reason she was seeking death was poverty. Due to her arthritis she could not go grocery shopping, she could not wash her clothes, she could not take a shower and nobody was helping her.

After buying her some groceries, arranging for a laundry service and arranging for someone to help her with some basic needs, she was happy to live and not die.

What we learned by caring for this woman, is that when she was assessed for (MAiD) she was not examined, but rather she was only asked questions. She was living in poverty, but they were only interested in her death, not her life. She wondered why they didn’t even offer her a sandwich. 

Make a donation to the Euthanasia Prevention Coalition (Link).

The Euthanasia Prevention Coalition opposes (MAiD) euthanasia because it gives medical practitioners the right in law to intentionally cause the death of a person. It is a form of homicide (murder). In fact, the law gives doctors and nurse practitioners the right in law to kill their patients, as long as two medical practitioners agree.

What about people with chronic injuries or medical conditions?

Donna Duncan, from Abbotsford BC, died by euthanasia in October 2021. Donna was not terminally ill, but rather she was injured from a car accident in February 2020 and was living with post-concussion syndrome. Due to the COVID protocols, Donna did not receive adequate rehabilitation and her symptoms persisted until she decided to seek out death by euthanasia to escape her suffering.

The family only found out after Donna had been approved for euthanasia and it was scheduled to happen within two days. Donna’s daughters attempted to get a court injunction. Donna was then examined by two psychiatrists. One psychiatrist found her depressed and in distress while the other determined that there was no evidence of depression or anxiety. Donna was then declared competent by a third psychiatric assessment and lethally injected later that day.

We are now facing the debate of expanding euthanasia to children “mature minors.” Prime Minister Trudeau established a Special Joint Parliamentary Committee to investigate the expansion of (MAiD) euthanasia to include euthanasia for “mature minors,” euthanasia by advanced directive and euthanasia for people with mental illness.

One problem is the lack of effective control of the law. The only requires two medical practitioners to approve a death, so even when Duncan's family challenged the death approval, the psychiatrist was only fulfilling the role of assuring that Duncan was competent.

Sadly we predicted this outcome. But we are standing against the wave.

We care and we oppose killing. Join us. 

Help us to be a voice and an active presence against this culture of death. Killing needs to be replaced by caring. 

Become a member of the Euthanasia Prevention Coalition (Membership link).

Assisted suicide is a cancer that is destroying authentic palliative care.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Terry O'Neill wrote an excellent article that was published by the BC Catholic on May 12 titled: Assisted suicide is a cancer that is destroying authentic palliative care.

Authentic palliative and hospice care does not hasten death.

O'Neill quotes key people including: Palliative-care expert Dr. Neil Hilliard from Abbotsford BC, Dr. Ebru Kaya, president of the Canadian Society of Palliative Care Physicians, Dr. Leonie Herx, the immediate past president of the Canadian Society of Palliative Care Physicians and myself.

Hilliard, who is a past medical director of palliative care in the Fraser Health BC region stepped back from his role after the BC government demanded that all palliative care facilities (non religiously affiliated) must provide euthanasia. O'Neill quotes Hilliard:

health facilities’ introduction of assisted suicide into palliative-care wards and hospices, following legalization of Medical Assistance in Dying (MAiD) in June 2016, has led to a reduction in true palliative-care services.

“It’s like a cancer growing within the palliative care programs,” said Dr. Hilliard who, in 2017, resigned as medical director of the Fraser Health Authority’s palliative-care program because of his opposition to the authority’s insistence that he support the performing of assisted suicide in hospices.

Dr Leonie Herx

O'Neill quotes Dr Herx from her testimony to the Special Joint Committee on Medical Assistance in Dying who stated:

“When patients’ palliative care needs are not met, the ensuing physical, emotional and spiritual suffering can lead to them feeling depressed, hopeless, and a burden to others— many of the factors driving requests for MAiD,” Herx said. “Earlier palliative care can alleviate suffering before it becomes irremediable.”

“With almost six years of lived experience now, we have seen significant deleterious effects of the impact of MAiD implementation on palliative care, including diminished resources and increasing distress experienced by palliative care clinicians,” Herx said.

She said some health authorities’ incorporation of euthanasia into palliative care has led to palliative nurses leaving their jobs because they felt unable to provide palliative care. And in Ontario, for example, some hospice palliative care nurse practitioners are using their full-time paid palliative care roles to provide assisted suicide.

Moreover, there is “increasing moral distress in palliative care clinicians from forced participation in MAiD due to some health authorities mandating that MAiD be provided in hospices and palliative care units or lose funding,” she said. “This is resulting in retention difficulties and early retirements from palliative care which is accentuating and accelerating the already critical shortage of specialist and generalist palliative care physicians.”

O'Neill also quotes Dr Kaya from her testimony to the Special Joint Committee on Medical Assistance in Dying who stated:

assisted suicide needs to be “distinct and separate” from palliative care to ensure that the latter does not suffer.

“By separating them, palliative care can continue to be the safeguard, as intended,” Kaya said. “MAiD assessors and providers are in a conflict of interest if providing palliative care at the same time. This does not prevent palliative care physicians from practicing MAiD – however they should not be providing palliative alongside MAiD for the same patient.”

Alex Schadenberg

O'Neill also interviewed me on the topic. Among other comments, I told O'Neill:

governments should stop giving lip service to improving palliative care and should devote more resources to improving it, especially now that MAiD is available.

“In my opinion, palliative care has been completely undermined” by MAiD, he said. “I haven’t seen anything to improve palliative care. Even if we had just left palliative care alone, where it could be a safe space, that would have made a big difference.”

Forcing palliative care facilities to provide euthanasia and assisted suicide (MAiD) has resulted in palliative care medical experts leaving the field, at a time when more end-of-life care is necessary. At the same time it has changed palliative care.

People need safe places to die. When BC Ministry of Health defunded the Delta Hospice Society (DHS) for refusing to kill their patients by euthanasia (MAiD) the DHS response was to commit to establish safe places to die in Canada. Groups and individuals who are committed to creating safe places to die need to join with the DHS and work towards this common goal.

Dr. Husel Acquitted in 14 alleged overdose deaths in Ohio – What Happened?

Sara Buscher is a lawyer and
Chair, Euthanasia Prevention Coalition USA

On April 20, 2022 an Ohio jury acquitted former doctor William Husel of intentionally murdering 14 patients with extremely large and lethal doses of fentanyl. Some claim his acquittal means doctors are free to deliberately overdose patients to hasten their deaths. Apparently, they are unaware he has lost his medical license and still faces civil suits brought by the patients’ families.

Husel worked in the Intensive Care Unit of an inner city hospital in Columbus, Ohio where he ordered lethal doses of fentanyl (500 to 2,000 micrograms) be given to patients, all of whom died within 12 minutes. He was indicted by a Grand Jury for 25 counts of intentional murder. The Prosecution went to trial on 14 counts after Husel refused a plea deal for up to ten counts of reckless homicide. Near the end of the trial, the Prosecution asked the judge to include charges of negligent homicide as “lesser included” offenses. The Defense would not agree, so the judge ruled it was too late to include them for the jury’s consideration.

In a May 10 People Magazine interview Husel said he would prescribe the same doses now for patients. After the trial the Ohio State Medical Board permanently and irreversibly revoked his medical license, which he agreed to surrender. In 2019, the Board had suspended his license after finding his extremely excessive doses of fentanyl and painkillers created a public danger that clearly and convincingly violated the Ohio Medical Practices Act.

Lawyers for the families say, “It would be incorrect to assume that the criminal verdict means Husel cannot be held liable in civil court for his actions…. How did that work for O.J. Simpson?”

The law typically uses three different burdens of proof and all are at play here. To find a person guilty of a crime, the burden is “beyond a reasonable doubt” which you can think of as being 99% certain the defendant is guilty. The Medical Board used the “clear and convincing” standard or about 75% certainty and the civil suits use “a preponderance of the evidence” standard which is anything beyond 50%.

Reasons for acquittal relate to the elements of intentional murder that must be proven under Ohio law: having a purpose to cause death and actually causing the death.

Prosecutors typically overcharge because 90% of criminal cases are pleaded out rather than going to trial. So they overcharge and then plead the case down for an appropriate charge. In Husel, the prosecutor charged intentional murder, would have plead out for reckless homicide and would have given the jury the option of a guilty verdict on negligent homicide. Each degree of guilt is easier to prove and carries a lower penalty. By refusing to deal, Husel forced the Prosecution to prove Husel intended to kill his patients.

The Defense successfully confused the jury into believing the Prosecution had to prove Husel had a motive for killing his patients. Motive is the why-- the reason a person commits a crime. It is never an element that has to be proven. Intent is not the same as motive. Intent means the actor decided to purposely do something criminal. Here, Husel decided to give drugs that would cause deaths. We don't know why he did it. He said he did it to provide comfort care, yet the Prosecution’s expert said Husel’s doses were 5 to 10 times the amount needed to provide comfort. So, he obviously didn’t do it to provide comfort. Maybe he gets a thrill from killing. Maybe he was trying to churn beds faster. Who knows? In any event, the jury struggled with “intent.”

In a May 10 interview with jurors, the Columbus Dispatch reported:

“A juror said ‘he believes Husel was guilty, but said the Prosecution failed to prove its case. The question of intent was just really hard to find beyond a reasonable doubt… and that was a hard, hard burden.’… ‘My honest opinion — that dude is guilty as hell. The Prosecution didn't prove it…. Everyone in that [jury] room felt those (fentanyl) doses (Husel ordered) were insane. We all said that. I believe in my heart that he was guilty of at least four or five that you could actually prove [the hospital’s initial investigation concluded five could have recovered with treatment], but what I feel isn't what we had to go on. The Prosecution just didn't prove intent.’”

Ohio’s intentional murder statute uses the strictest, hardest to prove definition of intent to kill: “the person's specific intention to cause a certain result (e.g., death)”. Other states allow intent to be proven using a “knowingly” standard – “knows or is aware his or her conduct is practically certain to cause the result.” Here, Husel said his intent was to provide comfort to people who were already dying. And, here, the evidence was clear the doses he gave were practically certain to cause death. In my opinion, he would have been convicted under a “knowingly” definition of intent.

The Defense also raised doubts about what caused the people to die. Their expert testified all of these people died from their illnesses. The Prosecution did not call a rebuttal witness. All of the patients were on life support that their families had agreed to have withdrawn. All died in 12 minutes or less after receiving the fentanyl. The question that was left unanswered was whether they died from the withdrawal of life support before the fentanyl would have killed them. Hopefully, the civil suits will shed more light on this.

Article: Dr Wes Ely comments on the acquittal of Dr William Husel (Link).

Climate activist asks for euthanasia (MAiD) based on eco-anxiety.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ryan Hook wrote an interesting article about Howard Breen, who is seeking death by euthanasia based on eco-anxiety. Hook's article was published by VICE on May 12, 2022.

Hook explains Breen's condition:

The 68-year-old eco-activist and member of the global group Extinction Rebellion has spent almost his entire life trying to warn people about the climate crisis. He’s been arrested for super-gluing himself to log booms and stopping air traffic on tarmacs. He’s even gone on hunger strikes.

Then in 2017, Breen’s doctor diagnosed him with clinical eco-anxiety and biosphere-related depression. It’s an intense fear of entropy related to the existential threat of climate change, and it’s becoming more common. Breen is so genuinely worried about global climate chaos—which has led to destructive and deadly heat waves, floods, and fires around the world—that he often experiences depression, anxious malaise, and panic attacks.

Breen's doctor diagnosed him with eco-anxiety in 2017.

In 2017, Breen’s doctor diagnosed him with clinical eco-anxiety and biosphere-related depression. It’s an intense fear of entropy related to the existential threat of climate change, and it’s becoming more common. Breen is so genuinely worried about global climate chaos—which has led to destructive and deadly heat waves, floods, and fires around the world—that he often experiences depression, anxious malaise, and panic attacks.

Breen's eco-anxiety has led him to seek death by euthanasia (MAiD).

If the world doesn’t immediately divest from fossil fuels and the climate crisis continues, Breen would rather not see what becomes of it. He wants a contingency plan. That’s why he said he’s applied for Canada’s Medical Assistance in Dying (MAID)—a program that allows citizens to take their own lives, under the care of a doctor, if they can’t cope anymore. The law was first adopted in 2016 for Canadians afflicted by grievous or incurable medical conditions but was eventually amended to include those determined to have a low enough quality of life. And next March, the program will be expanded even further to include people living with mental illness.

Breen feels he should be eligible.

Breen applied for MAiD and was turned-down in February 2021 because the assessors didn't consider his condition as qualifying for death by lethal injection. Since Bill C-7 passed in March 2021, Breen believes that he will qualify for MAiD when euthanasia becomes permissible for mental illness alone in March 2023. Hook wrote:

Currently, if a mental illness is the only medical condition leading someone to consider the program, they’re not eligible. Suicide isn’t most people’s response to hardship, and the vast majority of people who experience suicidal ideations recover with treatment. According to the Canadian government, however, the exclusion of mental illness from the medically assisted death program is temporary, and beginning March 17, 2023, Canadians whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria, will be eligible. They also must be fit to give informed consent without outside influence and be at least 18 years old.

It is concerning that Rebecca Johnson, a constitutional and criminal law professor at the University of Victoria, and whose mother died by euthanasia in June 2021, supports Breen's request for euthanasia (MAiD) and is suggesting that Breen becomes a "test case" to challenge the breadth of the law.

The article in VICE is clearly pushing the envelope for people experiencing eco-anxiety.

This story shows us how far the euthanasia law can go once it becomes acceptable to kill people.

No clear guidelines in report concerning MAiD (euthanasia) for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Final Report of the Expert Panel on MAiD and Mental Illness was submitted to Canada's Minister of Health, Jean-Yves Duclos and Justice Minsiter, David Lametti on May 6, 2022.

Similar to previous "expert" reports the Expert Panel offers recommendations but few clear guidelines.

Canada legalized euthanasia and assisted suicide under the term Medical Aid in Dying (MAiD) when the government passed Bill C-14 in June 2016. Previous to that, the Supreme Court of Canada struck down protections in Canadian law that prohibited euthanasia and assisted suicide in its Carter decision and euthanasia became legal in Québec in December 2015 with the implementation of Bill 52.

In March 2021, the Canadian govenment passed Bill C-7 which expanded the MAiD law by permitting euthanasia for people who are not dying, by eliminating the 10 day waiting period for people who are terminally ill, by permitting euthanasia for incompetent people who were previously approved for MAiD and at the last minute, Bill C-7 was amended to permit euthanasia for people with mental illness.

When passing Bill C-7 the government acknowledged that euthanasia for mental illness was different than other forms of MAiD, so they stated that their would be a two year moratorium on MAiD for mental illness providing time to develop guidelines around the killing. I believe the two-year moratorium is unenforceable making euthanasia for mental illness legal already.

The Euthanasia Prevention Coalition opposes MAiD. We oppose giving doctors and nurses the right in law to kill people. But considering that the recommentations from the "Expert" Panel on MAiD and Mental Illness concern guidelines for killing people with mental illness, one would think that the guidelines would offer fixed rules and yet the 19 recommendations for implementing MAiD for mental illness, lack clarity on key recommendations.

For instance, recommendation 2 concerning: Establishing Incurability, states

MAiD assessors should establish incurability with reference to treatment attempts made up to that point, outcomes of those treatments, and severity and duration of illness, disease or disability.

It is not possible to provide fixed rules for how many treatment attempts, how many kinds of treatments, and over what period of time as this will vary according to the nature and severity of medical conditions the person has and their overall health status. This must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person has a serious and incurable illness, disease or disability. As with many chronic conditions, the incurability of a mental disorder cannot be established in the absence of multiple attempts at interventions with therapeutic aims.

Incurability is a requirement in Canada's MAiD law, and yet the Expert Panel has stated that it is not possible to provide fixed rules concerning treatment.

In the Netherlands, a person requesting euthanasia for mental illness must be willing to try effective treatment. This is not an onerous request considering that the person is requesting to be killed.

Similarly, the Expert Panel deals with recommendation 3 concerning: Establishing Irreversibility in the same manner. It states:

MAiD assessors should establish irreversibility with reference to interventions tried that are designed to improve function, including: recognized rehabilitative and supportive measures that have been tried up to that point, outcomes of those interventions, and the duration of decline.

It is not possible to provide fixed rules for how many attempts at interventions, how many types of interventions, and over how much time, as this will vary according to a requester’s baseline function as well as life goals. Therefore, this must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person is in an advanced state of irreversible decline in capability.

Once again, Canada's MAiD law requires that the person's condition be irreversible and yet the Expert Panel states that it is not possible to provide fixed rules.

I am concerned that the current Special Joint Committee on Medical Assistance in Dying will also follow the same direction of this Expert Panel, by offering recommendations but few clear lines.

The Special Joint Committee on Medical Assistance in Dying (AMAD) is composed of Senators and MPs who are to study and make recommendations concerning:

1. MAiD for mature minors,
2. Advance directives for MAiD,
3. Regulations for Psychiatric MAiD once the C7 sunset clause is lifted March 2023,
4. The state of palliative care in Canada (was required as part of the 5 year review after C-14 but never completed),
5. Protections for persons with disabilities.

The mandate of the Special Joint Committee appears oriented to expanding MAiD in Canada.

The Expert Panel made some good recommendations, such as suggesting that assessments be done by independent experts, increasing the reporting requirements, providing income or housing support where necessary, having consultations with First Nations, Métis, and Inuit peoples, nonetheless, some of these recommendations are too little or too late a response.

People have been lethally injected for loneliness, depression, poverty, chemical sensitivities, fear of isolation and more.

The Expert Panel appears to be attempting to improve Canada's MAiD law while in reality the fundamental recommendations include no fixed rules.

Remember, the law only requires that a physician or nurse be of the opinion that the person fits the criteria of the law. Therefore, the Report of the Expert Panel on MAiD for Mental illness does not provide any assurances that people who are living with suicidal ideation will not die by euthanasia.

Sadly, Canada legalized euthanasia by giving doctors and nurses the right in law to kill their patients. It only requires that the assessors and the practitioner who lethally injects their patient be only of the opinion that the person, who they killed fit the criteria of the law.

Canada has now expanded the killing to people with mental illness alone and this "Expert Panel" suggests that the killing be done without clear rules.

When will people wake up and realize that killing people is not a solution?

More articles on this topic:

• The truly awful cost of Canada's assisted death program (Link).
• Abbotsford police investigating euthanasia death (Link).
• Euthanasia for mental illness. Killing people without a certain prognosis (Link)
• Profound social change with euthanasia for mental illness (Link).
• Article supporting euthanasia for mental illness provides excellent argument against euthanasia (Link).
• New euthanasia rules put psychiatrists into an impossible position (Link).
• The complexity of assessing mental health and capacity (Link).