Thursday, June 2, 2022

Dr Ramona Coelho: Offering euthanasia to a suicidal person leads to premature deaths.

By Michalina Ratajczak
Assistant to the Euthanasia Prevention Coalition Executive Director

Dr. Coelho's presentation to the Special Joint Committee on Medical Assistance in Dying. (Youtube Link).

On May 13th, 2022, the Canadian government’s expert panel on MAiD and Mental Illness released its final report, which recommended no added legislative safeguards to Bill C-7 for those living with mental illness. Dr. Ramona Coelho, who recently presented at a meeting of the federal Special Joint Committee examining the provisions of the Criminal Code relating to medical assistance in dying, noted that the expert panel’s report: more dangerous than I could have anticipated. It recommends no added safeguards in the legislation for those living with mental illness and rather suggests the assessor use certain cautions as a guide but that decisions should be made on a case-by-case basis without any operational guidance.
In her opening remarks to the the Special Joint Committee, Dr. Coelho, who was a witness representing the marginalized patients she frequently sees in her practice, noted how vulnerable such populations are to MAiD being raised as a legitimate course of treatment by their physicians:
I warned [at prior committees discussing Bill C-7] that many injuries and illnesses are accompanied by transient suicidality that ends with adaptation and support but that, on average, [lasts for] two years... the overwhelming majority of persons after those two years rate their quality of life as the same as age-matched healthy individuals. Offering MAiD in a period of known suicidality would lead to premature deaths of those who would have recovered. Now Bill C-7 is legal.
Coelho went on to describe some of the concrete outcomes of Bill C-7's passing which belie the final report’s assessments that it needs no further legal safeguards, including the following case:
A man had a small stroke affecting his balance and swallowing. The patient was depressed and isolated due to Covid-19 outbreak on his ward. The stroke neurologist anticipated the man would be able to eat normally and regain most of balance. He declined all therapy and psychiatry diagnosed him with an adjustment disorder, but they felt he would improve. However, he requested MAiD. Neither of his MAiD assessors had any experience in stroke rehabilitation and recovery. In this acute phase while struggling with his mood and isolation, with no therapy to gauge his final level of function, he received MAiD. He had no terminal illness but due to the fact that he was adapting to a slightly thickened diet, and was temporarily slightly undernourished, they considered him Track One eligible, and he received MAiD the following week. No safeguards were technically broken and yet he died when acutely down, isolated, and had not experienced living with maximal recovery from his stroke.

Under the two-track MAiD legislation, a patient is eligible for Track One if their providers deem that natural death is reasonably foreseeable.

Coelho went on to mention that 
there is no safeguard in Bill C-7 that forbids raising MAiD” to mentally vulnerable patients, and “...the related amendment was voted down by the Senate. This ignores current suicide research that shows messaging promoting suicide may lead to more people choosing it.

Dr. Coelho's excellent response to committee questions (Link).


In her follow-up remarks to the committee, Coelho summarized the witness reports to the committee as demonstrating that “MAiD regime safeguards do not work to protect Canadians.” The recommendations of the final report, which are mere recommendations and do not have the force of law, leave vulnerable Canadians open to the personal value judgments of physicians and MAiD assessors, who have varying opinions about what irremediable suffering entails. 

For example, Coelho mentioned that:

Ellen Wiebe [a doctor who operates a MAiD clinic in Vancouver] testified that if someone wanted MAiD because it took five years to access a service, she would consider that irremediable. Patients with unaddressed psychosocial suffering will be therefore given MAiD by assessors like her.
Instead of introducing strict medical standard of care and legal safeguards that would protect the vulnerable from the subjective value judgments of individual health practitioners such as Wiebe’s, the panel’s final report announces nineteen “recommendations” that: its view, can be fulfilled without adding new legislative safeguards to the Criminal Code. The Panel found that the existing MAiD eligibility criteria and safeguards buttressed by existing laws, standards, and practices in related areas of healthcare can provide an adequate structure for MAiD MD-SUMC so long as they are interpreted appropriately to take into consideration the specificity of mental disorders.
Two crucial recommendations in the final report (Link), establishing incurability and irreversibility, betray the supremacy of such individual interpretation - Recommendations 2: Establishing Incurability, and Recommendation 3: Establishing Irreversibility:
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.
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.

Dr. Ramona Coelho specializes in caring for immigrants and persons from marginalized communities. Thank you Dr. Coelho for your continued advocacy.

Previous articles by Dr. Coelho:

  • Why euthanasia for children is wrong (Link). 
  • Profound social change with euthanasia for mental illness (Link) 
  • Why expanding euthanasia keeps us up at night (Link).
  • Why I oppose euthanasia (Link).

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