Euthanasia and medical error. Revisiting the issue.

"patient deaths from avoidable causes ... are the third leading cause of mortality in Canada."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

An article by Michael Tutton published by the Canadian Press on February 9 concerns the recent promise by Canada's federal government to increase funding to the provinces for healthcare. Tutton questions whether the provinces will deal with the medical error that is happening in Canada's healthcare system.

Tutton begins with the story of Diane Breen who died in February 2022 after a medical error. He writes:

Kim and Jennifer DeWolfe say their 74-year-old mother spent eight hours waiting on Feb. 28 last year at the Aberdeen Hospital in New Glasgow, N.S., before being briefly seen by a doctor about a urinary tract infection.

Her charts said Breen — a runner without health conditions — told medical staff about a week of chills and cold sweats, but she was nonetheless discharged to her home with an antibiotic prescription.

Within hours, she was dead due to sepsis — the body's extreme reaction to infection.

Her daughters applied for a quality review of her care, but instead of learning what happened, they were launched into an opaque process that experts say is typical of the frustrating experiences shared by families across Canada.

"What perhaps could have saved my mother was a doctor who saw her at intake, or a nurse who authorized blood work, or being screened for sepsis," Jennifer DeWolfe, 49, said in a recent interview.

The article interviews Dr Rob Robson, a primary care physician and patient safety advocate who refers to a Canadian Patient Safety Institute report that states:

patient deaths from avoidable causes — ranging from long wait times to wrong diagnoses — are the third leading cause of mortality in Canada, following cancer and heart disease.

Tutton then reports that patient death reviews are secretive.

Robson said that in Nova Scotia, for instance, the law allows authorities to prevent detailed information about patient deaths from being released to families. The opaqueness of the quality-review process creates a "straitjacket where whatever was discussed in the review committees isn't shared," he said.

Nova Scotia Health spokesman Brendan Elliott said in a recent email that quality reviews are kept confidential to so that "everyone is free to discuss and share information. That confidentiality, he said, ensures the "frank and forthright participation" of those involved.

Kim DeWolfe said that after two meetings with the committee reviewing the care her mother received, "we still knew nothing more about how my mother died that night."

"This is nonsense," Robson said. "Explain to me how it makes sense that we spend time, effort and money to find out what happened, why it happened and how, and we're not going to tell you?"

Medical errors should be a central concern when considering approvals for euthanasia. Canada's euthanasia approval process requires one doctor or nurse practitioner to assess the requester and a second doctor or nurse practitioner to sign off on the assessment. This system of approving death does not catch cases of medical error.

Research by Dr Mark Graber that was published in the British Medical Journal titled: The incidence of diagnostic error in medicine reported that 10 - 20% of autopsies indicate that the person who had died was misdiagnosed.

The research states, with reference to medical error in the US health system:

Knowing the incidence of diagnostic error may be less important than being able to measure the likelihood of harm that results. Extrapolating from the Class 1 errors (a major discrepancy that likely leads to the patient's death) identified at autopsy, Leape, Berwick and Bates estimated that 80 000 deaths per year might be caused by diagnostic error, including both ambulatory and inpatient errors. A recent systematic review of autopsy data concluded that 36 000 deaths a year were due to diagnostic errors in just ICUs alone. These estimates, of course, do not include the many instances of non-fatal injury related to misdiagnosis, events that will be far more numerous, and the many instances where the harm is psychological or financial more than physical.

The autopsies were not related to assisted suicide deaths. In fact, rarely is an autopsy done after euthanasia or assisted suicide since the cause of death is not in question.

Nonetheless, someone who is misdiagosed and then approved for euthanasia will die 100% of the time. This should concern everyone.

Jennifer Monaghan

A CityTV news story by Meredith Bond from February 2022 concerned Jennifer Monaghan, who lived with chronic pain for 17 years, but had been misdiagnosed. The significance of the story is that Monaghan was planning to die by euthanasia because she was losing hope that her health could be restored.

Her correct diagnosis was not connected to an application for euthanasia, nonetheless Bond reported that Monaghan is happy to be alive. Her pain began to disappear and she became a grandma at about the same time.

The question is - how many people are being killed by euthanasia who have been misdiagnosed or was a victim of a medical error?

According to Brian Mastroianni who published an article in healthline.com in February, 2020 medical error is more common than you think. According to the data: In the United States, 12 million people are affected by medical diagnostic errors each year.

An estimated 40,000 to 80,000 people die annually from complications related to medical error and a similar number of people will experience a permanent disability related to misdiagnosis.

In October 2016 Mya DeRyan survived a suicide attempt. While recovering DeRyan learned that the terminal diagnosis that she was trying to escape from was in fact a wrong diagnosis.

In April 2013, Pietro D’Amico, a 62-year-old magistrate from Calabria Italy, died by assisted suicide at a Swiss assisted suicide clinic. His autopsy found that he was misdiagnosed.

Considering the data, it is dangerous and irresponsible to legalize euthanasia and assisted suicide. Many people, such as Jennifer Monaghan, lived with undiagnosed chronic pain for many years. We need to improve the healthcare system not kill the patient.