Wednesday, May 31, 2023

Has Canada's (MAiD) euthanasia law gone too far?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Walrus published an indepth article titled: Have Assisted Dying Laws Gone Too Far? that was written by Meagan Gillmore and published on May 30, 2023 for their June edition. This article offers significant insight into Canada's (MAiD) euthanasia law.

The article begins with the story of Tarra Carlson, who is autistic and ADHD. Carlson says that she is “petrified of growing old with a disability.” She would have difficulty applying and navigating through the disability support programs and her goal is to die before her husband died.

Gillmore writes:

Compared with disability support, medical assistance in dying, or MAID, seems relatively easy to request. Written applications differ by province or territory but are fairly straightforward; most are only a few pages long. For some of them, to confirm eligibility, an applicant simply has to sign and initial certain statements—for example, that they have an irremediable and grievous medical condition and are in a state of advanced decline. If any more health conditions were to crop up on top of her disability, eroding her independence completely, says Carlson, she’s pretty sure she’d qualify for MAID. “It’s a one-way ticket,” she says, “because you have no choice.”
As much as the story is irregular, the story is common. Gillmore continues by explaining the changes that occurred when Canada expanded euthanasia and passed Bill C-7 in March 2021.
That rosy perception began to darken when, in 2021, the legislation was expanded to include people whose deaths are not considered reasonably foreseeable—an option now known as Track Two. The development particularly angered many disabled Canadians. The change in legislation made it possible for disabled people to qualify for MAID even if they weren’t terminally ill. Over the past year, according to news reports, people have considered applying for or have died by MAID for reasons such as insufficient housing and meagre social supports that have left them in perpetual poverty. Carlson knows people with disabilities who have applied for MAID because they couldn’t find proper supports to live. “Canada has made it so that it’s become the only resource or recourse that people who are marginalized or poor have,” she says.

In 2024, Canada plans to further extend eligibility to people whose sole underlying condition is mental illness, prompting many to question whether MAID has gone too far. (The government was due to introduce this expansion in March 2023 but passed a law earlier this year to extend that deadline, citing the need to give medical professionals more time to prepare.)
Catalina Devandas-Aguilar
Gillmore reports that the disability community consider Canada's euthanasia law to be flawed from it's beginning because it listed disability as a medical condition that enabled eligibility for euthanasia (MAiD). Gillmore writes:
Concerns about the legislation aren’t new. Some say it was flawed from the outset and that Canada’s assisted dying laws have always singled out disabled people by listing “disability” as a type of medical condition that could guarantee eligibility. In 2019, before Track Two was legalized, Catalina Devandas-Aguilar, then UN special rapporteur for the rights of persons with disabilities, wrote that she was “extremely concerned about the implementation of the legislation on medical assistance in dying from a disability perspective.” In her report on the country’s compliance with the United Nations Convention on the Rights of Persons with Disabilities—which Canada ratified in 2010—she mentioned troubling accounts of people with disabilities who were institutionalized and offered MAID. She recommended the government investigate such claims and “establish adequate safeguards to ensure that persons with disabilities do not request assisted dying simply because there are no community-based alternatives or palliative care.”

In February 2021, three UN experts on the rights of seniors and people with disabilities as well as on human rights and extreme poverty wrote a letter to the federal government, urging it not to legalize Track Two. “There is a grave concern,” the letter stated, “that, if assisted dying is made available for all persons with a health condition or impairment, regardless of whether they are close to death, a social assumption might follow (or be subtly reinforced) that it is better to be dead than to live with a disability.”
Gillmore refers to the 90 day waiting period required in the law for people who are not terminally ill and then states:
But ninety days isn’t long enough for comprehensive reflection, says Virginia Duff, a Toronto-based psychiatrist. Most people, she says, would not likely reverse or even reconsider such a decision within that time frame. This is especially true, she adds, for people who have recently acquired a disability and are adjusting to its impact on their lives. “They’re in a crisis at the beginning,” says Duff. “They’re going to be regarding their future in a certain light and often in a negative light. But they don’t know at that point what they don’t know. And they don’t know that life with a disability can be very different from what they imagined it to be.”

...For Duff, who is visually impaired, the way we talk about MAID expansions ignores the complexities and years it may take to treat conditions such as mental illness. The language we use around it is also euphemistic: “The title of the act is ‘medical assistance in dying,’” she says. “But these aren’t people who would otherwise be dying. We’re not just assisting them. We’re actually making it happen, which is very different.”
Gillmore then explains that the number of Canadian euthanasia deaths is 20x the number of assisted suicide deaths in California.

For some, the availability of MAID isn’t so much a concern as the ease with which this country offers it. According to Health Canada, 31,664 people died by MAID in the five years after legalization. In 2021 alone, the number of medically assisted deaths in Canada—just over 10,000—was about twenty times higher than in California, a state with an assisted suicide program and similar population size. (In California, eligibility is granted only to those who are terminally ill.) Track Two was introduced in Canada in March 2021, and in less than a year, 219 people who were presumably not imminently dying had received it.
Heidi Janz
Disability professors, Heidi Janz and Catherine Frazee respond to the concerns of the disability community.
“Canada has become a poster child for how bad MAID can become,” says Heidi Janz, a long-time disability rights activist and playwright. An associate adjunct professor at the University of Alberta, she studies and teaches the ethics around end-of-life care and disability. Janz, along with Catherine Frazee, a professor emerita of disability studies at Toronto Metropolitan University, started the GRIM Project in 2022 to document the stories of disabled people who have considered MAID or have died by it. (Both Janz and Frazee appeared as witnesses for the AMAD committee, as well as several other sources I interviewed for this story.) The project takes its name from the Criminal Code’s language of a “grievous and irremediable condition.” Janz and Frazee have spent years listening to the stories of disabled Canadians, many of whom live in poverty and struggle with social isolation. MAID, says Janz, “has become an acceptable solution to poverty for people with disabilities.”

Catherine Frazee
These problems predate the MAID system,” says Frazee. She frequently hears stories of disabled Canadians turning to MAID out of desperation and thinks about them every day. They tell her they don’t want to die yet the government seems to be pushing them to. “But the MAID system makes it all a perfect crime because the MAID regime destroys the evidence,” she says. “It destroys the lives of the people who were here to report their experience of poverty and alienation and stigmatization and devaluation.”
Kerri Joffe, a lawyer who works with the disability community expresses that the problem is the language of Canada's euthanasia law. Gillmore writes:
But poverty is just “one piece of the puzzle” of why disabled Canadians are considering or are being approved for MAID even when they’re not dying, says Kerri Joffe, a staff lawyer with Arch Disability Law Centre, a Toronto-based legal clinic that focuses on disability rights law and policy in Ontario. The problems of disability poverty and the lack of affordable, accessible housing and proper home-care supports need to be addressed, she says. But Joffe, and others, have raised concerns that Canada’s MAID legislation denies disabled Canadians equal rights to life. The government needs to address this, she says, by removing Track Two altogether or changing the law “fundamentally so that it would comply with international human rights law.”
Gillmore writes about the February 2023 parliamentary report on euthanasia that advocated for further expansions of euthanasia to include euthanasia by advanced directive and euthanasia for "mature minors." Gillmore explains:

Yet the report also spoke favourably of further expansions, such as permitting advance requests for MAID. This would potentially allow people to stipulate under what circumstances they would want to receive MAID should they lose their capacity to consent to it. The committee also suggested that MAID be made available in certain circumstances to “mature minors,” though it recommended further consultations. (Currently, Belgium and the Netherlands are the only countries with comparable provisions for those under eighteen.) There should be no age limit to who can consent to receiving MAID, the report states; applicants should qualify if they are deemed capable of making the decision, though it does not go further to define “capable.” The committee also recommended that parents and guardians be consulted during the process, though not that they be required to approve of their child’s decision: “the will of a minor who is found to have the requisite decision-making capacity [must] ultimately take priority,” the report states.
Konia Trouton
illmore interviews Konia Trouton, a doctor and euthanasia provider who expresses her strong support for patient autonomy and choice. Gillmore writes:

Trouton, who now lives in Ontario, says she’s aware that some Canadians have received MAID even when the main cause of their suffering was a socio-economic factor not directly related to their qualifying medical condition. But that doesn’t technically make those cases ineligible. “The suffering and the irremediable disease don’t have to be the same,” says Trouton, citing the law’s language around safeguards: it does not explicitly state the need for suffering to be caused by a medical condition.

She points to other safeguards meant to ensure MAID applications are vetted appropriately. Applications go through at least two rounds of review. Two clinicians have to separately assess the MAID request to determine whether the applicant meets the medical criteria for it as outlined in the law, a step that can be done virtually.
Trouton explains that a patient needs to have considered medical treatment but is not required to have tried medical treatment and explains that one patient needed five interviews before being approved for euthanasia. Gillmore states:
Trouton usually calls her patients the day before their scheduled death to make sure they still want MAID. On the day of, to confirm that they understand what will happen to them, she asks them to tell her who they are and why they are there. “We do the same thing in surgery,” she says.

Madeline Li
Madeline Li, who is a psychiatrist and a euthanasia provider who doesn't support euthanasia for people who are not terminally ill. Li considers the law to be inherently flawed, as Gillmore reports:

Li developed the MAID program at UHN and says the law has always lacked sufficient safeguards, and this has only become more apparent as MAID has expanded. Specifically, the law needs to be more clinically informed, says Li, who is also a scientific researcher. The terms “reasonably foreseeable” and “incurability” must be defined medically, with specific time frames attached to the former and further explanations around the latter. A patient shouldn’t be deemed to have an incurable illness, for example, if they’ve refused treatments, she says. And providers need a clearer interpretation of what constitutes suffering in the context of MAID. “There needs to be clarification that the suffering needs to be medical suffering directly related to the medical condition,” she says. “And that sources of suffering indirectly related to the medical condition don’t qualify.”

Li would also like an oversight body to qualitatively review complex cases. What she’s proposing currently doesn’t exist on the federal level in Canada. She thinks clinicians need to be legally required to have more detailed conversations with patients who say they want MAID—conversations that don’t take the patients’ request at face value and aim to get at the best medical option for them.
Gillmore reports Li as saying:
“The problem has been that the people who first entered MAID work are now very experienced, but they’re confusing experience with expertise. They’ve been very focused on ‘Does a patient qualify?’ and not ‘Should a patient have MAID?’”
Gillmore then writes about the impending expansion of euthanasia to people with mental illness.
The looming expansion of MAID, under Track Two, to include people with mental illnesses has raised red flags for several psychiatrists, who say that allowing people with mental illnesses to die by MAID could rob them of the chance to find treatments that enhance their lives. According to Duff, it could violate the principles of suicide prevention. “One of the tools that we use to help prevent suicide is to eliminate the means,” she says. And if assessors comply with only the minimum requirements for the MAID expansions, “we’re just handing [patients] the means and not questioning why they want to kill themselves.”
John Maher
Psychiatrist John Maher told Gillmore:

“To say this is not suicide inducement or that it’s not suicide, I find bizarre,” says John Maher, a Barrie, Ontario, psychiatrist who has spent twenty years working with assertive community treatment teams. These twelve-person multidisciplinary teams work with people who have severe mental illnesses, including schizophrenia. There’s no consensus among psychiatrists that mental illnesses are irremediable, that they never get better. Maher argues that even patients with serious mental illnesses can improve; they often just need more time to find the right treatments that work for them—and for those treatments to be available to begin with.
Mitchell Tremblay wants to die by euthanasia based on his mental illness but he is concerned that the law will be abused. Gillmore writes:

Mitchell Tremblay says he plans to apply for MAID as soon as it becomes available for people with mental illnesses. Based in Guelph, Ontario, he has a disability and has been vocal online about his financial hardship... But even though he wants MAID for himself, he’s concerned that some other MAID applicants will be approved when they don’t actually have a serious, diagnosed, chronic mental illness—people who are experiencing a major depressive episode, brought on by events like a romantic breakup or the loss of a job or home, and whose mental health might improve with the right treatment.

“I think it’s going to be a national blight,” he says about expanding MAID eligibility while people don’t have proper supports. “There has to be all the avenues explored before MAID is the final option there for them.”
Maher states that with MAID for mental illness it won’t be clear how doctors should determine which suicidal patients will receive psychiatric care and which will be assessed for MAID. Gillmore continues:
“Suicide prevention work is about giving people hope: helping them make sense of suffering, giving them a sense of purpose in life, putting in speed bumps at those points in time when things look like there’s no hope of recovery,” says Maher. “The whole point of my team—our services, our care philosophy—is we don’t quit. We don’t go away. We don’t stop helping. We don’t stop trying to reduce suffering, we don’t stop helping people heal. We’re a recovery model.”
Gary Hertgers
Gary Hertgers learned about the euthanasia death of his sister when the manager of her apartment called him and said that the coroner had just left. He said he had just seen his sister Wilma two days earlier but she didn't tell him anything. Gillmore writes:
Wilma had been increasingly despondent since 2008, when her twin and long-time roommate, Jenny, died of cancer. Once a small business owner, Wilma had stopped working full time in the years after Jenny’s death. She increasingly complained of pain, Gary says. He remembers that she always seemed to be rotating through appointments with various specialists—oncologists, cardiologists, rheumatologists. Gary wanted to help his sister, and he and his family tried. But Wilma could be difficult at times, and he needed to set up boundaries for himself, he says. Still, his grief over Wilma’s death is unlike anything he’s ever experienced.

This is Gary’s third time grieving a sibling—and perhaps the most complicated. When he was almost sixteen, he watched his older brother, Martin, drown. It took him years to find some peace with respect to Martin’s death. He hasn’t come to that peace yet about Wilma’s.
Gary contacted Wilma's friends, who were willing to provide her help, but none of them knew of her plan to die. Gary recently told the government committee that Canada's euthanasia law needs to be retracted.

Gillmore then asks philospher Charles De Konink about euthanasia. De Konink states:
“What people desire most is to be loved,” especially when they’re dying or are in pain, says De Koninck. “And so many people are left alone in hospitals or in big houses, where nobody comes to see them. So they’re just stressed. They need friendship. They need concern. They need palliative care in that sense.”

For De Koninck, the existence of MAID should prompt questions about what is causing people to decide that death is better than life. The law’s vast acceptance in Canadian society, he says, is evidence that people have lost hope, that they are alone, or that they don’t have meaningful relationships.
Gillmore ends her article the way it began, with Tarra Carlson who is enjoying her life with her husband. She recognizes that people don't understand her or her disability, but she says that her life is not all doom and gloom.

Gillmore doesn't answer the question that her article is asking but after interviewing a myriad of people it appears clear that Canada's euthanasia law has gone too far.

I believe that Canada went too far when it legalized euthanasia, meaning, Canada gave physicians and nurse practitioners the right in law to kill their patients.

Tuesday, May 30, 2023

Philosopher Peter Singer on euthanasia and killing newborns

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Peter Singer
Dylan Matthewsa senior correspondent and head writer for Vox's Future Perfect section, has worked at Vox since 2014.

Vox published an interview by Matthews on May 30, 2023 with philosopher Peter Singer who is known as a father of the animal rights movement. Singer supports euthanasia and infanticide. Matthews states that the philosophy aspoused by Peter Singer has greatly affected him. 

People are too polite about Singer's philosophy. Singer has a eugenic philosophy and his writings are dangerous. He believes that certain lives are unworthy of life. His philosophy undermines the concept of human equality by justifying the killing of people who lack an undefined level of cognitive capacity.

Matthews asks Singer about his philosophy about killing human beings. Singer responds:

But what is correct about what you said was that when I started thinking about the ethics of how we treat animals, I started asking questions about, well, is it only inflicting suffering on animals that is bad, preventing them from having enjoyable lives? Or is it the fact that we kill them?

That led me to think, well, what is it that makes killing wrong? And because I’m not religious, I was not going to say “because we have an immortal soul,” or “because God forbids it.” I started thinking, well, maybe it’s something to do with our intellect, the fact that we want to plan for the future and that if we are killed, we can’t.

So I thought about that and that made me think, well, okay, so maybe the humane killing of a non-human animal is not as bad as the humane killing of a normal human being. I still think that.

But suppose that you have a human who lacks the cognitive capacities that enable normal humans to think about their future. That could be an infant. None of us were born with those capacities. Or it could be someone with a severe intellectual disability that was not treatable. For that matter, it could be somebody who didn’t really have much of a future to look forward to because they were terminally ill and they were expecting to die within weeks or months, and their quality of life had fallen to a level where they didn’t think it was worth going on.

Singer is justifying the killing of infants and people with disabilities who lack an undefinable level of cognitive capacity. Matthews asks Singer what he thinks about the pushback from the disability rights movement. Singer responds with his support for killing infants:

You’re right to say that in terms of the underlying ethical arguments, that’s not changed. I still think there are cases where parents should have the option of ending the life of their severely disabled infant.

Let me just say a couple of things why I think that’s not as radical as some people might think. It’s standard practice in neonatal intensive care units pretty much everywhere, that if a child is born with a very severe disability, doctors will ask parents whether they want to put the child on life support or not — or if the child is on life support when the disability is discovered, whether they wish to remove life support.

If you have, let’s say, a premature infant who’s had a massive brain bleeding, a hemorrhage in the brain, which does happen with very premature infants, and the doctors say, “Would you like to take your child off life support? This is the prognosis. Your child will never be able to live independently, will never be able to recognize the child’s mother or father, will basically be needing complete care. Would you like to take this child off life support?” That’s a decision to ask: “Would you like the child to die?” There’s no other way of glossing that.

Singer has always believed that there is no difference between killing and letting die and sadly the Supreme Court of Canada, in the Carter, euthanasia decision, agreed, but in reality there is a clear difference between killing and letting die, in a practical and a real sense. Letting die allows nature to take it's course, whereas killing someone requires someone to intentionally take that person's life.

Matthews questions Singer based on the consequences of his arguments for the lives of people with disabilities. Singer responds:

I do consider the consequences of our actions as the way to determine which actions are right or wrong, and if I were persuaded that the harms are really so serious that it is better not to talk about these issues, then I wouldn’t talk about them. But I haven’t been persuaded by that. And, of course, we have to balance it against the consequences of parents thinking about the issue in a way that doesn’t leave them tortured with guilt for making what many people would think of as a morally wrong decision.

I’m interested in social reform. For example, I think switching to voluntary euthanasia or physician-assisted dying, that movement has made very significant progress in the last 40 years, and I think has greatly reduced the amount of unnecessary suffering. But some people with disabilities are opposed to that as well, because they think pressure will be put on people with disabilities to end their lives.

That would be a serious consideration if there were clear evidence that that’s the case. But I really haven’t seen the evidence, either about the speech harms that you’re referring to or about pressure on people with disabilities to end their lives. So I continue to advocate for physician-assisted dying.

In general, I think that freedom of thought and expression is really important. I think that people have become, perhaps, overly sensitive in the last couple of decades about speech harm. It’s often said but rarely backed up with firm evidence about how serious it is. So that’s why I haven’t stopped talking about these issues.
Singer admits that when the euthanasia movement switched to voluntary euthanasia or physician-assisted dying that they became more successful. Notice that Singer does not say he is opposed to involuntary euthanasia since that would undermine is arguement for euthanasia of infants and other people who are unable to consent. Singer aspouses the concept that some lives are not worth living, including infants with disabilities, who cannot consent and people with dementia, who cannot consent.

When we consider the changes in Canada's euthanasia law the ability to consent has been undermined and the concept of killing someone who cannot request or consent is being debated.

When Canada legalized euthanasia the law required that a person must be capable of consenting at the time of death. Bill C-7 changed that requirement by making it possible to kill someone who cannot consent if that person had already been approved for death. Bill C-7 approved euthanasia for mental illness alone, which will come into effect in March 2024. People with mental illness have a questionable ability to consent. Canada's recent government euthanasia committee advocated for euthanasia of "mature minors" and euthanasia by advanced directive. Euthanasia by advanced directive would enable the killing of a person who is unable to consent or confirm their "wish" to die and euthanasia of "mature minors" changes the nature of consent that is required.

Euthanasia of infants with disabilities (infanticide) is being advocated by the Québec College of Physicians and discussed by Canadian politicians. Infants are not capable of requesting or consenting for death to be inflicted upon them.

The discussion about killing people with disabilities is eugenic. Eugenic euthanasia permits the killing of people who society deems "unworthy of life," and giving one group of people (medical professionals) the right to kill another group of people. This is a dangerous idea.

Human equality requires that every human being has an equal right to live and no one has the power to kill another human being.

I believe in human equality. I oppose killing people.

No justification for euthanising the vulnerable

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kevin Yuill
Kevin Yuill, author of the book - Assisted Suicide: The Liberal, Humanist Case Against Legalisation - has written an excellent article published by Spiked on May 22, 2023. Yuill responds to an article published in the Journal of Medical Ethics (JME), which has garnered a great deal of attention in the Canadian press. Yuill writes:
The article in question, written by two bioethicists at the University of Toronto – Kayla Wiebe, a PhD candidate in philosophy, and Amy Mullin, a bioethicist and professor of philosophy – tries to defend Medical Assistance in Dying (MAID), Canada’s now notorious euthanasia programme...

The article tries to respond to the widespread criticism that Canada is ‘euthanising its poor’. MAID is currently made available to anyone with a condition or disability that they believe ‘cannot be relieved under conditions that they consider acceptable’. In practice, this has led many people who are poor and helpless to seek an assisted death as a means of escaping their problems. In 2024, the eligibility criteria for MAID will be expanded further to include people who suffer from mental-health problems alone.
Yuill continues by commenting on euthanasia based on homelessness:
The case of Amir Farsoud, a disabled man who applied for MAID last year because he was about to be made homeless, sparked an international outcry and led many people to reconsider their support for assisted dying. As one popular Twitter blogger based in Scotland, where assisted-dying legislation is being considered, said recently: ‘Canada has pretty much changed my mind about assisted dying. It’s absolutely terrifying.’

Wiebe and Mullin see no problem with cases like Farsoud’s. In fact, they argue that it is ‘unacceptable’ to force people to wait for improvements in their personal circumstances before accessing MAID. They also see MAID as a form of ‘harm reduction’, as a ‘“lesser evil” between two or more less than ideal options’.
After explaining how Canada legalized euthanasia, Yuill states:
Of course, choosing MAID is not an expression of autonomy at all. Autonomy refers to an individual’s right or capacity to make free decisions for him or herself. But the final decision to grant MAID is made by doctors and the state, not by patients.

Tellingly, despite their appeals to autonomy, the authors of the JME article insist that patients should not have the right to decline medical treatment. They use an example cited by feminist scholar Catriona Mackenzie, who writes on relational autonomy. Wiebe and Mullin state:
Mrs H has cancer, has had part of a leg amputated, and her husband has left her due to her disability and regards her as an embarrassment. Mrs H, as described by Mackenzie, has lost all sense of self-worth, does not trust herself, and does not want any of the treatment options her medical team proposes. She wants to die. We agree with Mackenzie’s suggestion that Mrs H as so described is not fully autonomous. However, the judgement that she is not autonomous is grounded in the fact that in this particular case, we have an agent who lacks self-trust, has no self-worth and has evidently lost engaged hope.’
Using what can only be described as tortuous logic, Wiebe and Mullin have decided that those who seek death – who, almost by definition, have no self-worth and have plainly lost hope – should always be considered autonomous. This is because they are said to be making an active choice to be killed. Poor Mrs H, on the other hand, is told she lacks the ‘engaged hope’ of those demanding MAID. Therefore, the authors argue, she should not even be allowed to refuse medical treatment – a basic tenet of bodily autonomy and a well-established right in almost all areas of the world.
Yuill further unravels the inconsistent arguement by Wiebe and Mullin. 

He writes:
Ironically, the authors even condemn arguments that Canada should provide better palliative care and services for disabled and ill people rather than euthanising them: ‘This type of argument appears to us to licence paternalistically overriding the decisions of competent people whose suffering has led them to choose to die with medical assistance in order to make instrumental use of their suffering.’ Then they have the cheek to say that arguments for better service provision are ‘insensitive to the… very real suffering of people requesting MAID, and… therefore unsupportable, no matter how noble the cause’.
Yuill concludes:
What Wiebe and Mullin’s JME article unwittingly reveals is that arguments for euthanasia and assisted dying have nothing to do with autonomy. And they have even less to do with improving the lot of the suffering. If this article is any guide to the future of euthanasia in Canada, then we have a lot to worry about.
A previous article on the same topic:

Monday, May 29, 2023

Killing used as an acceptable solution to social problems?

MAiD exposes Canada's curable social illsby Margaret Shkimba, was published in the Hamilton Spectator on May 23, 2023. Shkimba  is not opposed to MAiD but recent media stories, about euthanasia for poverty and for prisoners, have given her pause for thought. Shkimba writes:

Long ago, I saw someone jump from the 403 overpass on King St. I was on the bus. Before he went over, our eyes locked, just for an instant, I was that close. It’s a sight that has haunted me ever since. I saw the blood stain on the pavement when I walked home from work that day. Of course there was nothing in the paper, no one talks about suicide, so I called the police for information. I was told he suffered with demons for years. His people believed he was at peace now. I felt relief. I was carrying his pain with me. I still do on some level.

Shkimba felt uncomfortable with a presentation made in her church that opposed MAiD. She writes:

While I support MAID, two stories appeared last week that have given me pause to ask if we can’t do better.

The first reported that a third of Canadians support poverty as a valid reason for MAID. That blows my mind. Unlike physical and mental health there is a cure for being poor. We could lift people out of poverty with a stroke of the proverbial pen. It could start with the provincial government increasing OW and ODSP payments to realistic, nonpunishment levels. It would be improved with passing livable wage legislation and rent controls. Even better would be the provision of deeply affordable housing. Easy, peasy, really. But a third of us would rather people kill themselves. Who are we?

The second introduced a MAID population I hadn’t considered: prison inmates. Inmates who fear they will die alone in jail seek MAID to die with their loved ones. We think we’re a humane country because we don’t have the death penalty. But we do. It’s just voluntary. While only a small number have availed themselves of MAID at present, given that the suicide rate in Canada’s prisons is appallingly high, over twice the national average according to the John Howard Society and the punitive and problematic nature of the carceral system, we can expect that number to increase.

MAID is exposing the bleeding wound of Canada’s many social injustices and it doesn’t look good. We can use it like a diagnostic. Then people don’t have to die.

I share Shkimba's concern for suffering people. Euthanasia is about killing people. Is killing ever an acceptable solution to social problems?

Tina Turner considered assisted suicide, husband's love gave her a reason to live

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Erwin Bach and Tina Turner 
Tina Turner died a natural death on Wednesday May 24,2023. 

In her memoir, Tina Turner: My Love Story, Turner explains that in December 2016 she signed up with the Swiss assisted suicide group Exit. reported on May 25 that:
The ‘Simply the Best’ icon, who passed away aged 83 on Wednesday (24.05.23) from natural causes at her home in Küsnach near Zurich, Switzerland, after years of health woes, thought about euthanasia before her music producer husband Erwin Bach, 67, donated his kidney to her.
Crowrivermedia continued:
She said in her memoir ‘Tina Turner: My Love Story’: “By December 2016, my kidneys were at a new low of 20 per cent and plunging rapidly.

“And I faced two choices: either regular dialysis or a kidney transplant.

“It wasn’t my idea of life. But the toxins in my body had started taking over. I couldn’t eat. I was surviving, but not living.

“I began to think about death. If my kidneys were going, and it was time for me to die, I could accept that. It was OK. When it’s time, it’s really time.

“I didn’t mind the thought of dying, but I was concerned about how I would go.”
Tina Turner's husband, Erwin Bach, told her that he didn't want to lose her, he didn't want her to die.
It was at that point her husband offered her a kidney, with the donation taking place in 2017.

Tina added: “He said he didn’t want another woman, or another life; we were happy and he’d do anything to keep us together.
“Then he shocked me. He said that he wanted to give me one of his kidneys. I was overwhelmed by the enormity of his offer.

“But because I love him, my first response was to try to talk him out of taking such a serious and irreversible step.”

“While I was understandably anxious about the transplant, I was far more concerned about him. After about an hour, it was my turn.

“When I awoke, I was so groggy that everything… the best moment was when Erwin came rolling into my room in his wheelchair.”
Tina Turner's story is similar to many other stories. 

Many people ask for assisted suicide because they don't want to be a burden on others, or they are afraid of future suffering. When Bach told Turner that he loved her and he wanted to her to live, and then offered her one of his kidneys, he affirmed his love for her. 

His love gave her a reason to live.

International online company sells and promotes suicide.

If you or anyone you know is struggling with mental health there are a number of ways to get help, including by calling Talk Suicide Canada at 1-833-456-4566.
Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was doing a google search on a US state assisted suicide bill when the top search results included an ad stating: Shop help for suicide - Amazon Official Site.

The ad stated: Find deals on help for suicide in books on Amazon. Browse and discover thousands of products.

When I clicked on the link I was brought to a page selling how to suicide books and information from a variety of authors.

The easy access to how to suicide books and information is a serious concern considering the many people who are experience suicidal ideation. Many people temporily struggle with suicidal thoughts. These people need treatment and support to get through their struggle. Instead, Amazon is encouraging people to die by suicide, their site is similar to counseling people to suicide.

When Canada legalized euthanasia and assisted suicide in 2016 it did so by creating an exception in the Criminal Code to homicide (Section 222 of the Criminal Code) and assisting a suicide (Section 241 of the Criminal Code). Therefore it remains illegal for me or you or Amazon to assist a suicide.

Section 241 of Canada's Criminal Code states:

241 (1) Everyone is guilty of an indictable offence and liable to imprisonment for a term of not more than 14 years who, whether suicide ensues or not,

(a) counsels a person to die by suicide or abets a person in dying by suicide; or

(b) aids a person to die by suicide.

Based on my search result and the wording of Section 241 of the Criminal Code, it appears that Amazon is breaking Canadian law.

Neha Raju and Tom Parfett
On May 10, 2023; an Ontario man was charged with two counts of Aid and Abetting suicide. Neha Raju and Tom Parfett were among alleged 1200 people who received packages of a suicide substance allegedly from Kenneth Law.

In November 2022, Representative Lori Trahan, Democrat of Massachusetts, co-sponsor Katie Porter, Democrat of California, and Republicans Mike Carey of Ohio and Chris Stewart of Utah sponsored Bill H.R.9260, to stop online suicide assistance forums, etc.

An article by Gabriel J.X. Dance and Megan Twohey titled: Bill Outlawing Online Suicide Assistance Would Open Sites to Liability reports on a bipartisan bill introduced in the House of Representatives amid rising concern over suicide rates among young people, and mounting evidence of online dangers. 

The article referred to the New York Times investigative report on a suicide website from December 2022:

The bill’s primary sponsor cited a Times investigation published last December into a website where members share detailed instructions on how to die and encourage one another to follow through with suicide plans. The investigation identified 45 deaths connected to the site and found hundreds of posts suggesting that the true toll was much higher.

Even as the trail of suicides connected to the site grows longer — The Times has since identified dozens more deaths, including several young teenagers — no one involved has faced legal consequences.
The article reports that Trahan, the bills sponsor, referred to the New York Times findings as “terrifying” and said that “it motivated us to act.”

Canada may need to amend Section 241 of the Criminal Code to define the term "everyone" to ensure that it prohibits online suicide websites and the online sale of suicide books, instructions and materials.

Thursday, May 25, 2023

Assisted suicide discriminates against people with disabilities

This article was published by the Cape Gazette on May 23, 2023.

By Daniese McMullin-Powell

Assisted suicide is a dangerous public policy that threatens the most vulnerable in society, especially people like me – people with disabilities. Upon initial consideration, many do not see how assisted suicide is particularly dangerous to the disability community. However, based on the weakening of the already-flimsy safeguards that is going on in other states that allow the deadly practice, the danger of abuse in assisted-suicide laws is real. I urge the Delaware Legislature to take a hard look at the facts of assisted suicide and to propose laws that help address the reasons people seek assisted suicide in the first place.

Assisted-suicide laws are inherently discriminatory and target people with disabilities. These laws lead to abuse and harm because the so-called safeguards within assisted-suicide laws are weak. According to a study published by the National Council on Disability, an independent federal agency, the safeguards in assisted-suicide laws are ineffective, and oversight of abuses and mistakes is absent. People with disabilities already face an uphill battle trying to receive fair treatment in a society that equates functionality with worth. It makes no sense to add to the disability community’s list of worries by legalizing a practice that would inevitably lead to abuse.

Alarmingly, in Oregon, where assisted suicide has been legal the longest, the safeguards that proponents used to pass assisted-suicide legislation are now being weakened and characterized as barriers. Originally, Oregon had a 15-day waiting period in its law, which was valuable because it gave patients time to reflect and seek a second medical opinion. After all, assisted suicide is not a reversible decision. However, in 2020, Oregon removed the 15-day waiting period for patients whose physicians believed they would die before the end of the 15-day waiting period. Last year, 20% of patients received the waiver, and some even died on the same day that they requested assisted suicide. This same-day suicide assistance doesn’t give patients time to seek a second opinion, or even to change their minds. Once legalized, there is always a push to make suicide more accessible. In truth, there are no safeguards that could adequately protect vulnerable people from abuse and harm due to assisted suicide. Even so, to remove existing safeguards, no matter how flimsy, would be foolish.

Assisted-suicide policy fails to address the primary reasons that drive people to seek it in the first place. Proponents claim that people seek assisted suicide to avoid unbearable pain at the end of life. However, this is simply untrue. According to data from Oregon, people most often cite disability-related concerns as their reason for seeking assisted suicide. Their top reasons include loss of autonomy, decreasing ability to participate in life activities and loss of dignity. These are serious concerns that people in the disability community live with every day. Instead of legalizing assisted suicide, society should focus on educating, and removing the stigma surrounding disability. We should focus on providing better care because the above concerns are all treatable with appropriate, multi-disciplinary care. If legalized, assisted suicide sends the wrong message to people with disabilities: You’re better off dead than alive.

As a result, assisted suicide is a deadly public policy that puts people with disabilities at greater risk for abuse and harm. The so-called safeguards in assisted suicide laws are flimsy at best and have been found ineffective at protecting patients from abuse. In states where assisted suicide is already legal, there are incremental steps being made to lessen what little safeguards are in place. At the end of the day, this confirms what we’ve always known: Assisted suicide is about fear of disability. I want to encourage our Delaware Legislature to educate the public and reduce the stigma around disability. The people of Delaware deserve quality medical care and supports at all stages of life, not a premature death.

Daniese McMullin-Powell is a disability advocate who lives in Newark

Nevada Governor Joe Lombardo must veto assisted suicide bill SB 239

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Governor Joe Lombardo

Please help us send the message to Nevada Governor Joe Lombardo to veto assisted suicide Bill SB 239 that passed yesterday. Governor Lombardo only has five days to veto the bill.

Send a message to Governor Lombardo urging him to veto SB 239 through (this link)
or call hin at: (775) 684-5670 and ask him to veto SB 239 or send your message by Twitter at: @JosephMLombardo

Remember when you are filling out the form to refer to Bill SB 239.

Bill SB 239 passed in the Nevada Senate by a vote of 11 to 10. Yesterday it passed in the House by a vote of 23 to 19.

Tell Governor Lombardo that legalizing assisted suicide gives doctors the right in law to be involved with causing the death of their patients at the most vulnerable time of their lives. Assisted suicide is not about freedom or choice but it is actually a form of cultural and medical abandonment. A caring culture supports good end of life care and it opposes assisting suicides. 

If you have a personal story, share it with Governor Lombardo. It is important to remind the Governor that the disability community opposes assisted suicide because it leads to a further devaluation of their lives.

The assisted suicide lobby, over the past few years, has expanded existing assisted suicide legislation. Oregon eliminated their reflection period and has eliminated their residency requirement. Vermont is permitting assisted suicide by telehealth, they are forcing medical practitioners who oppose assisted suicide to refer patients to death and they have eliminated their residency requirement. Washington state and Hawaii have also expanded their assisted suicide laws.

Once assisted suicide is legal, the assisted suicide lobby will lobby or launch court cases to expand the law. The original assisted suicide bill is designed to pass in the legislature, once passed incremental extentions will follow.

Send your message to Governor Joe Lombardo urging him to veto SB 239 through (this link) or you can send your message by Twitter at: @JosephMLombardo

Wednesday, May 24, 2023

Hon. Ed Fast MP speaks on euthanasia for mental health in Canada's parliament

Hon. Ed Fast MP
Hon. Ed Fast (Abbotsford, CPC) 

Moved that Bill C-314, an act to amend the Criminal Code (medical assistance in dying), be read the second time and referred to a committee.

For further information about the Bill C-314 debate in parliament (Article Link).

*Sign our petition supporting Bill C314 (Petition Link).

Hon. Ed Fast MP: 

Mr. Speaker, I am pleased to speak to my private member's bill, Bill C-314, the mental health protection act.

In its very essence, this bill is about reaffirming the dignity and worth of each and every human life. It is about recognizing that it is the most vulnerable among us, the disabled and the mentally ill, to whom we owe the greatest duty: to defend and protect their lives and to provide them with every possible opportunity to live life to the fullest.

Medically assisted suicide was legalized in Canada in 2015 by the Supreme Court's Carter decision and later under the Liberal government's Bill C-14. Under this legislation, medical assistance in dying, or MAID, as it is commonly called, was strictly limited to those consenting adults who had an incurable disease that caused enduring, intolerable suffering that could not be alleviated, and where natural death was reasonably foreseeable, which they call the foreseeability test.

At the time, the government and its supportive stakeholders assured Canadians that this was not a slippery slope, where the scope of MAID would continually be expanded to include more and more vulnerable Canadians. However, not surprisingly, in the intervening eight years since the Carter decision, the government has begun to expand Canada's MAID regime to include more and more defenceless Canadians, most particularly those living with disabilities.

In late 2019, a Quebec lower court judge in the Truchon case ruled that the foreseeability test I just mentioned was unconstitutional, requiring Parliament to respond with additional legislation. Sadly, the Liberal government chose not to appeal the Truchon case to the Supreme Court of Canada, presumably because the decision lined up with the Prime Minister's intent to dramatically expand assisted suicide to other vulnerable Canadians. This leaves us with the perverse situation in which the Supreme Court of Canada, the highest court in the country, has never been allowed to opine on whether the reasonable foreseeability test is constitutional.

In any event, the Liberal government responded to Truchon by tabling Bill C-7, which initially eliminated the foreseeability test but expressly excluded mentally ill persons from being caught up in its MAID regime. Here is what the justice minister said at the time:

The fact that there would be risk of ending the life of a person whose symptoms would have, in part, why we are of the view that it is safest not to permit MAID on the sole basis of mental illness.... There is also ongoing uncertainty and disagreement as to the potential impact on suicide prevention if MAID were made available to this group.

He went on to say:
...there is no consensus among experts on whether and how to proceed with MAID on the basis of mental illness alone. On a question of such importance and with so much uncertainty and expert disagreement, it is incumbent upon us to proceed with caution and prudence.
Those were our justice minister’s views until the unelected Senate suddenly introduced an amendment that expanded MAID to those Canadians whose sole underlying condition is mental illness. Sadly, the justice minister and the government accepted the amendment without protest and, overnight, became zealous proponents of assisted death for the mentally ill. What happened to the caution and prudence the minister was preaching? What about the impact on suicide prevention the minister was so concerned about? What happened to his view that it was safest not to permit MAID on the sole basis of mental illness?

I agree with the Minister of Justice on one thing, which is that, as he has said, this is indeed a complex issue and is deeply personal. It is deeply personal because it involves life, a precious human life.

I would remind the minister and his government that the issue is also profoundly simple; that is, the principle that all life, all human life is precious and worthy of defence and protection, especially for those who do not have the ability to speak for themselves and have no one to speak for them.

One of the primary functions of government is to protect its citizens, to protect life. In fact, the right to life is expressly enshrined in section 7 of our Charter of Rights. Sadly, the government's Bill C-7 fails to protect the lives of our most vulnerable. It removes the critical safeguards that the original euthanasia legislation included in response to the Carter decision. Removing those safeguards will have irreversible consequences for those who suffer from mental illnesses like depression.

What is equally disturbing is that the Liberal government has also signalled its intention to extend the so-called “treatment option” to minor children. That would arguably make Canada the most expansive, most liberal, assisted suicide jurisdiction in the world. Clearly we are on the slippery slope many of us warned about. Canadians have a right to conclude that the Liberal government has gone too far and too fast in its zeal to implement and expand the scope of assisted death.

My bill will reverse this momentum and repeal the government's decision to extend MAID to the mentally ill. It will put a full stop to the expansion of assisted suicide to mentally disordered persons. Let me be clear. My bill does not in any way reverse the rest of Canada’s MAID regime. Assisted death will remain available for those suffering from irremediable, incurable and intolerable illnesses and diseases. My bill is simply focused on reversing the government’s actions in expanding assisted suicide to include the mentally ill. It would arrest Canada’s slide into normalizing assisted death as an alternative treatment option, something so many of us had predicted would happen.

The evidence from mental health experts is very clear. Contrary to what our justice minister is now saying, there is absolutely no consensus in Canada that the mentally ill should be covered by Canada’s medically assisted death regime. In fact, here is what experts and other stakeholders in the mental health community are saying. John Maher, psychiatrist with Canadian Mental Health Association, states that:
Inducement to suicide while simultaneously denying mental health care to two-thirds of Canadians who urgently need it is an unconscionable failing.

Directly undermining suicide prevention efforts is an insidious and ablest perversion of our mental health care duty.
Dr Ramona Coelho
Drs. Ramona Coelho and Catherine Ferrier, co-founders of Physicians Together with Vulnerable Canadian, penned a statement that was endorsed by over 1,000 physicians. This is part of what it said, 
“Given that there is no medical evidence to reliably predict which patients with a mental illness will not get better, MAID for mental illness will end the lives of patients who would have recovered…Medicine …would fail in its mission if it were to deliberately end the lives of patients living with mental illness… Legislators must work towards safeguarding the lives of the most vulnerable including those placed at a greater disadvantage because of mental illness.”
Dr Sonu Gaind
Dr. Sonu Gaind, chief of the Department of Psychiatry at Sunnybrook Hospital, Toronto, stated, 
“The Ministers have provided false reassurances that we can somehow separate people who are suicidal from those who are seeking psychiatric euthanasia. That is simply not true. In my opinion, that is dangerous misinformation coming from our federal Minister of Justice and our federal Minister of Mental Health and Addictions providing a false sense of safety that does not exist.”
Trudo Lemmens
Trudo Lemmens, professor and chair in health law at the University of Toronto, said, 
“I urge Parliament to take very seriously how offering MAID for mental illness deprives disabled persons, particularly those with mental illness, from equal protection against premature death. Persons experiencing mental illness deserve to be protected against premature death by an unreserved focus on ensuring access to all required health care and social support services. Facilitating their death does exactly the opposite.”
Sephora Tang
Finally, Sephora Tang, psychiatrist and assistant professor in the Department of Psychiatry at University of Ottawa, said, 
“One cannot prevent suicide while at the same time facilitating it. Placing expectations upon mental health professionals to do both undermines the effective delivery of recovery-oriented mental health care. Canadians deserve to live in a country that is committed to safeguarding the right to life and security of every person. Current MAID legislation fails to achieve this overarching social good.”
Even Canada's justice minister has publicly acknowledged the fact that issues such as irremediability, competency and suicidality are not anywhere close to being resolved to justify such a major policy shift in favour of death. Furthermore, medically assisted death flies in the face of the government’s own promotion of suicide prevention programs, including the recent creation of a national 988 suicide hotline.

It cannot be both ways. It cannot claim, as the Liberal government has, that it wants to prevent suicide deaths on the one hand, when it actively promotes assisted suicide for the mentally ill on the other. Over the last eight years, many of us have expressed our concern and expectation that the Carter decision and Bill C-14 would be expanded by future court decisions, and that these decisions would leave more and more vulnerable populations exposed to the reach of medically assisted suicide.

Our concerns were pooh-poohed. We were accused of fearmongering and of misrepresenting the intentions of this Liberal government. Yet, today, the Truchon decision and the travesty of Bill C-7 bear out our concerns. That is why more and more disability groups have set the alarm bells ringing and are vehemently opposing this legislation. They argue that this legislation amounts to a deadly form of discrimination, making it easier for persons with disabilities to die than to live.

We are hearing more and more reports of the poor and homeless approaching food banks to ask for assisted death, not because they are suffering from a grievous illness but because they do not want to go hungry and homeless. The headline in the British magazine The Spectator asked last year, “Why is Canada euthanising the poor?”

The response from some bioethicists appears to be, “Well, why not?” In fact, a new paper by two bioethicists at the University of Toronto makes the case that euthanizing the poor should be socially acceptable. That is indicative of the path on which our country finds itself. It is terrifying.

We also have verified reports of veterans suffering from PTSD who are being counselled by the Liberal government to consider medical assistance in dying rather than being provided with the treatment and supports they need to recover.
These are the vulnerable that the Liberal government promised to protect. Canadians have the right to ask whether this government is exercising the requisite caution and care to avoid unnecessary overreach and ensure that MAID is not abused or misapplied.

Let me conclude. My private member's bill, Bill C-314 gives all of us parliamentarians an opportunity to take a deep breath and reconsider the perilous road we have embarked upon. As I mentioned, my bill simply reverses the expansion of Canada’s assisted death laws to the mentally ill. At the very least, I would ask my colleagues to allow my bill, at second reading, to go to committee where there could be more discussion.

Have we gone too far and too fast with Canada's assisted suicide program? Will we evolve into a culture of death as the preferred option for those who suffer from mental illness or will we choose life?

I implore my colleagues to choose life. I wish them much wisdom as they make that choice.