Showing posts with label Australian Care Alliance. Show all posts
Showing posts with label Australian Care Alliance. Show all posts

Thursday, February 20, 2025

Victoria Australia debates expansions to it's euthanasia law.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Victoria Australia is considering legislation to expand their euthanasia law. Victoria was the first Australian state to legalize euthanasia in June 2019.

When Victoria was debating euthanasia, in order to get the bill passed, they agreed to a bill with several "safeguards" including a 6 month terminal illness prognosis and the requirement that doctors cannot initiate the discussion around euthanasia.

Similar to nearly every jurisdiction that has legalized euthanasia or assisted suicide Victoria is now considering expanding their euthanasia law to include a 12 month terminal illness prognosis, a reduction in the waiting period and allowing physicians to introduce the topic of euthanasia.

Callum Godde and Holly Hales reported for AAP news that:
A ban on Victorian health practitioners raising voluntary assisted dying (VAD) with terminally ill patients would be lifted under legislation set to be introduced to state parliament in 2025.

The government also wants to mandate practitioners' providing a bare minimum of information to patients if asked about the end-of-life process, even if they object.

Under the reforms, the life expectancy barrier for eligibility would be extended from six to 12 months for all patients, a third assessment requirement for neurodegenerative patients removed and the time between first and final VAD requests shortened from nine to five days.

A requirement would be added for people to be an Australian permanent resident for at least three years and an exemption for those who haven't lived in Victoria for 12 months to get access if they have a "substantial connection" to the state.
According to Godde and Hales, the Green Party believes that the proposal doesn't go far enough. The Green Party wants to eliminate the requirement of a terminal prognosis.

The Australian Care Alliance reports that as of June 30, 2024 there have been at least 1282 people who have died by euthanasia in Victoria Australia. Victoria Australia allows euthanasia and assisted suicide.

Thursday, January 16, 2025

Register for our EPC zoom event: Australia's experience with euthanasia on Tuesday January 21.

Join the Euthanasia Prevention Coalition and the Australian Care Alliance for a live Zoom presentation on Tuesday January 21 at 3 pm (Eastern Time).

Register for the Zoom presentation. (Registration Link).

Canada legalized euthanasia by amending the federal criminal code to create a national exception to homicide (murder).

Australia is similar to the United States whereby states that legalize euthanasia and assisted suicide do so by amending state laws. Therefore every Australian state has a different law.

Richard Egan with the Australian Care Alliance will join Alex Schadenberg to provide an update concerning what is happening with euthanasia and assisted suicide in Australia.

The Australian laws require scrutiny now that Britain is debating the legalization of assisted suicide. 

British politicians who support assisted suicide have become interested in Australia's experience since Canada's euthanasia (MAiD) law has become toxic based on the many negative stories and reports.

Register for the Zoom presentation. (Registration Link). Once you register, a confirmation email will be sent to you.

Monday, January 13, 2025

Queensland euthanasia report indicates another 26% increase in deaths.

This report was published by the Australian Care Alliance.

Euthanasia and assistance to suicide became legal in Queensland on 1 January 2023 under the Voluntary Assisted Dying Act 2021.

Numbers

A report on the first six months of legalisation states that there were 245 deaths under the Act - 139 deaths (56.73%) by “practitioner administration”, that is euthanasia and 106 by “self-administration”, that is assisted suicide.
245 deaths in six months represents about 1.31% of all deaths - higher than WA after one year and twice Victoria's rate after 4 years.

A second report, covering 1 July 2023 - 30 June 2024 states that there were 793 deaths under the Act - 532 deaths (67%) by “practitioner administration”, that is euthanasia and 261 (33%) by “self-administration”, that is assisted suicide.

This represents about 1.9% of all deaths in 2023/24 – a 45% increase on the rate for the first six months of operation.

A quarterly report covering 1 July 2024 - 30 September 2024 states that there were 241 deaths under the Act – representing 2.4% of all deaths in Queensland in that period, a further 26% increase on the rate for 2023-24. 

One relevant factor in this higher rate compared to other Australian states could be that the eligibility criteria in Queensland include a prognosis that the condition is " expected to cause death within 12 months" whereas it is six months (except for neuro-degenerative conditions) in the other states.
Practitioners

Registered nurses are allowed to administer the prescribed lethal substance to cause a person’s death. 172 registered nurses have done the training (compared to 187 medical practitioners and 22 nurse practitioners).
Of the 120 practitioners involved in 2023-24 as coordinating or consulting practitioners 47 of them were involved in 21 or more cases (that is on average at least one case every 17 days).
20 nurses and nurse practitioners administered a lethal substance to a person in 2023-24, compared with 51 medical practitioners.
Of these 71 State trained professional killers, 28 are serial killers, having killed five or more people each in 2023-24.

Prognosis

Unlike other United States and Australian jurisdictions which limit assisted suicide (and, in Australian jurisdictions, euthanasia) to those with a prognosis of 6 months or less to expected death, the Queensland law allows access to those with a prognosis of expected death within 12 months.

This increases the likelihood of wrongful deaths from errors in prognosis.

Refusing treatment and symptom management


The Queensland Government explicitly states that those seeking euthanasia or assistance to suicide may meet the eligibility criteria of a terminal illness that is causing suffering by refusing medical treatment and symptom management.

This makes it clear that this regime is about facilitating the intentional ending of life and not about relieving unavoidable suffering at the end of life. Under these provisions people with otherwise non-terminal conditions such as a young person with insulin dependent diabetes could be euthanased.
Timeframe

The law generally requires a nine-day period between a first and final request but this can be waived if two medical practitioners agree the person may die or lose decision-making capacity within that period.
In 2023-24, 275 people had the nine-day waiting period waived. This is 34.7 % of those who died under the Act.
Where a person is assessed as likely to imminently losing decision-making capacity there must be a real doubt as to the person ‘s current decision-making capacity so this provision increases the likelihood of wrongful deaths from lack of decision-making capacity.

Government facilitation of suicide and euthanasia

The Queensland Government has established Queensland Voluntary Assisted Dying Support Service which will only provide information and assistance on suicide and euthanasia and will not provide any assistance or information on “any other health concerns, including your underlying conditions”.

The QVAD-Support service will directly link a person seeking to end their life with a medical practitioner willing to help them do so.
Any registered health practitioner who has a conscientious objection to facilitating the suicide of or euthanasing his or her patients must if asked by any person for such assistance or information give the person either the details of QVAD-Support Service or of a registered health practitioner willing to facilitate the person’s death.
The Queensland voluntary assisted dying pharmacy is funded to supply the lethal poisons for suicide to individuals and for euthanasia to administering medical practitioners or nurses.

Reporting

Clause 8 of the Voluntary Assisted Dying Regulations 2022 requires the Voluntary Assisted dying Board to collect some minimal information that is then required to be published in an annual report to be provided by 30 September each year.

This includes basic demographic data (age, sex and region) of applicants and data on the underlying condition as well as the number of deaths from self-administration or practitioner administration of lethal poisons prescribed under the Act.

The time between first and final request is to be reported.
No data on referrals for additional assessments of eligibility or decision-making capacity is to be collected. Nor is there any provision for reporting on complications, the time between administration of the poison and loss of consciousness, or the time between administration of the poison and death.

Given the general complication rate of 7% or higher reported from other jurisdictions this is a concerning lack of transparency that undermines any future claim that there are no problems with the practice of assistance to suicide and euthanasia in Queensland. We will never know.

No safe space

The Act imposes on all hospitals, nursing homes and residential aged care facilities in Queensland the obligation to allow suicide and euthanasia by lethal poison on their premises for any permanent resident of the facility and for any other resident where a “deciding medical practitioner” determines transferring the person for this purpose is not “reasonable”.

This is a violation of the human rights of freedom of association, freedom of religion and freedom of conscience.

The sick and elderly should be able to choose to be treated or to live in a place where no-one is intentionally killed or helped to commit suicide.
Lethal substances at large

One of the obvious risks of prescribing and supplying lethal substances to be kept in the community is that the lethal substance may be ingested by a person other than the person for whom it is prescribed.
The Queensland coroner investigated an incident, in which after a woman was prescribed lethal drugs under the Act but died in hospital before ingesting the drugs, her husband subsequently used the drugs to kill himself.

More articles about the Queensland experience with euthanasia.

  • Coroner's report after man dies by taking his wife's assisted suicide drugs (Link). 
  • Coroner examines case of Australian man who died after taking her assisted suicide drugs (Link).
  • Man dies after taking wife's assisted suicide drugs (Link).

Thursday, December 19, 2024

398 people killed by euthanasia and assisted suicide in New South Wales Australia.


The Australian Care Alliance published a report on the First Annual Euthanasia Report in New South Wales Australia which indicated that 398 people died by euthanasia and assisted suicide (November 28, 2023 to June 30, 2024). It is concerning, in the last four months of the report (March 1, 2024 - June 30, 2024) 267 people were reported to have died by euthanasia and assisted suicide representing 1.33% of all deaths in that period.

Euthanasia and assistance to suicide became legal in New South Wales on November 28, 2023, when the Voluntary Assisted Dying Act 2022 came into operation.

Euthanasia and assistance to suicide

The Act provides for the Voluntary Assisted Dying Board, which it established as an “agent of the Crown”, to issue a “a voluntary assisted dying substance authority” to a medical practitioner to prescribe a lethal poison either for the purpose of the patient named in the authority ingesting the poison in order to cause the person’s own death (suicide) or for the lethal poison to be administered to the person by a medical or nurse practitioner (euthanasia).

The number of deaths


An Interim Report covering November 28, 2023 - February 29, 2024 reports that 131 people had their lives ended under the Act. – 91 (69.5%) by receiving a lethal injection from a medical or nurse practitioner and 40 (30.5%) by ingesting a lethal substance prescribed by a medical practitioner. This represented 0.95% of all deaths in NSW in the three months December 2023-February 2024 – almost 50% higher (46.1%) than the rate in Victoria after four years of legalization. In 3 months, NSW ended the lives of the same number of people (131) as Victoria did in the first year of legalisation.

The first annual report covering 28 November 2023-30 June 2024 reports that 398 people had their lives ended under the Act - 315 (79.1%) by receiving a lethal injection from a medical or nurse practitioner and 83 (20.9%) by ingesting a lethal substance prescribed by a medical practitioner.

An Interim Report covering 28 November 2023-29 February 2024 reports that 131 people had their lives ended under the Act. – 91 (69.5%) by receiving a lethal injection from a medical or nurse practitioner and 40 (30.5%) by ingesting a lethal substance prescribed by a medical practitioner. This represented 0.95% of all deaths in NSW in the three months December 2023-February 2024 – almost 50% higher (46.1%) than the rate in Victoria after four years of legalization. In 3 months, NSW ended the lives of the same number of people (131) as Victoria did in the first year of legalisation.

The first annual report covering 28 November 2023-30 June 2024 reports that 398 people had their lives ended under the Act - 315 (79.1%) by receiving a lethal injection from a medical or nurse practitioner and 83 (20.9%) by ingesting a lethal substance prescribed by a medical practitioner.

The differences between Victoria and New South Wales euthanasia and assisted suicide deaths.

Firstly, in Victoria medical practitioners cannot suggest assisted suicide or euthanasia to a patient – the request has to come from the person whereas in NSW the option of euthanasia can be offered by a medical practitioner with no initial suggestion from the person that are considering this

Secondly, in Victoria administration of a lethal injection by the practitioner is only available if there is an identified issue with self-administration. In NSW death by practitioner administration can be freely chosen. Only 15% of Victorian cases involve practitioner administration – compared to 79.1% so far in NSW. International evidence indicates that overall rates are higher when euthanasia is freely on offer compared to jurisdictions where assisted suicide is the only or default option.


Underlying condition

The First Annual Report gives no details of the conditions involved in the 78 cases described as “other” conditions (that is, not cancer, neurodegenerative or respiratory conditions).

Prognosis

The eligibility criteria include a prognosis - determined by two medical practitioners neither of which need to have any specific qualification or experience in the relevant condition – on “the balance of probabilities” that death will occur within 6 months (or within 12 months for neuro-degenerative conditions).

The handbook prepared by NSW Health acknowledges that “predicting when a person is entering the final months of their life can be difficult”.


This means that there will inevitably be wrongful deaths of people who may have had years to live from errors in prognosis.

Curiously the NSW Health handbook states that a Board authority to prescribe will remain valid for six months (or 12 months in the case of a neurodegenerative disorder) but that the patient can wait a further six months from when the prescription is written to have it filled. So NSW Health is envisioning patients given a prognosis of six months to live still being alive 12 months after this prognosis has been given.

In the case of authority to suicide by prescribed poison there is not time limit on how long the supplied poison may be kept before it is ingested.

Decision-making capacity

The NSW Health handbook states: 

“In the event that a coordinating practitioner becomes aware that a patient has permanently lost decision-making capacity after supply of the voluntary assisted dying substance for self-administration, the substance must be returned and disposed of as the patient is no longer eligible for voluntary assisted dying.”
This admission points to a serious risk in the scheme set up under the Act. Once the final review is completed before the coordinating practitioner applies for an authority to prescribe the lethal poison for self-administration there are no further checks on a person’s decision-making capacity and no requirement for any further contact between the coordinating practitioner and the patient.

The person may well lose decision-making capacity before ingesting the lethal poison. In this case there is simply no protection and no way of ever knowing if the person was subsequently cajoled, bullied, tricked or even physically forced to ingest the lethal poison.

Agents

The Act provides for the collection of the lethal poison for self-administration from the pharmacy by an “agent” of the patient, without imposing any restrictions or qualifications – not even an age restriction – on who can be designated by the patient. The agent is authorised by the Act to collect and store the poison, and also to prepare it and supply it to the patient to ingest – but not to actually administer it to the patient. As there is no witness required to be present at the time the lethal poison is ingested, we will never know if agents (or others) breach this provision.

Homeless, prisoners and forensic mental health detainees

NSW Health is keen that no one miss out on access to euthanasia or assistance to suicide.


Its handbook suggests that “as a particularly vulnerable group” what the homeless need is a “respectful approach that honours their autonomy and treats them with genuine kindness at the end of life” by providing support if they request “assisted dying”. No hint is given in the handbook that the vulnerability of a homeless person may mean that any request for euthanasia or assistance to suicide is a desperate cry for real help.

NSW Health’s Policy Directive charges the Justice Health and Forensic Mental Health Network with the task of making sure prisoners and those in forensic mental health detention don’t miss out on euthanasia or assistance to suicide by linking them with “authorised practitioners, and assist[ing] those services and practitioners with accessing the patient in appropriate settings and circumstances.”

Euthanasiasts everywhere

NSW Health’s Policy Directive mandates every Local Health District to “endeavour to have a sufficient number of authorised coordinating, consulting and administering practitioners within their services to support timely access to each step of the voluntary assisted dying process for patients”. It has been advertising full time jobs for medical practitioners to be employed solely to facilitate assistance to suicide and perform euthanasia.

No safe spaces

NSW Health has also issued “guidance” for private residential aged care and health facilities which reflects the Act’s ultimate refusal to allow any private facility to remain truly euthanasia and suicide free.

Even health facilities which are operated on the basis of an ethic which rejects euthanasia, must allow the State’s “care navigators” on to their premises to link up patients with doctors willing to kill them. In making a decision about whether transferring a patient out of the facility for euthanasia or assistance to suicide, the patient’s treating physician must consult with the patient’s “coordinating, consulting or administering practitioner”.

Monday, April 8, 2024

Belgian 2023 euthanasia report. Euthanasia for psychiatric reasons almost doubled.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

When jurisdictions release their euthanasia data I publish an article updating the data from the previous year. This year I missed the February 27 release of the 2023 Belgian euthanasia data. 

The 2023 basic data indicates that the number of euthanasia deaths increased by 15.4% to 3,423 deaths and there were 48 euthanasia deaths for psychiatric conditions up from 26 in 2022.

Thankfully the Australian Care Alliance published an article on the Belgian euthanasia experience which includes the 2023 data. Here is their report.


Euthanasia became legal in Belgium on 3 September 2002.

Increase in numbers

In Belgium deaths by legal euthanasia increased more than fourteenfold (1456%) from 235 in 2003 – the first full year of legalisation – to 3,423 in 2023. From 2020 to 2021 alone the increase was 10.4%, with further increases of 9.85% from 2021 to 2022 and 15.4% from 2022 to 2023.

Officially reported euthanasia now accounts for one in 33 (3.03%) of all deaths in Belgium in 2023.

Organ donation

There was a total of 64 cases of organ donation with euthanasia in Belgium between 2005 and 2021.

One case involved a 52 year old woman with a mental disorder manifested with the symptom of auto-mutilation – cutting to cause self-harm. Her consent to euthanasia and organ donation was accepted despite this particular mental illness.

Polypathology

In 2023 there were 793 cases (23.2% of all cases) of euthanasia for polypathology, that is two or more conditions none of which in itself is sufficient ground for euthanasia.

Death not expected in the foreseeable future

In 2023 there were 713 cases (20.8%) of euthanasia where the person was not expected to die in the foreseeable future. Euthanasia where death was not expected increased by 38.9% from 2022 to 2023 while euthanasia where death was expected only increased by 10.47% over the same period.

This included 372 (10.9% of all cases) for polypathology; 35 for cognitive disorders; 48 for psychiatric disorders (double the number for 2022); and a range of physical non-terminal conditions, including arthritis (18), eye disorders (8), chromosomal and congenital abnormalities (3) and injuries from external causes (9).
No physical suffering

In 2023, 56 (1.9%) cases involved no physical suffering at all. This includes, for example, some cancer patients “whose physical suffering is alleviated by painkillers” but who “may suffer psychologically from the loss of dignity or a loss of autonomy.”

Five children

Five children have so far been killed under the Belgian law. Three children were killed by euthanasia in 2016/2017. These were a 17-year-old child who was suffering from muscular dystrophy; a nine year old child, who had a brain tumour, and an 11 year old child, who was suffering from cystic fibrosis.

Luc Proot a member of the Belgium’s Federal Euthanasia Evaluation and Control Commission, commented to Charles Lane of the Washington Post that he “saw mental and physical suffering so overwhelming that I thought we did a good thing”. As Lane points out he is referring to the Committee approving the cases after the fact based on reports from the doctors who carried out the killing. It is curious that Proot refers to “mental and physical suffering” when the Belgian law specifically refers only to “unbearable physical suffering” in relation to children in contrast to a reference to “unbearable physical or psychological suffering” for adults. This comment raises a doubt in relation to each of these three cases of child euthanasia as to whether there was “unbearable physical suffering” that could not be alleviated.

Good palliative care can relieve the various forms of physical suffering associated with end-stage brain tumours.

Life expectancy for people with cystic fibrosis (CF) is increasing significantly in response to developments in treatment regimes. In the United States the median predicted age of survival for people with CF has now increased to 47 years. It is by no means clear that the 11 year old child euthanased in Belgium in 2016 or 2017 was facing imminent death. He or she may have had years to live. Depression is also a particular issue with CF. The “mental suffering” mentioned by Luc Proot may have been relieved through appropriate treatment.

The 17 year old child had Duchenne muscular dystrophy (DMD). “Until relatively recently, boys with DMD usually did not survive much beyond their teen years. Thanks to advances in cardiac and respiratory care, life expectancy is increasing and many young adults with DMD attend college, have careers, get married and have children. Survival into the early 30s is becoming more common, and there are cases of men living into their 40s and 50s.” On the available information it is not clear whether in this case the child was both imminently dying and experiencing unbearable physical suffering that could not be alleviated.

A fourth child was killed by euthanasia in 2019; and a fifth child was killed in 2023.
Euthanasia to complete failed suicide attempts

Between 2014 and 2017 two patients who were in an irreversible coma after a suicide attempt were euthanased based on an advance directive 5 months and 35 months respectively before the suicide attempt.

Euthanasia for psychiatric conditions and dementia

In 2023 there were 41 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 48 cases of euthanasia for psychiatric conditions.

In 2022 there were 42 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 26 cases of euthanasia for psychiatric conditions.

Between 2018 and 2021, there were 97 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 102 cases of euthanasia for psychiatric conditions and including depression/bipolar disorder (36), personality disorders (35), anxiety/stress disorders (10), schizophrenia (10), autism (6), and anorexia (2).

Extraordinarily, one person was euthanased in 2018 for “Commonly occurring behavioral and emotional disturbances during childhood and adolescence (such as attachment disorder)” and one person in 2020 for “Mental and behavioral disorders related to the use of psychoactive substances”.
The Commission reports that:
In young patients, the unbearable and persistent nature of the suffering was frequently associated with experiences from the past. In this regard, it was a question of sexual abuse, neglect as a child, rejection by parents, self-destructive behavior and suicide attempts. In addition, failed suicide attempts have made those affected aware that there is also another, more dignified way to end their life.

Euthanasia by advanced directive

19 people were killed by euthanasia in 2023 while unable to give consent, pursuant to an advanced directive. 

A case of euthanasia without request

One case reported in 2016/2017 concerned an interruptive act of life without request from the patient.

In this complex case where the patient had not made an explicit request, some members of the Commission felt that the law on euthanasia had been violated and that the file should be sent to the public prosecutor. Indeed, demand is one of the essential legal conditions. However, other members considered that a referral to the prosecution was not appropriate. The two-thirds majority, legally required for referral to the King's Attorney (see Article 8 of the law) was not reached (9 for referral to the King's public prosecutor, 7 against).

This high threshold of two-thirds majority of the Commission for referral to the public prosecutor helps explain why only one case has ever been referred (in 2015). 

Euthanasia tourism

The place of residence is only required to be reported in the first part of a euthanasia report filed by the doctor performing euthanasia. This part only gets open when questions arise. However, in 2020 and 2021 doctors did refer in the second part of the report to people who were foreigners who came to Belgium to seek euthanasia. There were 79 such cases reported in this way (up from 45 reported in 2016 and 2017) but there may be many more. Of the 79 reported cases “More than half of the deaths were expected in the near future” meaning several were cases where death was not expected in the short term.

There were 110 cases of euthanasia tourism in 2023. Of these 44 (40%) were cases where death was not expected in the foreseeable future.

Conclusion

The 22-year experiment with euthanasia in Belgium is fatally flawed. It has resulted in the abandonment of the disabled, the mentally ill, the suicidal and the victims of child abuse to hopelessness and State sanctioned death by lethal injection.
 

Thursday, November 16, 2023

Fighting Back Against Legalised Euthanasia and Assisted Suicide

Message from the Australian Care Alliance

Euthanasia and assisted suicide will, when the NSW Act comes into operation on November 28, be legal in 26 jurisdictions – including all six Australian states.

In Colombia, Italy, Germany, Austria and Canada it became legal following decisions of high courts based on an alleged constitutional or charter right.

In the Netherlands, euthanasia was first declared legal by courts interpreting the defence of “force majeure” (in the common law the “defence of necessity”) to mean that when a doctor is faced with otherwise unrelievable suffering in the patient he or she is, as it were, forced to kill the patient if the patient requests it.

In some US States, such as Oregon, assisted suicide became legal following a popular vote.

In all other jurisdictions, including the Australian states it came about as a decision of the legislature or Parliament.

BETTER OFF DEAD

In every case, legalisation creates an exception to the otherwise universally applied criminal laws prohibiting murder – to which consent is never a valid defence – and assisting a person to suicide.

Legalisation also abandons a public policy commitment to suicide prevention for all – in Australia commonly referred to as a “Towards Zero” policy. 

These carve outs from the criminal law and from suicide prevention efforts are based on the idea that some people are right to think they are better off dead. It then becomes a good thing for the State to authorise health practitioners (or in Germany anyone at all) to either supply the person with a lethal substance to commit suicide by ingesting it or directly administer a lethal substance to kill them. 

Generally, the public and parliamentary case for legalisation has been based at first on a claim that a small number of terminally ill (or chronically ill) people cannot be adequately helped by palliative care so that direct killing – by suicide or euthanasia – is the only way to provide them with a peaceful death. 

This has been combined with an argument that the choice to end one’s life is a valid exercise of autonomy. This argument has most often been advanced by the white, well and wealthy.

For example, James Downar, a pioneer of euthanasia in Ontario, has described the typical case as involving a self-willed captain of industry who demands the right to exit on his own terms because that is how he manages the rest of his affairs. 

Reported deaths by assisted suicide in 2022 accounted for 0.43% of all deaths of white Californians – 27 times the rate for blacks and 14 times the rate for Hispanics. 

However, there is accumulating evidence that once legalised euthanasia becomes a threat to more vulnerable people. 

Since 1998, 125 Oregonians have died from ingesting a prescribed lethal substance after expressing concerns about the financial cost of treatment. 

In Canada, euthanasia is now being openly offered as an alternative “solution” for poverty, homelessness and disability, including the notorious offer of euthanasia to a female veteran and Paralympian as an alternative to waiting for a stair chair. 

From March 2024 euthanasia will also be offered as a “solution” for people dealing with mental illness as it already is in the Netherlands and Belgium. 

Two cases from the Netherlands highlight the tragic abandonment involved in this approach: 

A man in his 60s with Asperger’s, described as “an utterly lonely man whose life had been a failure”, was euthanased because he was “horrified at moving into sheltered accommodation”. Although he had been diagnosed with “severe and probably chronic depression with a persistent death wish” another psychiatrist, after seeing him just once, certified that he was free of depression in order to facilitate his euthanasia. 

Another man in his 30s, also with Asperger’s, was euthanased based on his distress at “his continuous yearning for meaningful relationships and his repeated frustrations in this area, because of his inability to deal adequately with closeness and social contacts”. 

In Belgium, persistent suicidal ideation is now accepted as valid grounds for euthanasia. 

In opposition to the notion of being Better Off Dead is the wonderfully named disability group NOT DEAD YET! 

These are some of their astute observations on assisted suicide, based on their lived experience of disability: 

Although intractable pain has been emphasized as the primary reason for enacting assisted suicide laws, the top five reasons Oregon doctors report for issuing lethal prescriptions are all disability issues: “loss of autonomy”, “less able to engage in activities”, “loss of dignity” “loss of control of bodily functions” and “feelings of being a burden”. 

In judging that an assisted suicide request is rational, essentially, doctors are concluding that a person’s physical disabilities and dependence on others for everyday needs are sufficient grounds to treat them completely differently than they would treat a physically able-bodied suicidal person. There’s an established body of research demonstrating that physicians underrate the quality of life of people with disabilities compared with our own assessments. Nevertheless, the physician’s ability to render these judgments accurately remains unquestioned. Steps that could address the person’s concerns, such as home care services to relieve feelings of burdening family, are not explored. In this flawed world view, suicide prevention is irrelevant.

STATE PERMIT TO KILL 

In Victoria it is not sufficient for a doctor to agree that you are better off dead before being able to kill you. You also need a formal permit from the Secretary of the Department of Health and Human Services. 

Victoria boasts of its 68 so-called safeguards but these are illusory. Mostly they just require ticking a box. 

Dr Nick Carr was found to have acted unprofessionally and fined when he failed to get the required two people to actually witness an applicant sign the final request form. 

However, no action has been taken against the Secretary of Health for issuing a permit based on that unverified application despite the VAD Review Board clerk picking up the error. 

A recent Freedom of Information request obtaining Review Board minutes has revealed that the Board is more focused on threatening and persecuting any aged care or health facilities that resist euthanasia and assisted suicide or doctors that criticise its implementation than in preventing abuses. 

After receiving a report of a person having a seizure after ingesting the lethal poison prescribed under a State issued permit, the members of the Board with clinical experience simply claimed that the seizure was unlikely to be related to the ingestion of the substance – showing no awareness that this was a reported complication in Oregon. 

In response to reports of some deaths from assisted suicide being unduly prolonged the Board recommended more recourse to euthanasia instead. 

The promise of a peaceful death by assisted suicide or euthanasia is a false promise – the complication rate reported in Oregon averages 7.5% each year. 

In the Netherlands, complications occurred in 3% of cases of euthanasia, including spasm or muscular twitching, cyanosis (blue colouring of the skin), nausea or vomiting, tachycardia (rapid heartbeat), excessive production of mucus, hiccups, perspiration, and extreme gasping. In one case the patient’s eyes remained open, and in another case, the patient sat up. 

In 10% of cases the person took longer than expected to die (median 3 hours) with one person taking up to 7 days.

In Victoria and other Australian states there is no requirement for reporting complications.

COERCION 

Assisted suicide and euthanasia laws usually require that a request be voluntary and free of coercion. To be truly voluntary a request would need to be not just free of overt coercion but also free from undue influence, subtle pressures and familial or societal expectations. 

A regime in which assisted suicide is made legal and in which the decision to ask for assisted suicide is positively affirmed as a wise choice in itself creates a framework in which a person with low self-esteem or who is more susceptible to the influence of others may well express a request for assisted suicide that the person would otherwise never have considered.

 Elder abuse, including from adult children with “inheritance impatience” is a growing problem in Australia. This makes legalising assisting suicide unsafe for the elderly.

Some supporters of assisted suicide don’t care if some people are bullied into killing themselves under an assisted suicide law. AS Dr Henry Marsh, a British neurosurgeon and proponent of legalising assisted suicide and euthanasia, put it "Even if a few grannies get bullied into [suicide], isn’t that the price worth paying for all the people who could die with dignity?".

DEATH BY ADVANCED DIRECTIVE

Courts in the Netherlands have now authorised the direct killing by administration of a lethal substance of a person who is declaring they want to live and physically resisting the administration of the substance if a doctor considers them to no longer be fully competent and the conditions of a previously made advanced directive for euthanasia to be present. 

Signing a document stating that “If I ever have to go to a nursing home and I am no longer competent to decide, then I authorise in advance a doctor to kill me” is sufficient to justify what would otherwise be murder.

ERRORS 

Go Gentle founder, Andrew Denton, was forced to admit to the Project when pressed that “There is no guarantee ever that doctors are going to be 100% right”. 

Whether it is a wrong diagnosis, faulty prognosis, failure to offer effective treatment or missing depression or coercion, there are people wrongly killed by euthanasia in each of the 26 fatally flawed experiments in legalised euthanasia or assisted suicide.

SUICIDE PREVENTION LIES 

It was claimed during the parliamentary debate in Victoria that legalisation would prevent 50 suicides each year. Not only has there been no such decline, but there were 62 more suicides in Victoria in 2022 than in 2017, when this claim was made. The suicide rate among those aged over 65 years increased in Victoria between 2019 and 2022 by 42 per cent—five times the increase in New South Wales. 

The international evidence shows decisively that legalising assisted suicide and euthanasia does not prevent suicide and probably increases non-authorised suicide as well as the overall suicide rate. 

We need to reaffirm suicide prevention for all and not abandon those we think would be better off dead by affirming suicide or euthanasia as a valid choice.

FIGHTING BACK

Be informed – See Australian Care Alliance website – especially under FACTS. http://australiancarealliance.org.au/ 

Some hope – in Canada a recent attempt to prevent euthanasia for mental illness coming into force on March 2024 as scheduled was defeated by just 17 votes – 167 to 150. 

In Australia we need to analyse the evidence and keep criticising the dangers of the euthanasia program. 

In 1941, Hans and Sophie Scholl read the powerful denunciation of the Nazi’s Action T4 euthanasia of the disabled program by Bishop von Galen. In her trial for treason for the distribution of the White Rose leaflets urging opposition to Hitler and Nazism, Sophie said “Somebody, after all, had to make a start”. Professor Kurt Huber, who also was executed as a participant in the White Rose group, said the leaflets aimed “To call out the truth as clearly and audibly as possible into the German night”. 

We need to be those who “make a start” and “call out the truth”, and refuse to co-operate with in any way or to accept as permanent the euthanasia and assisted suicide regimes.

Friday, November 10, 2023

Canada: Women, the lonely, and people with disabilities, at risk to euthanasia

This article was recently published by the Australian Care Alliance.
Article: Health Canada reports 13,241 assisted deaths in 2022 representing 4.1% of all deaths (Link).
In October 2023 the Fourth Annual Report on Medical Assistance in Dying in Canada was published. It stated that there had been 13,241 reported cases of euthanasia and assisted suicide in 2022, bringing the total of such deaths since legalisation to 44,958.
The number of cases each year has more than quadrupled (466%) in 6 years from 2,838 in 2017, the first full year of legalisation, to 13,241 in 2022 with annual increases of 57.8% (2018); 26.4% (2019) 34.2% (2020); 32.4% (2021) and 31.2% (2022).
“Fewer than seven” cases of assisted suicide have occurred each year since 2019. Canadian practice overwhelming uses euthanasia. The 2019 report stated that: “providers are less comfortable with self-administration [assisted suicide] due to concerns around the ability of the patient to effectively self-administer the series of medications, and the complications that may ensue”.
In 2022 euthanasia and assisted suicide accounted for 4.1% of all deaths in Canada. Provincial rates of euthanasia are highest in Quebec - 6.6% in 2022 and British Columbia - 5.5% in 2022.
Underlying conditions

Very limited data is provided on the “main condition” for which euthanasia is performed.
In 2022, for 8.3% of cases the “main condition” is reported as “multiple comorbidities” and a further 14.9% as “other conditions” - that is other than cancer, cardiovascular, respiratory, neurological or organ failure. For these two categories combined, 25% of cases involved “frailty” and 11.9% involved diabetes. Other conditions cited included vision or hearing loss, tendency to falls; and difficulty swallowing. For women these two categories now account for nearly one out of three (29.1%) deaths by euthanasia.
The 2021 report comments “Multiple comorbidities and other conditions encompassed a wide range of diseases or conditions, including frailty, diabetes, arthritis, and osteoporosis”. Note that these are not terminal conditions.
In only 161 cases in 2022 did the clinician administering euthanasia give their specialty as oncology. Additionally, 806 cases involved some consultation with an oncologist. This means that in 2022, at least 7,649 Canadians were euthanized on the basis that they had cancer with no discussion with an oncologist about this course of action. This represents 90.6 % of cases of euthanasia for cancer.
The majority (67.7%) of those administering euthanasia were primarily engaged in family medicine.

The 2022 report notes that the second opinion on eligibility was given by a nurse practitioner in 7.3% of cases.

“Death be reasonably foreseeable” - no longer required


The Canadian law initially required that “death be reasonably foreseeable”. The decision of the Ontario Superior Court of Justice in AB v Attorney General of Canada delivered on 19 June 2017, in paragraph 81, interpreted this requirement as not requiring any connection whatsoever between the underlying conditions for which euthanasia is sought and the reasonable foreseeability of death – which can be based simply on advanced age. The woman in this case was 79 years old.

On 11 September 2019, the Quebec Superior Court, in the case of Truchon c. Procureur général du Canada, invalidated the relevant provisions in the Canadian law which limited euthanasia to cases where “natural death has become reasonably foreseeable” and the Quebec law which required that the person be “at the end of life”. The effect of this decision was suspended for six months.

The Canadian Government introduced Bill C-7 into the House of Commons in February 2020 to give statutory effect to the decision. The Bill became law from 21 March 2021 opening the way for euthanasia to be given to people with chronic, non-terminal conditions, including people with a disability.

463 such cases were reported for 2022. -59% of these involving the euthanasia of a woman whose death was not reasonably foreseeable.
In Ontario in 2022, 121 out of 3934 (3.1%) euthanasia cases involved a person whose natural death was not reasonably foreseeable.
Short time between initial request and euthanasia being performed

Section 241.2 (3) (g) of the Canadian Criminal Code required a physician to “ensure that there are at least 10 clear days between the day on which the request was signed by or on behalf of the person and the day on which the medical assistance in dying is provided or — if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstance”.

Of the 7,384 people killed by euthanasia in Canada in 2020 for whom data is available on the length of time between first request and when euthanasia was administered some 34.3% or 2,532 people were euthanased in less than 10 days of first requesting it.
For 905 of these people the only justification given for the haste with which euthanasia was performed was that loss of capacity to consent was imminent. This raises real questions about the validity of the original request. If a person is on the verge of losing capacity what degree of certainty can there be that the person currently has full capacity?
In the period April 2021 to March 2022 in Quebec, 50% of people were euthanized less than 10 days after making a request. However, only 13% of people had a prognosis of less than 2 weeks to live.
Under the revised law from 21 March 2021 there is no longer any required waiting period for any person whose death is said to be “reasonably foreseeable”. Same day request and lethal injection is acceptable.
In other cases, a 90 day waiting period is specified but if the two assessing practitioners think that loss of decision making capacity is imminent this can be waived entirely.

Advanced directive

Euthanasia can now (since 21 March 2021) be provided on the basis of an advanced directive to persons who have lost decision making capacity. This is not supposed to be done if the person resists or refuses by "words, sounds or gestures".
However, this requirement is undermined by a provision that "involuntary words, sounds or gestures made in response to contact do not constitute a demonstration of refusal or resistance". How do we know they are "involuntary"?
In Ontario in 2022, 190 out of 3934 (4.83%) involved euthanasia of a person who at the time they were killed was incapable of giving consent.

Reasons for requesting euthanasia

The 2022 annual report states that loss of ability to engage in meaningful life activities (86.3%) followed closely by loss of ability to perform activities of daily living (81.9%) were the most common reasons for a euthanasia request.

Inadequate control of pain, or concern about it (59.2%) ranked much lower.

Disturbingly 35.3% reported as a reason for their euthanasia request “Perceived burden on family, friends or caregivers” and 17.1% reported “Isolation or loneliness”.
So in 2022 some 2,294 Canadians were given a lethal injection because they were lonely: Why didn't the doctor or nurse practitioner just have a cup of tea and a chat with them instead of giving them a lethal injection?
For Quebec, between April 2021 and March 2022, 1700 (47%) of people euthanased gave a reason as “Perceived burden on family, friends or caregivers” and 824 (23%) of people reported “isolation or loneliness” as a reason.

Needed disability services and palliative care not provided
In 2022 there were 328 cases where palliative care was not accessible if needed – an increase of 63% from 2021 when cases had already increased by 60% from the 126 cases in 2020.
The 2021 report notes even where palliative care was being accessed or was available “this result does not offer insight into the adequacy or quality of the palliative care services that were available or provided”.
In 2022 there were 568 cases where disability support services were needed but NOT received (up from 332 in 2020 – an increase of 71%). In 2021 this included 12 of the 219 people whose deaths were “not reasonably foreseeable”.
The 2020 report stated that “Disability support services could include but are not limited to assistive technologies, adaptive equipment, rehabilitation services, personal care services and disability based income supplements.” The 2021 report admits that, even for those who were reported as having received disability support services, the data “does not provide insight into the adequacy of the services offered”.

Denied assisted living but offered assisted suicide

Roger Foley, who has a crippling brain disease, has been seeking support to live at home. He is currently in an Ontario hospital that is threatening to start charging him $1,800 a day. The hospital has told Roger that his other option is euthanasia or assisted suicide under Canada’s medical assistance in dying law.

Candice Lewis: pressure for euthanasia based on disability

Candice Lewis (right)
Candice Lewis was a 25 year old Canadian woman who happened to have cerebral palsy.

In September 2016 Candice went to the emergency room at in Newfoundland after having seizures.
The doctor told her she was very sick and likely to die soon. He offered her assisted suicide. The doctor also proposed assisted suicide for Candice to her mother Sheila Elson.

This offer was repeated despite both Candice and her mother making it clear that this was not an option Candice would consider. The doctor told Sheila she was being selfish by not encouraging her daughter to choose assisted suicide.
Candice describes how bad it made her feel that a doctor was offering her assisted suicide.

More than twelve months later Candice had recovered well and her health was much improved. Candice wasn’t having any seizures, was now able to feed herself, walk with assistance, use her iPad. She was more alert, energetic and communicative. She was able to walk down the aisle as a bridesmaid at her sister’s wedding in August 2017. She was doing what she loved most, painting and being with her family.

Candice and her mother Sheila were interviewed by Kevin Dunn, who is produced a film on euthanasia and assisted suicide called Fatal Flaws for the Euthanasia Prevention Coalition. The film of the interview can be viewed here.

Candice has since passed away from natural causes.

There are several take home lessons from Candice’s experience:
  • Doctors can get the prognosis wrong. Candice was told she was dying but is flourishing twelve months later. A wrong prognosis can lead to assisted suicide or euthanasia. A life can be thrown away needlessly;
  • People with a disability already suffer discrimination in health care. When assisted suicide and euthanasia are legal, people with a disability are more at risk of being offered death as a solution because doctors and others consider that they would be better off dead;
  • Once doctors are authorised by the law to provide assisted suicide and euthanasia some of them will feel empowered to offer it to anyone they think would be better off dead. This undermines patients’ trust in doctors and can cause great distress.
A taste for killing?

Of the 1746 physicians and 91 nurse practitioners who euthanased people in 2022, some 336 of them did so 10 times or more – up 29.2% from 260 in 2021. The 91 nurse practitioners killed an average of nearly 14 people each – twice the average for medical practitioners of 7 people each.

Conclusion

Canada's court ordered experiment with euthanasia is already out of control with significant rates of failure to comply with the legal requirements and processes. No action appears to have been taken in response to identified cases in which euthanasia is performed contrary to the law. People with disabilities are being harassed to choose assisted suicide against their will.