My key reasons for opposing assisted dying (euthanasia & assisted suicide) Part 1.

Gordon Friesen

By Gordon Friesen
President, Euthanasia Prevention Coalition

There are many reasons to oppose the legalization of assisted death. However, most of the ones we hear most frequently are not actually calls for the rejection of assisted death as such. They are concerned with more limited goals, associated with the interests of particular groups.

In this list, we can place the demand for doctors' conscience rights, the demand for greater Palliative Care access, and the disabled demand for greater social support. All of these are worthy goals, but they do not actually call for a prohibition of assisted death.

I therefore thought it would be useful to share my own key reasons for prohibiting (not merely palliating) the practices of assisted suicide and euthanasia.

Key Reason # 1:

It is much better for modern society to continue in the principle that all killing is wrong, than to return to pre-modern debates over which killings are permissible.

Killing a spouse is not loving nor compassionate

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

People Magazine published an article on August 1 by Emily Palmer stating that David Hunter (76) who was recently convicted of manslaughter for killing his wife Janice, on December 18, 2021; did so "out of love."

The story of David and Janice Hunter will be used by the assisted suicide lobby to justify the concept of "compassionate homicide."

David Hunter was convicted of manslaughter, meaning that the judge determined that it was not a pre-meditated murder, and sentenced him to two years in prison. He was then released after being credited for serving 19 months in jail awaiting trial.

A previous article by Ryan Fahey published by the Mirror on May 10 reported that Hunter confessed to killing his "terminally ill" wife. Haematologist Dr Ourania Seimeni said Janice had myelodysplastic syndrome (MDS), which is not necessarily terminal. The doctor admitted that 30 per cent of cases of MDS lead to leukaemia.

Fahey also reported that Hunter tried to plead guilty to the lesser charge of manslaughter but the charge of murder went forward to trial.

According to the accepted statement of facts, David Hunter killed his wife Janice by asphyxiation and then attempted to cause his own death by consuming a large amount of pills, but medical staff saved his life.

Research by Donna Cohen, a suicide researcher, and others prove that murder / suicide is rarely related to "compassionate" homicide.

Cohan stated the following in a Minnesota Tribune article from March 2009:

When people read reports of a murder-suicide they will often ask the question, was this an Act of love, or desperation? Cohen who has researched this question tries to find answers. 

She stated in the article:

That notion is common in murder-suicides, said Cohen, who has testified before Congress, written extensively and helped train families and physicians. She is a professor of aging and mental health at the University of South Florida and heads its Violence and Injury Prevention Program. 

"If they were consulted, families usually would try to stop it,'' she said. "In fact, murder-suicide almost always is not an act of love. It's an act of desperation."

Cohen also recognizes that murder-suicide does not equate with assisted suicide. Cohen stated:

Some people equate murder-suicide with assisted suicide and the right to control when you will die, Cohen said. "It usually is not the same. This is suicide and murder.''

I accept the idea that David Hunter was emotionally moved by his wife's "wish to die" but I do not accept the concept it is loving or compassionate to kill her.

A loving and compassionate response would be to help her receive pain and symptom relief and to assure her that her life had meaning, purpose and value.

Alzheimer's Association ends agreement with assisted suicide group. Killing is not caring.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alzheimer's is a terrible condition. Research, treatment and care is needed for people with Alzheimer's and their families. 

The Alzheimer's Association announced that they have ended their agreement with an assisted suicide group.

Contact the Alzheimer's Association at: media@alz.org and thank them that they have recognized that: 

Assisted suicide does not maximize quality care and support. 

A world without Alzheimer's must not be achieved by killing people with Alzheimer's

Assisted suicide is the ultimate form of abandonment. People with Alzheimer's deserve to be cared for and upheld as a human person deserving of life with dignity.

The Alzheimer's Association sent out a media release on January 29 stating that they have ended their agreement with Compassion & Choices. Here is the release:

January 29, 2023
Email: media@alz.org

Chicago, January 29, 2023 — In an effort to provide information and resources about Alzheimer’s disease, the Alzheimer’s Association entered into an agreement to provide education and awareness information to Compassion & Choices, but failed to do appropriate due diligence. Their values are inconsistent with those of the Association. We deeply regret our mistake, have begun the termination of the relationship, and apologize to all of the families we support who were hurt or disappointed. Additionally, we are reviewing our process for all agreements including those that are focused on the sharing of educational information.

As a patient advocacy group and evidence-based organization, the Alzheimer’s Association stands behind people living with Alzheimer’s, their care partners and their health care providers as they navigate treatment and care choices throughout the continuum of the disease. Research supports a palliative care approach as the highest quality of end-of-life care for individuals with advanced dementia.

About the Alzheimer's Association

The Alzheimer’s Association is a worldwide voluntary health organization dedicated to Alzheimer’s care, support and research. Our mission is to lead the way to end Alzheimer's and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer's and all other dementia®. Visit alz.org or call 800.272.3900.

The Alzheimer's Society has recognized that promoting assisted suicide denies their clients the human and dignified care that they need and deserve. Killing is not caring.

Why is MAiD considered a right but palliative care is not.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Janis M. Miyasaki asks the question in her article published by the conversation on June 14 that: Why is access to medically assisted death a legislated right, but access to palliative care isn’t?

Dr Miyasaki explains her concern based on personal experience. She writes:

John started his first appointment in the Neuropalliative Care Clinic with, “I want to talk about MAID.” In our clinic, his request for medical assistance in dying is common. As legislated by government, I referred him to the MAID navigator. I had one request: that John wait to make his MAID decision until after seeing a community palliative care physician.

At his next appointment, John informed us he had withdrawn his MAID request because his primary symptom —pain — was now well controlled after our suggestions and those of the community palliative care doctor. John lived for two more years, during which he became closer with his daughter and continued to enjoy the company of his siblings.

The article explains how MAiD is considered a priority:

In June 2016, the passed legislation that gave all eligible Canadians the right to request MAID. Colleges of Physicians and Surgeons required physicians to refer people who request MAID to services or arrange for a physician who would make the referral.

Since then, every province and territory devoted resources to navigate requests and assessments for MAID. Typically, provinces have a website for self-referral, easily found by internet search and/or dedicated health-care staff to help navigate the MAID process or inform those who are MAID-curious.

Dr Miyasaki then explains how palliative care is not prioritized:

By contrast, the referral process for palliative care is often convoluted. Many provincial web pages simply give a definition of palliative care (some confuse the issue by including the MAID navigation site) but do not provide a central access point for physicians or nurses. Referral forms (where available) are complex, which creates another barrier to access. Many palliative care programs have an unofficial prognosis of three to six months’ life expectancy for services, despite research demonstrating that early palliative care improves outcomes and in fact, can prolong life.

Dr Miyasaki offers a solution:

The solution requires a multi-faceted approach. All health-care providers need to have general palliative care skills because, in the way we all learn to control blood pressure and read a basic electrocardiogram, palliative care is part of good medical care.

At a systems level, placing as much importance on palliative care as we do on MAID might make navigation to palliative care less difficult for patients and clinicians. Given the broader applicability of palliative care, it is time for palliative care to become an independent department. Up to 28 per cent of Canadians will be seniors, which means more people with multiple, chronic conditions that could benefit from a palliative approach.

Building the palliative care workforce is essential. The palliative care workforce in Canada is estimated to be 773 doctors for a population of 39 million. Once the palliative care workforce is established, educating the public that palliative care includes a holistic approach to wellness and meaning in life can help re-frame and increase acceptance.

There are more people like John who should connect with a palliative care team before walking down the road to MAID. Let palliative care help you live well, now.

Sadly, (MAiD) euthanasia has changed palliative care. Palliative care centers are being forced to offer MAiD which confuses the purpose and nature of palliative care. Further to that, several palliative care professionals are advocating for MAiD, once again creating confusion about what palliative care is and what it can do.

Palliative care professionals must maintain a separation from euthanasia (MAiD) if palliative care is to maintain its purpose.

Pope Francis: "Right to die" has no legal ground.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Pope Francis stated at a meeting on November 29, in reference to an Italian court decision, that some state tribunals are deciding that:

"the main interest of a disabled or elderly persons is to die or not get treatment"

Last June Pope Francis responded to a reported euthanasia death by stating.

"We are called never to abandon those who are suffering, never giving up but caring and loving to restore hope".

On October 28, the leaders of Christian, Jewish and Muslim faith communities issued a Declaration against euthanasia and assisted suicide.

A UK man received a suspended sentence after killing his mother by pushing her off a balcony.

Alex Schadenberg
Executive Direction, Euthanasia Prevention Coalition

Langley Lodge Care Home in Essex UK

Robert Knight, in the UK, plead guilty to manslaughter for killing his mother, June Knight who had been diagnosed with Alzheimer's.

According to the BBC news, Knight was cleared of murder and received a two year suspended sentence for pushing his mother off of the balcony at the care home where she lived. The case referred to as a "mercy killing". The BBC news report stated:

Knight placed his mother on a railing before pushing her to her death on 10 December, Basildon Crown Court heard. 

He was cleared of murder and was sentenced to two years in prison suspended for two years. 

Sentencing Knight at Basildon Crown Court, Judge Samantha Leigh said: "You are someone who acted out of love and desperation. 

"You have been punished enough and you have to live with what you have done."

She added that it had been a "very sad case" and described it as a "mercy killing".

Caring not killing

Essex Police Detective, Daniel Stoten, told BBC news:

Det Ch Insp Daniel Stoten said the jury had agreed that Knight had suffered a loss of control when he killed his mother. 

He said: "I do not doubt that Robert Knight loved his mother deeply, but his actions were deplorable and they have affected many, many people."

The sentence must be appealed.

I recognize that Alzheimer's is a difficult condition, but a suspended sentence for killing a mother with Alzheimer's offers a green light to others experiencing similar situations. The message to society is that Alzheimer's makes you a second class citizen and that the court will deal leniently when these people are killed.

Everyone deserves to be cared for, not killed.

Hawaii assisted suicide law came into effect.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Hawaii's assisted suicide law came into effect on January 1. According to the Associated Press very few doctors and pharmacies are willing to prescribe or dispense lethal drugs.

• Hawaii assisted suicide bill passes (March 1, 2018)

Melinda Ashton, the chief quality officer for Hawaii Pacific Health, one of the state's largest healthcare providers, told the Associated Press:

“There are a number of health care providers, nurses and others who are really uncomfortable about this, so asking anybody to participate as a patient ends their life is a really tough thing,” 

“The most recent barrier does seem to be we haven’t yet located a pharmacy willing to provide the medication.”

The Euthanasia Prevention Coalition promotes a model of caring for people, never killing.

Canadian woman abandoned to death. Has euthanasia become the only option for some?

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I spoke to a woman, today, about the sad story of the death of her only daughter. Her daughter was dying with cancer and her care was so substandard that she decided that euthanasia was her only option.

Shortage of palliative care is pushing people to euthanasia.

She said, my daughter wanted to be cared for at home, but the home care was minimal and not good. Her daughter was dying from cancer but she was living with neglect.

Her daughter decided the euthanasia was her only option. She signed the forms for euthanasia and waited to be killed.

Her mother, who had cared for her parents when they died, was trying to care for her daughter, but she lived one hour away. She tried but failed to find good home care in the community.

In the end, her daughter died before the lethal injection was done. 

Her mother repeated that she only wanted to be cared for at home, she only wanted her pain controlled, instead she died a horrible death.

The Euthanasia Prevention Coalition supports excellent care. A recent news article indicates that Canada is not providing good end-of-life care, but euthanasia is available. 

No one should be abandoned to death by euthanasia or to dying a bad death.

Caring not Killing is the answer.

If you need to speak to someone about your experience with euthanasia or assisted suicide please call Compassionate Community Care at: 1-855-675-8749.

• Euthanasia in Canada: A cautionary tale.

Australian man killed his wife and called it a mercy killing - Judge calls it murder.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

An Australian man who pled guilty to murder in the death of his wife, claiming that the act was part of a suicide pact that he had with his wife. The Judge decided that this was an act of murder and not mercy.

Victoria Laurie, the Senior reporter for the Australian, reported that Justice Bruno Fiannaca sentenced Kevin John Keith (71) to 10 years imprisonment before parole in the death of his wife Kerrie Anne. The article reported:

During the trial, Keath’s lawyer Karen Farley QC had told the Supreme Court it was her client’s “only and deepest” regret that he had not fulfilled the agreement with his wife to kill himself.

Instead, Mr Keath drove to a nearby town and confessed to police on the night of the killing, saying he was “guilty as sin.” Keath told police he had not killed himself because he wanted to ensure his wife’s body was treated with dignity.

Mrs Keath had left a suicide note saying the couple had a suicide pact and after “dispatching” her, her husband was going to kill himself “as a loving act” to her. The couple had made a suicide pact after they lost a large sum of money from a bad investment.

Justice Fiannaca told Mr. Keath that he had a duty to look after his wife, not to kill her. The article reports that Justice Finnaca responded to the Mercy Killing plea in this manner:

the question of euthanasia “is a vexed question in society.” ... that Keath had repeatedly stated that he had not wanted to become bankrupt and live on in a flat on a pension, or rely on his son for help.

The judge noted that his wife had “wished to die and she wished for you to take her life…Notwithstanding that, you have no right to take her life.”

“It would be very sad indictment on our society if one sought to justify a killing …to avoid a lifestyle that is seen to be intolerable,”

Justice Fiannaca referred to it as an act of murder, not mercy. 

We should not ratify your desire to kill yourself or to be killed.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

On August 16, the Hastings Center Report published an article by Norman Cantor arguing in favour of permitting euthanasia or assisted suicide on someone with dementia. They also published a rebuttal to Cantor by Daniel Sulmasy where he argues that permitting assisted suicide or euthanasia for people with dementia, even if they have requested it, is wrong and will cause more harm than good.

Sulmasy argues that permitting assisted suicide or euthanasia (Medical Aid in Dying) for persons with Alzheimer or dementia is not a good solution to the problem and will do more harm than good.
 
Sulmasy states that We should not ratify your desire to kill yourself. He says:

Most of your essay concerns finding legal justifications for various methods of ending your life should you become afflicted by Alzheimer disease. Rather than discuss your legal reasoning, I want to address this issue of “self‐deliverance” (your preferred term for suicide under these circumstances) head on.

I know how you feel. Many of us have been there, witnessing someone who was once a professor lying in bed, staring vacantly, no longer able to converse, no longer in control of bowel and bladder function. Reasonable people are bound to think, “I never want to end up this way. I'll kill myself first.”

But we should not endorse letting you, or anyone else, act on such inclinations. We should never ratify the idea that the world is better off without you even if you come to believe it. We should mourn your loss, not precipitate it. The reason we shouldn't endorse your killing yourself is the same reason you gave in your essay about why we should not let you soil yourself—out of respect for your basic human dignity. You are valuable not only for your intellect but as a fellow human being. Should you develop a dementing illness, we should keep you warm, comfortable, and clean, treat your pain, and care for you.

You may counter by asserting that if you develop deep dementia, we will then, in a sense, already have lost you. Yet you know that's not really true. The most profound pathos we feel in seeing someone we love develop dementia comes from knowing the person who suffers from that awful disease. It will be you, or Aunt Molly, or Cousin George who is now demented, not really “someone else” and certainly not nobody. Everybody is a somebody—even a demented person. Martin Luther King had to forcefully remind us that this is what respecting dignity really means—recognizing that everybody is a somebody.

You say you don't want to be a burden on others. I understand that sentiment, but we should not construct a society in which that feeling is endorsed by those who would be charged with caring for you. Even common courtesy suggests that when someone says, “I wouldn't want to be a burden,” the proper response is, “Not at all.” It is not respectful of human dignity to endorse anyone's belief that their illness makes them too much of a burden on the rest of us.

Anyone who sees someone with Alzheimer disease feels bad for that person. Yet your view of what it is like to be a person with Alzheimer disease is not necessarily the view of a person with the disease; that person may not know what has been lost and may even be content. Your fear is based on how you now believe you will appear to others. As a fellow human being, but especially as a physician, I have moral obligations that are less dependent on an abstraction like your precedent autonomy than on treating the actual patient before me. To sedate you rather than feed you if you say you are hungry because the person before me is not the “real” patient seems cruel, based on allegiance to a cold ideology. Ethics is best when it is a response to reality rather than to abstractions.

Sulmasy then argues that - We Should Not Ask Doctors To Help You To Do So:

None of this is to say that we must do everything conceivable to prolong your life. We both agree that you can forgo life‐sustaining treatments that you (or those who represent you) deem to be more burdensome than beneficial. ...

Moreover, we can do more now than in the whole history of humankind to treat your symptoms. Alzheimer disease is typically not painful, but associated conditions may be painful, and pain and other symptoms ought to be treated vigorously. Clinicians and society have obligations to work to improve palliative care and hospice for the demented among us, and to do more to help caregivers. These are the pressing issues to which we should be devoting our attention. Assisted suicide is both a distraction and a seductively inexpensive alternative to this kind of hard work.

You might disagree, but clinicians, the law, and the person on the street all recognize that there is a difference between forgoing life‐sustaining treatments and killing a patient (or assisting a patient in killing himself or herself). When I, as a physician, discontinue ventilator support because the patient has determined that it has become more burdensome than beneficial, I am acknowledging the limits of medicine. That is a good thing. When I act with the intention of making someone dead, or help someone to make herself dead, because I cannot otherwise cure or relieve the suffering that she has deemed unacceptable, then I have, in effect, refused to accept the limits of medicine. Medicine becomes the ultimate solution to the problem of human suffering. That is a terrible power—a power so great that it cannot help but be corrupting. It is a power no doctor should want and no wise society should grant to its healers.

Behind the closed door of the examination room, even powerful and independent persons like you become vulnerable. This is the nature of illness. Countertransference is a powerful force in the patient‐physician relationship. As a physician, I know that it can make my feelings of helplessness in the face of incurable disease seem like your independent judgment; your choice to ask me to help you end your life can be an acquiescence to my judgment that your life is not worth living or is too much of a burden on others. We need a firm boundary. The understanding that this option is off the table helps to establish the conditions of trust that make the healing relationship possible for you and for all patients.

Sulmasy then explains why - We Should Not Give This the Force of Law. 

Autonomy is a thin reed upon which to rest the massive weight of legalized medical killing. Even if your decision is genuinely substantially autonomous, free from any coercive, manipulative, or misinformed influences, you really need to think about the impact that legal sanction of the practices you describe will have on others. Once we let you make a first‐person determination that your life is not worth living, then it is really not that big a step to permit third‐person determinations that the lives of others are not worth living. After all, it was not fanatics but a respectable psychiatrist and a law professor who introduced the phrase “lebensunwerten Lebens” (“life unworthy of being lived”) in 1920. They first argued that “mercy killing” was justified for terminally ill persons who autonomously decided that their lives were no longer worth living, and then they extended this logic to allow others to decide this for the mentally incapacitated.

This is why people living with disabilities are so fearful of legalized assisted suicide and other forms of medically assisted killing. It is not so much that they anticipate being lined up in wheelchairs and forcibly injected (at least not in the near term). It is the assault to their dignity that comes with social sanction of the idea that lives characterized by incontinence, cognitive incapacity, and dependence on others are unworthy of life and so can be ended by direct killing. Norm, if we sanction your starving yourself to death so that you don't suffer Alzheimer disease, then we throw a question smack in the face of countless disabled persons everywhere: why are you still burdening yourself (and us) with your life, which is similarly unworthy of life?

Moreover, suicide is not a purely self‐regarding act. We know that publicity about assisted suicide for the terminally ill can lead to copycat suicides among the mentally ill. And there is emerging evidence that overall suicide rates increase in places where physician‐assisted suicide is legalized for the terminally ill.

Above all, your essay illustrates the disingenuousness of arguments that legalized physician‐assisted suicide (PAS) is the end goal of proponents. As you well note, under current laws, patients with Alzheimer disease who want to end their lives directly face a catch‐22. When someone with Alzheimer disease is still competent, it is too early in the course of the disease to qualify for PAS since the condition is not yet terminal. Yet if one waits until one is terminal, then because of the depth of the dementia, one would be disqualified by lack of decisional capacity. The whole point of your essay is to find legal ways out of that catch‐22. Yet the terrain is, as you freely admit, murky. If I stop hand feeding you and sedate you, at your advance request, is that really a refusal of life‐sustaining treatment? Is it assisted suicide? Or is it euthanasia? All this points out is that there will be pressure to permit third parties to make substituted judgments, interpret advance directives, and provide euthanasia for those unable to participate in assisted suicide due to dementia. This is not a psychological slippery slope; it is just logic. If the terminally ill with capacity can access PAS, then it just seems like discrimination to prevent those who lack capacity from equal access to death. Voluntary assisted suicide laws will beget nonvoluntary euthanasia. Legislation to move in this direction is already brewing.

Sulmasy ends his article by re-iterating that permitting euthanasia and assisted suicide is not the answer.

We agree, Norm, that Alzheimer disease is bad. It's really bad. But the ramifications of your proposed solution are wide. And the compassionate care we are capable of providing for you, if we are wise and respectful, is probably better than you think. So, before you sign your advance directive, let's talk it over. What we really need is your intellect and energy focused on the struggle to improve care at the end of life—providing better access to hospice and palliative care, better education about forgoing life‐sustaining treatments, better financial and social support for the frail elderly and their caregivers.

Previous articles about this topic:

• Dutch Minister of Health comments on forced euthanasia.
• Dutch doctor reprimanded for euthanasia without consent of woman with dementia who resisted.
• Euthanasia assessor resigns over euthanasia for dementia in the Netherlands.
• Should we starve Alzheimer patients to death?
• Murder of woman with dementia leads to demand for more euthanasia.

Assisted dying was supposed to be an option. To some patients, it looks like the only one

Peter Stockland, the former editor-in-chief of the Montreal Gazette and the publisher of Convivium forum was published in MacLean's Magazine on June 22, 2018 stating that MAiD (euthanasia) was supposed to be an option, but is becoming, in some cases, the only option.

Peter Stockland

By Peter Stockland

Canadians were asked in 2016 to accept what is now called Medical Assistance in Dying (MAiD) as standard practice in the health-care system. But as the second anniversary of the federal law sanctioning assisted suicide passes this month, ambiguities embedded in the new regulatory regime are turning end-of-life care into a troubling leap of faith for doctors and patients alike.

Even the Collège des Médicins in Quebec, which sped ahead with its own statute in advance of Ottawa’s Bill C-14, has sounded a strong warning note about patients “choosing” medical assistance in dying purely because their preference for palliative care isn’t available.

“End-of-life care cannot be limited simply to medical assistance in dying,” Collége President Dr. Charles Bernard writes in a May 29 recently published letter to provincial Health Minister Gaétan Barrette. “That option makes no sense, from a medical point of view, unless it is part of a robust and complete system of palliative care in Quebec.”

Yet provincial foot-dragging on plans to substantially expand palliative care services is actually denying patients the very choice that was promised in the shift to MAiD, and making it increasingly problematic to discern which patients truly wanted to have a doctor deliberately end their life, Bernard says.

“In certain identified cases, patients, for the lack of (palliative) care, might have had no choice but to ask for medical assistance in dying to end their days ‘in dignity,’ which deeply concerns us,” the Collège president tells the minister.

Worse, he adds, the Collège has been hearing increasing concerns from its member doctors about re-direction of already scarce resources from palliative care to medical assistance in dying, which risks a violation of both the letter and the spirit of Quebec’s law governing end-of-life care.

At the other end of the country in British Columbia, an active proponent of MAiD, acknowledges that she, too, struggled to adapt to the vagueness of the federal law. Dr. Ellen Wiebe says she ultimately concluded she would have to rely on her personal best judgment about whether or not to administer death. Neither the re-written federal legislation, nor provincial regulations that followed it, define with clarity when a patient can receive MAiD, she says.

At the same time, Wiebe believes wholeheartedly that any mentally competent person who requests medically assisted death for the relief of suffering has a right to receive it. And suffering, she says, is a subjective judgement for the patient to make. The result, she says, frequently leaves her working “at the edge” of the law.

A prominent voice in the Dying With Dignity movement, Wiebe says when she undertook training in the Netherlands for administering euthanasia, she saw the issue as one of a clear-cut human right to autonomy. Falling back on personal judgment felt paternalistic to her. Leaving it to the personal judgment of some professional authority—even a doctor like herself—felt like interference in a fundamental human right to die when one chose.

“Then when I started doing it, I realized that I personally must be convinced in each case. I provide what is right up to the edge of the law, and never beyond, of course. I’m working beyond where some providers would work…it varies on how risk-averse people are. We have to submit 17 pages of paperwork, and we are being scrutinized line by line.”

She acknowledges, however, that the line, or edge, has already shifted significantly since she provided her first medically-assisted death in February 2016. (That was four months ahead of the law being changed to make it legal, but Wiebe notes she had judges’ approval to proceed.) Part of the challenge is the federal legislation now permits—or limits, depending on perspective—MAiD to when death is in the “foreseeable future” but does not clearly define what that means.

Wiebe says the personal definition she initially worked from was based on testimony federal Justice Minister Jody Wilson-Raybould gave to the Senate on June 1, 2016. Kay Carter, the central figure in the 2015 Supreme Court decision that led to the overturning of the old law, would qualify under the “foreseeable future” wording, according to the justice minister.

In her testimony—two weeks before Bill C-14 became law—the minister said the legislation was “carefully crafted” to give “purposeful flexibility” to doctors. It did not set time limits or require proof of a “causal relationship between any single medical condition and the foreseeability of death.”

Wiebe notes that Kay Carter was 89 when she died, and had suffered from spinal stenosis, a painful though non-life threatening, condition. Her life expectancy would normally have been about five years, she says, adding: “If that was natural death in the foreseeable future according to our justice minister, then that was good for me.”

But just over a year later, in June 2017, Ontario Superior Court Justice Paul Perell ruled in a case called A.B. versus Canada that a 77-year-old who suffered from inflammatory arthritis faced death in the “foreseeable future” and was eligible for MAiD even though, as Wiebe points out, the woman’s life expectancy was about 10 years and she was still an avid hiker.

Wiebe says she adjusted her personal judgement accordingly, though she remains “very, very careful” in such cases where pain relief is the primary objective and non-terminal conditions are involved. She is confident the oversight system of the B.C. coroner’s office and the province’s College of Physicians and Surgeons acts as an effective public safeguard. “I expect,” she says, “to be scrutinized.”

But B.C. Conservative MP Mark Warawa wonders where that scrutiny and those safeguards were last January when Wiebe entered a Vancouver Orthodox Jewish nursing home and administered medical aid in dying to an elderly patient even though the facility didn’t allow MAiD and Wiebe didn’t have visiting privileges there. Administrators at the Louis Brier Home accused her of “sneaking in and killing” the patient.

Wiebe emphatically rejects suggestions of wrongdoing. On the contrary, she says, she works within the law to protect the rights of patients to receive MAiD whether or not the facility permits the procedure.

“To me, places don’t have moral rights. Places don’t have consciences, only people do. It’s not just any place. It’s [the patient’s] home. Someone [denying MAiD] is taking [a patient’s] rights away to die in their home. That’s why a place should never have rights.”

Warawa says the fact there wasn’t a criminal investigation is troubling enough. The current law allowing MAiD is due to be reviewed by 2021. How can any such review of Bill C-14 be meaningful, he asks, when existing legislation apparently isn’t being enforced in cases such as Wiebe’s?

“In my opinion, Ellen Wiebe broke the law, and the police should have been involved,” says Warawa, who sat on the special legislative committee that held hearings into C-14 before its passage. “I respect that people now have the right under the law to end their life prematurely through assisted suicide. But as a legislator, I think it would be a horrendous mistake to even consider expanding it when we aren’t upholding what already exists.”

Echoing the concerns now being voiced by doctors in Quebec, Sarnia-Lambton MP Marilyn Gladu is most concerned about the detrimental effects on palliative care that might come from the rising clouds of confusion around MAiD. Gladu achieved the remarkable feat in late 2017 of having her private members bill adopted unanimously by both the House of Commons and the Senate. The bill binds the Liberal government to having in place a framework for palliative care by December of this year.

But it took six months for the health minister to open a promised nation-wide consultation to get consistent palliative access. And Gladu still doesn’t know if the minister has made good on a commitment to consult with her provincial colleagues. She also points out that the word “palliative” was mysteriously absent from the recent federal budget, though Health Canada says that since 2017 federal government has committed to giving the provinces $6 billion over 10 years from a combination of homecare and palliative care, along with another $184.6 million for home care and palliative care in Indigenous communities.

All that would be disconcerting enough for Gladu. It’s made worse at the provincial level B.C.’s NDP government has mandated that MAiD be made available in all hospices and palliative care centres that receive 50 per cent or more of their funding from tax dollars.

“That is a really bad idea,” Gladu says. “People doing palliative care don’t have the same experience as people doing medical aid in dying. They’re not as familiar with the requirements.” A new standard recently issued by the Nova Scotia College of Physicians and Surgeons would allow paraplegic patients to receive MAiD if they’ve refused the treatment and medicine necessary to prevent bedsores.

“Clearly, that is not the intent of the legislation,” Gladu says.

Gladu adds that a highly probable unintended consequence will be to frighten patients away from palliative care and leave them, as Quebec’s Collège des Médicins is now warning, believing the “choice” of medical aid in dying is the only real option they have if they wish to die with dignity.

That would be a troubling example indeed of good faith requiring blind faith to ignore a looming hard fall for Canada’s public health care system.

Peter Stockland, a former editor-in-chief of the Montreal Gazette, is publisher of Convivium, an online forum for faith-based debate on public policy and social issues.

Canada's Assisted Dying law - one year later.

Alex Schadenberg

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

One year after the legalization of euthanasia and assisted suicide, Canada has become the prime example of how legalizing assisted dying cannot be controlled and why these laws are naturally expansive. Society needs policies that encourage caring and not killing.

On June 17, 2016; Canada's Senate passed euthanasia bill (C-14) in time for their summer break. Even though some groups claimed victory based on the amendments to C-14, EPC was concerned by the fact that the most dangerous language in C-14 remained intact. Bill C-14 uses undefined language that (in my opinion) is designed to enable expansion of Canada's euthanasia law.

The Euthanasia Prevention Coalition continues to oppose euthanasia. 

• EPC has successfully produced the Euthanasia Deception documentary focusing on personal stories by people with direct experience with euthanasia,
• EPC has successfully distributed the Caring Not Killing pamphlet that explains why euthanasia and assisted suicide are not necessary and what you can do to make a difference,
• EPC is working with the Compassionate Community Care service that offers advice and direction for family and friends of people who are considering dying by assisted death or people facing difficult end-of-life decisions. Contact CCC at: 1-855-675-8749. 

More people are dying by euthanasia than projected.

Even though we are well into 2017, the data from 2016 indicates that there were 970 reported assisted deaths in Canada. 

Other than Québec, where there were 463 deaths in the full year, these deaths occurred in 6.5 months (June 17 - Dec 31). The percentage of assisted deaths is highest in British Columbia, where there were 188 assisted deaths, where they have two euthanasia clinics, as compared to 189 assisted deaths in Ontario. The 970 reported assisted deaths represented 0.6% of all deaths in Canada. 

There may be more assisted deaths. 

According to the report, not every province has a legal requirement to report assisted deaths while Nunavut and the Yukon territories did not submit information based on privacy concerns and the small number of assisted deaths.

A CBC news report (April 20) stated that there were more than 1324 assisted deaths since legalization.

The number of deaths is high in comparison to Belgium where there was 235 reported assisted deaths in its first full year (2003), 349 in its second full year and 393 in its third full year after legalization. Currently Belgium is approximately 1/3 of Canada's population.

In 2015, there were 2021 reported Belgian assisted deaths, up from 1924 reported assisted deaths in 2014. A study published in the New England Journal of Medicine (March 2015) found that more than 40% of the assisted deaths were not reported in 2013.

Conscience rights for medical professionals are not protected.

Bill C-14 did not protect conscience rights for medical professionals. The Coalition for HealthCare and Conscience launched a legal challenge to the Ontario College of Physicians policy that forces physicians, who oppose killing, to "effectively refer" their patients to a physician who will kill. Effective referral is defined as referral for the purpose of the act. The court case was heard (June 13 - 15) in an Ontario court. Some physicians will leave Ontario if they are forced to participate in euthanasia.

At the same time, the Québec government has pressured palliative care units to participate in euthanasia.

Conscience rights are recognized in Canada's Charter of Rights and Freedom but the euthanasia lobby claims that patients have a "right to access" euthanasia and thus claim that conscience rights must be limited.

Expansion of euthanasia law.

Before the ink was dry, the first court case was launched to expand Bill C-14. Recently two people from Montreal launched a similar court case to expand Canada's euthanasia law to people who are not terminally ill.

Canada's federal government did not waste time to announce that they were conducting research into expanding euthanasia to people with dementia, who stated in their advanced directive that they wanted to die by euthanasia, children, and people with psychological suffering alone.

Abuse of the law.

The law requires the physician, or nurse practitioner, who lethally injects their patient to self-report the act. Self-reporting systems enables those who lethally inject their patients in questionable circumstances to cover-up abuse of the law. 

In late September 2016, Dr Will Johnston reported on two British Columbia deaths that appear to abuse the euthanasia law. In November I was contacted by a man who stated that his Aunt, who died by euthanasia, may only have had a bladder infection.

Based on the Québec government euthanasia report 14% of the assisted deaths did not comply with the law.

Further to that, a Canadian bioethicist is already promoting euthanasia / organ donation, a study was published explaining that up to 138 million dollars can be saved by euthanasia.

Once society crosses the line and decides that it is acceptable to kill people, the only remaining question is who will be killed.

Meanwhile a Toronto study that was published in the New England Journal of Medicine found that requests for euthanasia were based on existential distress and not uncontrolled pain.

The euthanasia debate needs to go beyond theory and buzz words and become based on human reality. People usually ask for euthanasia when they are emotionally and/or psychologically distraught by their medical or personal situation. Therefore euthanasia becomes an abandonment of people at the most vulnerable time of their life.

The answer to euthanasia is to care for people and not to kill people.

Euthanasia: Man needs a pal not a pill.

Every once in a while I read a letter to the editor that hits the nail on the head. 
This letter was published by Saukvalley.com on Friday March 10, 2017.

By Margaret Brechon Dixon

I read with sadness the article in the March 4 SV Weekend, “Changing views on end-of-life decisions.” The author [Jim Nowlan] describes a scenario that is indeed unfortunate and yet familiar to many. An elderly gentleman with health issues is alone, forlorn, and no longer sees a purpose to his life. As the gentleman says, “I am ready to go.”

What I find disturbing about the article is the proposed solution: a pill to end his life. It all sounds so compassionate, but this is euthanasia, the direct taking of another’s life. It may have names that make it all seem palatable, like “death with dignity” or “aid in dying,” but the reality is the same.

If the gentleman is clinically depressed, there are medications for that. Perhaps he just needs a friend to talk with. Why are some so quick to offer death as a solution under the guise of individual autonomy?

When the state legalizes physician-assisted suicide, the role of the doctor is changed from healer to – well, you know. Disability rights groups oppose such laws because their lives may not be valued. St. Pope John Paul II labeled this as the culture of death because it denies the inviolable dignity of the human person.

I would suggest to the author that what his friend needs is a pal, not a pill.

If you need to speak to someone about ending-of-life medical issues, euthanasia or assisted suicide contact Compassionate Community Care (CCC) at: 1-855-675-8749. 

CCC believes in Caring not Killing.

Mary Kills People Promotes Euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.

The local radio station, that I listen to, is playing a commercial for Mary Kills People, a six part drama on Global Television in Canada.

People have contacted me wondering what to do about Mary Kills People. We are disgusted by media outlets who insist on promoting euthanasia and assisted suicide without having the honesty and professionalism to equally promote programs that offers an alternative point of view. 

I have personally not wasted my time watching Mary Kills People. I would first urge you to boycott the show. If you have watched the show email your assessment of Mary Kills People to: info@epcc.ca.

I urge all of our supporters to contact the CRTC and demand equal programming. 

Global needs to do a series on people with disabilities who live fulfilling lives, or people with a terminal illness who through effective symptom management and social supports live a fulfilling life until their death, or people who had a terminal illness who survived? We need real stories that provide hope, we need stories that promote caring not killing.

Programs that portray euthanasia as heroic, caring and maybe even daring, are promoting euthanasia. These programs don't show us the real life circumstances of a person who is lonely and afraid of suffering, and feel that they have no real alternative, these programs portray euthanasia as an act done by strong independent people. People we should emulate.

Social change is accomplished through drama that changes our ideas of what constitutes reality, what is a good death, what is murder and what is mercy.

I am also concerned about the contagion effect connected to programs that promote killing. 

This is not the first time Global has aired a program promoting euthanasia. In 2012 Global aired: Taking Mercy, a program that promoted eugenic euthanasia featuring: Robert Latimer, who killed his daughter with cerebral palsy, Annette Corriveau, who had two disabled adult children who she wanted euthanized and pro-euthanasia "ethicist" Arthur Schaefer. At that time, the Euthanasia Prevention Coalition and the Council of Canadians with Disabilities responded with strong opposition to portraying the lives of people with significant disabilities as - life unworthy of life.

Recently Liz Carr, a famous British actress who is also a leader of the disability rights group Not Dead Yet UK, produced a successful musical opposing assisted suicide called: Assisted Suicide: The Musical (Comments by Paul Russell). Carr, who is an incredible comedian, proves that opposing assisted suicide can also be entertaining.

You can respond to the propaganda by screening the Euthanasia Deception documentary in your community and by donating to the Euthanasia Prevention Coalition production costs for our next video that is now being produced under the working title - Fatal Flaws.