Report on Quebec nursing homes confirms the need to rethink nursing homes

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

During the COVID-19 crisis, several nursing homes in Ontario and Quebec had uncontrolled outbreaks leading to the deaths of hundreds of residents with a large number of nursing home staff becoming sick. The outbreaks in these nursing homes was so critical that the Ontario and Quebec government's asked the federal government for assistance from Canada's military.

On May 27, I wrote about a Canadian military report stating that there were disturbing conditions in Ontario nursing homes. Military personnel who were caring for nursing home residents reported of systemic nursing home elder abuse. According to the CBC News Report by Nick Boisvert:

The list of allegations includes:

• Repeated use of medical equipment between COVID-19 patients and others who had not tested positive, without it being disinfected. 

• Improper use of personal protective equipment (PPE) by staff and doctors. 

• Housing of COVID-19 patients with residents who had not tested positive. 

• Staff reusing gloves or not washing hands between resident interactions. 

• Staff being aggressive with residents during medical procedures. 

• Residents calling for help with no response for up to two hours. 

• The presence of insects, including cockroaches and ants.

The military report stated that one resident choked to death due to negligence of a staff member.

The Canadian military released a similar report concerning Quebec nursing homes. Compared to the Ontario report, it appears that the Quebec report may have been 'cleaned up' before being released.

It is estimated that 2700 Quebec nursing home residents died from COVID-19. According to Les Perreaux and Tu Thanh Ha, reporting for the Canadian Press:

Orderlies showed up late or disappeared during their shifts. Boxes of surgical masks and narcotics went missing. Long-time employees quarrelled with newcomers and repeatedly ignored safety instructions.

The 60-page report summarizes the observations of more than 1,000 military personnel deployed at 25 Quebec seniors’ homes.

While some homes were praised for having efficient management, the military detailed a litany of poor medical practices or management issues at other locations.

The CP article focused on several nursing homes that were featured in the military report:

At Montreal’s Grace Dart Extended Care Centre, where 61 patients have died, personal protective equipment (PPE) was an issue. “Prevention and control of the contamination didn’t follow the guidelines set by [the local health authority]. On our arrival, the use of PPE was a major problem,”

The military said Vigi Mont-Royal, where 70 residents died, had trouble controlling the distribution of PPE and medications. For example, a shipment of 20 boxes of surgical masks and one of narcotics disappeared.

“We noticed that [safety] guidelines were not followed by some civilian employees despite constant reminder by our military … each day we witnessed employees who didn’t follow the protocols set up by the facility.”

The response that we are hearing is that we need to improve nursing homes. I agree that existing nursing home care is often substandard, but the answer to the problem is to move to a system of home care.

The report of the Parliamentary Committee on Palliative and Compassionate Care that was published in November 2011 is a fundamental guide to moving healthcare systems forward.

In its recommendation XV on page 52, concerning Palliative and End-of-Life care the report states:

Home care is foundational to transforming Canada’s health care system. In reality it is a paradigm shift in our vision of health care. Allowing patients to stay at home has pronounced benefits for everyone involved, not least of which, the person being cared for in their own home and community. This is important as our nation seeks ways to improve the care of the elderly and vulnerable.

We need to learn from the community living movement. I recognize that the needs of people with disabilities can be very similar to the needs of the elderly.

We need a caring culture: a culture that does not institutionalize the elderly, infirm or people with disabilities, but rather offers compassionate community care.

Policies that promote home care and enable people to live independently need to be implemented. For people experiencing dementia or Alzheimer's, a community such as Hogeweyk, in the Netherlands provide an excellent example of how this is done.

Institutionalizing and warehousing people results in a culture of abandonment, abuse and often death.

Let's rethink the concept of nursing homes.

More than 5400 Canadians died by euthanasia in 2019 more than 13,000 since legalization

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

The media was reporting that there have been more than 6700 MAID deaths in Canada since it was legalized. I estimate that there have been at least 13,000 euthanasia deaths and here is how I defend this estimate.

The 6700 deaths was based on the Fourth Interim Report on Medical Assistance in Dying released by Health Canada on April 25, 2019 which stated that there were 6700 assisted deaths up to October 31, 2018. The data in the report from Quebec and the three Territories was incomplete. The Quebec data in the Health Canada report was up until March 31, 2018. (Link to my commentary on the report)

The Health Canada report was sloppy by stating that the number assisted deaths represented 1.12% of all deaths. The Health Canada report divided the number of reported assisted deaths into the total deaths, but they did not remove the total Quebec deaths from March 31 - October 31 from the equation.

The number of assisted deaths as of December 31, 2018, was approximately 7949.

(The government of Canada estimated that there were 5444 assisted deaths in 2019 and 4438 assisted deaths in 2018 in Canada on February 24, 2020)

On March 21, 2019 I reported that there were 7949 assisted deaths in Canada as of December 31, 2018 representing 4235 assisted deaths in 2018, an increase of 50% over 2017, representing almost 1.5% all deaths in 2018. The data from my report was obtained from a presentation by Jocelyn Downie, an academic euthanasia activist, who spoke on March 15, 2019 to a Royal Society of Canada luncheon in Ottawa. 

Similar to the Netherlands and Belgium, nearly all of the assisted deaths are euthanasia (lethal injection) rather than assisted suicide.

We don't have national assisted death statistics for 2019 but we do have accurate data from Ontario and Alberta. 

According to the data from the Ontario Office of the Chief Coroner there were 1789 reported assisted deaths in 2019, 1499 in 2018, 841 in 2017 representing nearly a 20% increase in Ontario assisted deaths in 2019. 

What is more striking about the data is the increase in the second half of 2019 where there were 1015 assisted deaths in the second half of 2019 up from 774 in the first six months of 2019, meaning that Ontario will likely have more than 2000 assisted deaths in 2020.

Alberta Health Services updates there assisted death data regularly. The Alberta data indicates that there were 377 assisted deaths in 2019 up from 307 in 2018, and 206 in 2017. The data indicates a 23% increase in Alberta assisted deaths in 2019.

A report by Marney Blunt for Global News stated that the number of assisted deaths are increasing quickly in Manitoba. Blunt reported that the number of Manitobans dying by euthanasia skyrocketed. The report stated:

When medically-assisted death first became legal in 2016, 42 people requested the service and 24 received it. That number rose in 2017, when 142 people requested MAiD and 63 people received it. 

Those numbers almost doubled in 2018, when 239 requested and 138 received. Last year, 313 people asked for a medically-assisted death, and 177 people received it.

The data indicates a 28% increase in Manitoba reported assisted deaths in 2019.

Since Ontario, Alberta and Manitoba had approximately a 20% increase in 2019, I would assume that there was a similar increases nationally. Therefore there approximately 5000  (4235 + 20%) assisted deaths in Canada in 2019 and 13,000  assisted deaths since legalization. Even if the numbers were slightly lower than 5000 in 2019, today is January 20, so it is safe to say that there has been 13,000 assisted deaths since legalization.

But that is not the whole story.

Canada's data collection system does not account for under-reporting of assisted deaths, but Quebec's data collection system can account for under-reporting. Quebec employs a multi report system making it possible to uncover the number of times a physician didn't report the assisted death.

Based on an analysis by Amy Hasbrouck and Taylor Hyatt, the Quebec interim report indicated that between April 1, 2017 – March 31, 2018 there were 142 unaccounted assisted deaths in the data representing 17% of all assisted deaths. The Quebec Interim report also indicated that 7 assisted deaths did not fit the criteria of the law, 22 assisted deaths did not follow procedural safeguards and in 67 assisted deaths, the physician did not provide the necessary information to determine if the patient fit the criteria of the law.

Based on the Quebec Interim report, if we extrapolate the data to all of Canada, it would suggest that there may have been more than 2000 (17%) unreported assisted deaths in Canada and approximately 60 assisted deaths that did not fit the criteria of the law.

This article is based on hard facts and conservative estimates. The fact is that Canada's assisted death law is quickly going out of control. The recent federal government consultation, that employs biased questions, is not concerned about Canadians whose lives are taken without due process.

Québec man sentenced to two years in the death of his wife. He claimed it was a "mercy killing."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Michel Cadotte

Michel Cadotte, the Québec man who killed his wife, Jocelyne Lizette (60) by suffocation on February 20, 2017, was found guilty of manslaughter by a jury.

Cadotte, claimed that his wife wouldn't have wanted to live this way. Cadotte had asked for euthanasia for his wife and was turned down because she was not capable of making the request herself as repored by CTV news.

Yesterday, Cadotte was sentenced to two years, less day and three years probation for killing his wife by suffocation. Jesse Feith, reporting for the Montreal Gazette stated:

Superior Court judge Di Salvo added while sentencing him to prison Tuesday, Cadotte also “committed the irreparable” by suffocating Jocelyne Lizotte to death, an act that can’t be excused “even if it was done in the name of compassion.”

The article reported Justice Di Salvo state:

“You cannot do this to someone who is ill, vulnerable, dependent and incapable of expressing their will,” she said. “Even if they’ve expressed a desire to die in the past.”

The Canadian government is considering extending euthanasia to incompetent people who made a previous request for euthanasia.

Feith reported that the Crown and the Defense are both examining the sentence. The article reported:

Prosecutor Geneviève Langlois told reporters the Crown will closely review the decision before deciding if it will appeal the sentence.

Defence lawyer Elfriede Duclervil said she was disappointed with the sentence. She then took the opportunity to reiterate how the case shed light on gaps in the health system —  especially when it comes to helping caregivers — that pushed Cadotte to his breaking point.

The Justice system upheld the rule of law by convicting Cadotte but it remains confused when similar acts are done based on "Medical Aid in Dying."

Quebec man found guilty of manslaughter in the death of his wife. He said it was a "mercy killing."

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Michel Cadotte convicted.

Michel Cadotte, the Québec man who killed his wife, Jocelyne Lizette (60) by suffocation on February 20, 2017, was found guilty of manslaughter by a jury.

Cadotte, claimed that his wife wouldn't have wanted to live this way. Cadotte had asked for euthanasia for his wife and was turned down because she was not capable of making the request. CTV news reported:

The trial has heard that a year earlier Cadotte sought a medically assisted death for his wife of 19 years and was told by centre staff she didn't qualify. A head nurse at the Emilie Gamelin long-term care facility testified Cadotte admitted to her she suffocated his wife.

Nicolas Welt, the lawyer for Cadotte, argued that his client was not criminally responsible because of his state of mind at the time of the murder.

Michel Cadotte trial. Murder or "Mercy Killing?"

The National Post stated that the media framed the case as a "compassionate killing." and reported that Justice Helene Di Salvo charged the jury with determining whether Cadotte was to be convicted of second-degree murder or manslaughter. The National Post reported:

Cadotte’s lawyers had argued, without the jury present, that an acquittal should be possible, but the judge ruled it wasn’t an option. 

The accused had admitted to killing Lizotte and the legal criteria had not been met for acquittal, Di Salvo ruled. In her final instructions, she told the jurors they should not take into account the potential sentence, because sentencing is the judge’s responsibility.

I agree with how the judge ruled and the decision of the Jury, but I expect that this court decision will be appealed.

Michel Cadotte trial. Murder or "Mercy Killing"

The following update was part of the webcast produced by the disability rights group, Toujours Vivant - Not Dead Yet. You can watch the full webcast here.

In Québec, the trial of Michel Cadotte in the homicide of his wife Jocelyne Lizotte two years ago is wrapping up. Mr. Cadotte is accused of second degree murder after he admitted to smothering his wife who had dementia; he claims he wanted to end her suffering.

Québec man uses "mercy killing" defense in wife's murder.

Psychologist Gilles Chamberland testified that Cadotte’s actions were not related to depression. Nor was he overwhelmed with caring for his wife, since she was in a long-term care facility. Mr. Cadotte had asked for euthanasia on his wife’s behalf but been refused.

Evidence presented at trial showed that Ms. Lizotte’s condition was no better or worse than it had been in some time, but that Mr. Cadotte had been drinking heavily over the weekend leading up to the homicide.

Mr. Cadotte claims he killed Ms. Lizotte “out of compassion,” but a report filed by Dr. Chamberland said Cadotte wanted “end her suffering,” to stop his own pain.

Intimate partner violence among elders is neither rare nor new. A 2007 study of murder-suicides from the Clinical Interventions in Aging journal found that life-ending violence is often explained away as “altruistic,” especially in cases where one party is ill. This distortion prevents “proper investigation into the specifics of the case, especially with regard to victim consent.” In one incident, a husband “claimed his wife had terminal cancer, but the autopsy found she had no evidence of any illness.”

These murders may be inspired by the perpetrator’s “strong need to control [the spouse’s] fate.” Some even thought death was preferable over sending their partners to a nursing home.
The study rightly concludes that “[domestic] violence events should never be viewed as romantic or altruistic as it is often erroneously reported in the news media.”

Disabled girls and women are also at a higher risk for abuse, including at the hands of their partners. In a 2017 submission to the United Nations, Women Enabled International explained that “women with disabilities worldwide experience domestic violence – including physical, sexual, emotional, psychological, and financial abuse – at twice the rate of other women.”

These women must also rely on the abuser “to meet personal needs; indeed, when the abuser is also a caregiver, it is frequently impossible for women with disabilities to get help.” Women may be unable to leave a dangerous living situation because they don’t have transportation or can’t find an accessible shelter. The longer women stay in abusive environments, the higher the risk that violence will escalate to homicide.

McGill study: Euthanasia requests precede palliative care.

Published by Toujours Vivant - Not Dead Yet.

This article was researched and written by Amy Hasbrouck and Taylor Hyatt.

On December 5th CTV News reported on a new study from McGill University Health Centre looking at whether euthanasia is actually used as a “last resort” after palliative care has been tried, as promotors claim. This study shows that, though the reasons people ask for euthanasia relate to issues that could be addressed by palliative care (and consumer-controlled personal assistance services), people who ask for euthanasia are often not getting these services before deciding to die, or palliative care hasn’t had time to take effect.

Researchers examined patient files at two teaching hospitals and a long-term care facility. Between December 2015 and the beginning of June 2017, a total of 80 people requested euthanasia; 43, or just over half, were euthanized.

Demographic information about people who asked to die was provided, but the researchers didn’t give those details about the sub-group of people who were killed. Five people under 50 years old sought euthanasia; the youngest being 32. The rest were split fairly evenly, with 36 people under 70 years of age and 39 between 70 and 92 years old. Eighty-one percent (65) of the applicants had cancer-related illness.

The reasons people wanted to die were described in more detail than in most studies. The researchers listed three broad categories: “suffering” (cited in 92% of the files), “control” (75%), and “loss of future” (25%), plus several others.

In the “suffering” category, the authors listed (actual, current) “pain, nausea, or difficulty breathing“ (cited by 30 people) whereas the “Control” category included the wish to “avoid future suffering,” (cited by 14) “avoid loss of capacity” (mentioned by 4 people) and “avoid a bad death” (5 people). “Physical suffering” was contrasted with existential suffering (cited by 19 people), psychological suffering (16 people) and exhaustion (mentioned by 4).

Additional reasons given for euthanasia requests include:

• 27 people wanted to control the time and manner of their death; 
• 16 wanted to minimize the impact of their condition on others; 
• 15 people were concerned about “loss of autonomy;” 
• 13 people cited the lack of treatment options and their deteriorating condition; 
• 10 wanted to “avoid loss of dignity.”
  

Ten people (12.5%) gave no reason for wanting to die.

The authors noted that “physicians are often reluctant to tell patients they are dying, that conversations about death occur very late in the illness, and that palliative care/hospice options are often not discussed.”

In fact, 7 people (9%) had Level of Intervention (LOI) forms in their charts (similar to a Medical Order for Life-Sustaining Treatment) that called for life-saving interventions, while an additional 16 people (20%) had no LOI form, causing a default to life-saving treatment.

As well, most people were not receiving palliative care when they made their request to die.

• 7 people had palliative care consults more than 100 days before the request, and another 7 had palliative care consults in the three months before they asked to die. 
• 26 (32%) palliative care consults were requested 1–6 days prior to the request; 
• 16 (20%) had a palliative care consult the day of or after they asked to die; 
• 11 people, (14%) never had palliative care (usually because they refused).
  

As we mentioned, of the 80 people who asked for euthanasia, 43 (or 54%) were euthanized, while 37 people (or 46%) did not receive euthanasia:

• 13 lost decision-making capacity after submitting their request; 
• 8 people “did not meet the eligibility criteria.” including:
  
  • 4 who were deemed incapable of making a decision; 
  • 2 who weren’t at the end of life; 
  • 1 who was not in a state of “advanced and irreversible decline;” 
  • 1 whose suffering was not “constant and unbearable;”

• 7 died before they could be euthanized. 
• 5 people “changed their minds.” 
• 2 chose palliative sedation (not clear if it was “Continuous”), 
• For 2 people, no reason was documented for the denial of the request.
  

Of the 43 euthanasia, 38 took place after the federal law, with its 10-day “cooling off” period, went into effect. However the waiting period was waived in 60%, or 23 of those cases. In 19 of the 38 cases, euthanasia was performed one to six days after the request was made.

Only imminent death or loss of capacity is supposed to justify cancelling the waiting period, but the reasons given suggest that doctors didn’t apply that safeguard:

• Fear of loss of capacity was cited in 7 cases. 
• “worsening symptoms,” was noted in 5 cases. As the authors point out, this “may or may not have implied that death or loss of capacity was imminent.”
  

In the remaining 11 cases,

• 6 doctors didn’t give a reason for dropping the waiting period; 
• 3 files listed “avoiding provider-based delays”; and 
• 2 doctors cited “patient demand”.
  

The study found that only 14 people out of 80, (18% of files reviewed), had consulted a palliative care provider more than a month before requesting euthanasia. That’s no assurance that services were in place to control pain, help process grief and maintain autonomy. Though Québec’s practice guidelines state that “[euthanasia] remains exceptional,” the researchers conclude that this is not what happens in real life. 

The “exceptional” practice of euthanasia is becoming the norm as it gains as the preferred treatment option for ill and disabled people.

Toujours Vivant-Not Dead Yet is a non-religious organization by and for disabled people. Its goal is to inform, unify and give voice to the disability rights opposition to assisted suicide, euthanasia, and other ending-of-life practices that discriminate against people with disabilities.  

They present a weekly online discussion in English every Friday at 3 p.m. to offer up-to-date information about assisted suicide, euthanasia and ending-of-life practices for the disability community. 

Please click on the link: https://www.youtube.com/watch?v=OpWjpN5ZLmE to join the webcast.

Quebec Political party pledges to extend euthanasia to Alzheimer's patients.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Coalition Avenir Québec (CAQ) says that if they are elected on October 1, they will increase provincial funding for Alzheimer’s research by $5 million a year and host public consultations on advanced consent for medically assisted deaths for those with Alzheimer’s and related diseases.

René Bruemmer reporting for the Montreal Gazette that CAQ candidates Marguerite Blais and François Bonnardel announced in St-Sauveur on Monday morning the parties intention to increase funding for Alzheimer's research and extending euthanasia to people with Alzheimer's. The article states:

Bonnardel’s mother suffers from Alzheimer’s, and he has said he would support a law that would allow a person to request a medically assisted death through prior consent in a living will.

“I see my mother, today, it’s 15 years (that she has had Alzheimer’s). Do I want to die like her? No... I want the choice to decide. I think a large majority of Quebecers want this choice.” 

... we want to open this debate for the 125,000 families who live with Alzheimer’s daily,” Bonnardel said. “We will do it because we have to do it. It’s a question of dignity.”

In July 2018, a Dutch doctor was reprimanded for euthanizing a woman with dementia who resisted. According to the case:

The doctor secretly placed a soporific in her coffee to calm her, and then had started to give her a lethal injection.

Yet while injecting the woman she woke up, and fought the doctor. The paperwork showed that the only way the doctor could complete the injection was by getting family members to help restrain her.

It (the paperwork) also revealed that the patient said several times 'I don't want to die' in the days before she was put to death, and that the doctor had not spoken to her about what was planned because she did not want to cause unnecessary extra distress. She also did not tell her about what was in her coffee as it was also likely to cause further disruptions to the planned euthanasia process.

Canada's federal government announced in December 2016 that they had commissioned studies into the issues of euthanasia for children, euthanasia for people with psychiatric conditions alone and euthanasia for people with Alzheimer's/Dementia if they request euthanasia for this condition while competent.

If you permit euthanasia for people who had previously stated that they wanted to die by lethal injection, but who are now incompetent, you are denying these people the right to change their mind. 

Similar to the case in the Netherlands you cannot assume that the previous wishes of a person remain the current wish of the person.