Euthanasia and social class

By Odile Marcotte
Retired Professor Department of Computer Science, UQAM and a Euthanasia Prevention Coalition board member.

Odile Marcotte

The June 2026 issue of the L'actualité magazine includes an article on euthanasia entitled "Le dernier choix," i.e., The last choice. This article is a reasonably good one and does not exhibit a bias towards euthanasia, except in the beginning and end of the article, which feature (as usual) a patient suffering from a grievous illness asking for and receiving the "treatment" called euthanasia. The article, however, raises several questions that need to be addressed.

Consider the issue of social class (or socio-economic status), which I will address in this post. Studies have shown repeatedly that among the patients dying through euthanasia or assisted suicide, the proportion of patients with higher education and financial means is greater than in the general population. This is indeed confirmed by Dr. Louis Daigle, who has euthanized more than 650 people over a period of nine years. 

Daigle states that the suffering of seeing oneself waste away is what MAiD allows his patients to avoid. Indeed, after a good life, after earning good money and enjoying many travels, they will not accept what they call "an undignified death." Dr. Daigle goes on to say that those patients request euthanasia because they wish to "hold the reins" until the very end of their life.

Dr. Daigle, who specializes in emergency medicine, seems to have empathy for the people he euthanizes. His fellow doctors at the Collège des médecins du Québec, along with the pro-euthanasia lobby in Québec and Canada, have succeeded in:

• making euthanasia legal,
• making it a procedure paid by medicare and performed in all hospitals,
• redefining palliative medicine as a discipline that includes the possibility of ending the life of a patient, 
• extending euthanasia to patients not at the end of their life and not enjoying the same comfort as the rest of the population, and 
• denying palliative care homes (at least in British Columbia and Québec) the permission to exclude euthanasia from its services.
  

In other words, the comfortable class has achieved its goals and persuaded the rest of the population to support euthanasia as a way of avoiding "suffering" at the end of life, even though this profound change has huge and unforeseen consequences for every individual.

Euthanasia has become a social class issue.

Daily Mail article exposes the expansion of euthanasia to children.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Sign and share our EPC petition opposing child euthanasia (Link).

James Reinl, the social affairs correspondent for the Daily Mail published an exposé on March 19, 2023 concerning the possible expansion of euthanasia to children in Canada. Reinl writes:

When Canada changed its laws in 2016 to permit euthanasia, voters were assured the lethal injections would only be available for seriously ill adults who needed to hasten a looming death and end their suffering.

Much has changed these past seven years.

The government is now weighing whether to extend euthanasia to children and the mentally ill.

Reinl continues:

In another worrying sign, a top medical body in the French-speaking eastern province of Quebec says lethal injections should be made available to seriously ill newborns.

Supporters of assisted suicide say they help some very sick people end their agony. Critics say they are the start of a slippery slope that sees ever-more vulnerable people ending their lives prematurely.

Alex Schadenberg

Reinl asked me about the direction of Canada's euthanasia law. Reinl stated:

'Now we've legalized euthanasia, everything's turning upside down,' Alex Schadenberg, director of the Euthanasia Prevention Coalition, a campaign group, told DailyMail.com.'It used to be seen as a last resort. Now, we think in terms of denying people a service that should be available to them.'

Reinl then asked me about the government funded MAiD activity book for children. I told him that the Children's MAiD Activity Book is designed to normalize killing. Reinl wrote:

Schadenberg and others were stunned recently by a 'MAiD Activity Book' aimed at helping children understand why a relative would choose euthanasia, and how the process works.

Critics point to the innocent, child-like language used in the 26-page government-funded booklet to explain a process that is, for many, macabre.

Reinl describes the MAiD activity book:

A doctor or nurse practitioner uses medicines to stop the person's body from working,' says the booklet.

'When their body stops working, the person dies.'

It describes euthanasia as a last-ditch procedure reserved for consenting adults afflicted with a sickness or disability that 'hurts their body or their mind so much that it feels too hard to keep living.'

It explains how MAiD drugs make recipients doze off and lapse into a coma before a 'third medicine … makes the person's lungs stop breathing and then their heart stops beating.
'The person does not notice this happening and it does not hurt,' adds the book, which was written by Ceilidh Eaton Russell, a McMaster University lecturer and an expert on child grief.

'When their heart and lungs stop working, their body dies. It will not start working again.'

The MAiD activity book was published last year by Canada's Virtual Hospice and paid for with money from Health Canada. Reinl explains that Canadian politicians are debating the expansion of MAiD to minors, while the euthanasia lobby group, Dying with Dignity, advocate euthanasia for 12 year olds.

Reinl completes his exposé by stating that Quebec physicians want euthanasia of newborns.

That limit is too high for Dr Louis Roy, from the Quebec College of Physicians — he says newborns who enter the world with 'severe malformations' or 'grave and severe syndromes' should be entitled to a doctor-aided death.

In my interview with Reinl, I provided much more information. I hope that he will continue to investigate how insane Canada's euthanasia law has become.

• Article: Canadian Virtual Hospice promotes euthanasia book for children (Link).
• Canadian children may be euthanized with or without parental consent (Link).

Canada has become a world leader in euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kevin Yuill

Kevin Yuill, who authored the book, the Secular case against assisted suicide, wrote an article explaining how Canada has become the world leader in euthanasia that was published on October 26 by Spiked.

Yuill explains that in March 2023, Canada will permit euthanasia for mental illness alone. This would be the second expansion since Canada legalized euthanasia. He wrote:

On 17 March 2023, Canadian law will change to make people whose sole underlying medical condition is mental illness eligible for what Canada refers to as ‘medical assistance in dying’ (MAID). MAID covers both euthanasia and assisted suicide, although the vast majority of cases in Canada are euthanasia, which means that a doctor actively ends a person’s life, rather than giving that person the means to do so him or herself.

This will be the second expansion of euthanasia since it was legalised in 2016. In March 2021, Canada made a new category of patients eligible for MAID. Before then, only those whose death is ‘reasonably foreseeable’ were eligible. ‘Track Two’, however, is available to those with a ‘serious or incurable condition’ for whom death is likely but not imminent. Patients are now said to qualify for MAID if they suffer from a condition or disability which ‘cannot be relieved under conditions that they consider acceptable ’.

Yuill tells the stories of Mitchell Tremblay and a Veteran living with PTSD. He writes:

The next expansion could lead to a ‘rush for the doors’. These are the words of 40-year-old Mitchell Tremblay, who is hoping to take advantage of the law change. Tremblay was diagnosed with severe depression as a teen and also suffers from anxiety, alcoholism, personality disorders and continual suicidal thoughts. He can’t work and lives on a disability payment of just under $1,200 (£800) a month. ‘You know what your life is worth to you’, he told interviewers recently, ‘and mine is worthless’.

Tragically, MAID is increasingly being seen as a solution to people’s distress, no matter the cause. Some doctors and counsellors are even recommending it to certain patients and clients. In August, for example, an army veteran seeking treatment for post-traumatic stress disorder and a traumatic brain injury was rightly outraged to be offered MAID by an employee of Veterans Affairs Canada, entirely unprompted.

Yuill states that its not surprising that the number of euthanasia deaths has increased so quickly. He writes:

Last year, euthanasia accounted for 3.3 per cent of all deaths, a third more than in 2020. Statistics from Health Canada show that social reasons for wanting euthanasia are already important and will likely climb as the criteria for eligibility expands. In 2021, for instance, 17.3 per cent of people cited ‘isolation or loneliness’ as a reason for wanting MAID. In 35.7 per cent of cases, patients believed that they were a ‘burden on family, friends or caregivers’.

Yuill then writes about the expansion of euthanasia to people with mental illness:

Dr John Maher, a psychiatrist, was shocked when a patient recently discussed the possibility of MAID with him ‘because of his belief no one will ever love him’. No wonder it rattled him. Psychiatrists get up in the morning to help those in mental distress and to prevent suicide – not facilitate it.

Until recently, the Canadian public had been broadly sympathetic to MAID’s original goal – of alleviating suffering among the dying and seriously ill. But there is no majority support for allowing MAID for mental-health conditions. In a poll conducted this year, fewer than half of all Canadians supported extending MAID to adults diagnosed with a serious mental illness.

Yuill continues by commenting on the recent proposal to extend euthanasia to infants and those who are "tired of living":

Dr Louis Roy of the Quebec College of Physicians recently recommended to Canadian lawmakers that MAID be ‘offered’ to children born with severe disabilities up to the age of one. This disturbing proposal was unsurprisingly met with fierce criticism. But another of Roy’s shocking suggestions went almost unnoticed: that MAID should be provided for those elderly people who are ‘tired of being alive’.

Yuill then comments on the euthanasia lobby's past connection to eugenics.

These and other arguments marshalled in favour of euthanasia in Canada bear a striking resemblance to those made in the past to justify eugenics. At the turn of the 20th century, the most fierce proponents of euthanasia and eugenics were physicians and academics. In the US, Dr Ella K Dearborn cheerfully called for ‘euthanasia for the incurably ill, insane, criminals and degenerates’. Dearborn thought it entirely reasonable that everyone should pass an examination allowing them to continue living. In 1906, one sociologist noted in the Minneapolis Journal: ‘I would personally rather administer chloroform to the poor, starving children of New York, Philadelphia, Chicago and other American cities, than to see them living as they must in squalor and misery.’

The steady expansion of Canada’s euthanasia laws has echoes of this dark eugenicist vision. Take the case of Amir Farsoud, an impoverished 53-year-old with a chronic back condition, who is about to be made homeless. Farsoud has applied for MAID not because he wants to die, but because he fears the future. ‘I don’t want to die’, Farsoud said, ‘but I don’t want to be homeless more than I don’t want to die’. He already has one of the two doctor’s signatures required.

Yuill ends the article by suggesting that Canada's euthanasia law should cause other countries to reject euthanasia. He writes:

But perhaps Canada is also doing the world a favour. In six short years, it has shown that the initial justification for MAID – people’s freedom to alleviate their own suffering from terminal illness – is only a more palatable precursor to something much darker. What we’re seeing in Canada today is what happens when a country convinces itself that lethal injections are a normal part of healthcare. It is what happens when death is treated as a solution to life’s problems. This anti-human movement must be resisted.

Kevin Yuill is a long-time writer on issues related to euthanasia and assisted suicide.

Quebec College of Physicians slammed for justifying infant euthanasia

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Article: Infant euthanasia proposed by the Quebec College of Physicians (Link)

The National Post published a thorough article by Catherine Lévesque on October 11 titled: Quebec College of Physicians slammed for suggesting MAiD for severely ill newborns.

In the article Lévesque interviews people from the disability community, from the medical community and myself.

Lévesque explains the issue:

Dr. Louis Roy, from the Quebec College of Physicians, told the Commons’ Special Joint Committee of Medical Assistance in Dying (MAID) on Friday that his organization believes MAID can be appropriate for infants up to age one who are born with “severe malformations” and “grave and severe syndromes” for which their “prospective of survival is null, so to speak.”

Krista Carr

Lévesque first quotes from Krista Carr with Inclusion Canada;

“Most families of children born with disabilities are told from the start that their child will, in one way or another, not have a good quality of life,”

“Canada cannot begin killing babies when doctors predict there is no hope for them. Predictions are far too often based on discriminatory assumptions about life with a disability,”

Carr then says:

“An infant cannot consent to their own death. This isn’t MAID, it’s murder. And providing MAID to a person who cannot consent is a standard that is wildly dangerous for all persons with intellectual disabilities in Canada,”

 Alex Schadenberg

 

She then quotes me saying that legalizing infant euthanasia for babies who are will die is simply not necessary.

“Why would you then have to give the child a lethal dose? If the child is not going to survive, the child can be kept comfortable and die naturally. There’s no reason for us to kill the child. There’s no reason for us to do this at all,”

To further clarify the position of the Québec College of Physicians, Léveque quotes from a December 2021 press release:

The press release said that MAID could be an avenue for infants who are subject to “extreme suffering that cannot be soothed, coupled with very dark prognostics,” while adding that this treatment would have to be regulated by a “strict protocol.”

The College mentioned the Netherlands’ Groningen Protocol — a detailed process that includes unbearable suffering confirmed by at least one doctor and informed consent from both parents — as an avenue to explore in Canada for euthanasia for severely ill newborns.

It also recommended making MAID accessible to minors from 14 to 17 years old, with the authorization of parents or of a tutor, adding that suffering has no age and that it can be as intolerable as for adults.

Léveque continues the article by quoting comments made by National Post columnist Ben Woodfinden, who originally reported about Dr Roy's testimony:

“Assisted death or suicide isn’t even the right word for what’s being described here. A baby cannot consent, a baby cannot decide they want to end their own life, it’s not about any kind of ‘choice’ or ‘autonomy.’ It’s straight up infanticide,”

Dominic Evans

American disability activist and film maker, Dominic Evans told Léveque:

“I have many friends who were told this in infancy who have lived into adulthood and have thriving lives,”

“My disability was not diagnosed until I was four, but it was as though I had already ‘died’ because everybody was so abysmal towards being diagnosed with a disability.”

Léveque ends the article by quoting me (Alex Schadenberg). I told Léveque that infant euthanasia is not about "autonomy" or "choice" and it opens the door to further expansions.

“Now, it’s not about my autonomy, my choice. If I can do that to a newborn, why can’t I do that to someone who never asked for it, who never showed any interest in it but now has Alzheimer’s?”

He added that the accepted criteria have evolved quickly since C-14 was passed in 2016 and C-7 in 2021. The sunset clause that temporarily restricts MAID for people whose sole underlying medical condition is mental illness will expire in March 2023.

Catherine Lévesque has written a thorough article but further to this article, the Groningen Protocol is not limited to children who will almost certainly die anyway. It also approves death for infants who are suffering or are likely to experience possible future suffering.

Once the door to killing without consent is completely opened, the swath of people who become eligible for being killed expands exponentially.

Infant euthanasia proposed by the Quebec College of Physicians.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Article: Quebec College of Physicians slammed for justifying infant euthanasia (Link).

EPC has created a postcard opposing infant euthanasia to be sent to Members of Parliament (MP's). Order the postcards at no cost by contacting EPC at: 1-877-439-3348 or office@epcc.ca

A presentation by Dr Louis Roy for the Québec College of Physicians to The Special Joint Committee on MAiD on September 7 urged Canada's Federal government to adopt a protocol to permit infant euthanasia.

Dr Roy suggested that this should only be allowed in rare circumstances, such as a newborn who is unlikely to survive. 

Infant euthanasia opens the door to a new justification for killing since the baby lacks competence and is not autonomously capable of choosing to be killed. Infant euthanasia is a form of eugenics whereby protocols will determine which lives are worth living.

Euthanasia was sold to Canadians under the guise of competent adults freely choosing to have their lives ended based on terminal illness or unremittent suffering. Bill C-7, that was passed in March 2021, among other things, extended the reason for killing from terminal illness to chronic illness or disability.

If infant euthanasia is approved it may lead to the approval of euthanasia for people with dementia who never requested or indicated an interest in euthanasia since infant euthanasia creates the precedent that someone else, such as a power of attorney, can request that a person be killed.

The Euthanasia Prevention Coalition opposes all forms of euthanasia and assisted suicide, nonetheless, it is clear that expanding killing to babies negates the "safeguard" that only people who can capably request to die can be approved for death.

More articles on the topic:

• Netherlands euthanasia experts advocate for child euthanasia with or without consent (Link).
• New York Times article promotes infanticide (Link).
• Newsweek promotes infant euthanasia (Link).
• Euthanasia of newborns with disabilities and infanticide.
• Dutch paediatricians want to legalise euthanasia for children under 12.
• Euthanasia of babies with disabilities.
• The Groningen Protocol for euthanasia of disabled babies in the Netherlands.

Quebec will officially extend euthanasia to include psychiatric conditions.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article by Sidhartha Banerjee, for the Canadian Press reports that the Québec government has officially decided to extend euthanasia to people with mental illness. The article reports:

Health Minister Danielle McCann told a news conference Tuesday that people with mental health issues who aren’t responding to treatment would be able to ask for the procedure — but she stressed such cases would be exceptional.

Before euthanasia (MAID) was legalized in Canada, the Québec Health Minister predicted that there would be about 100 lethal injection deaths per year. In 2019 there were approximately 5000 euthanasia deaths in Canada and there have been 13,000 since legalization.

The Québec College of Physicians is suggesting that euthanasia for mental conditions will be rare. Banerjee reported:

“We don’t expect many of these patients will qualify, because one of the other criteria that remains is to suffer from a disease that is not curable, which is not necessarily the case of all mental health situations,” said Dr. Yves Robert, the college’s secretary. “It will really be an individual, case-by-case decision that will be done.”

The decision of the Québec Health Minister is based on the September Québec lower court decision that struck down the "terminal illness" requirement in the euthanasia law. Since the law permits euthanasia for physical or psychological suffering, by removing the "terminal illness" requirement people with psychological suffering, who are not terminally ill qualify for euthanasia.

*Article: Quebec court expands Canada's euthanasia law by striking the terminal illness requirement. Euthanasia for psychological reasons is next (Link).

Dr Mark Komrad

Psychiatric professor Dr. Mark Komrad, commented on the Québec decision by warning American psychiatrists of his concerns:

Every nation that legalized these procedures has gradually expanded the criteria, according to the dictates of cherished values like fairness, parity, and related values that make it very difficult to deny these procedures to those just beyond whatever line has been drawn. And so it creeps. We in the US, need to be prepared that this mission creep is our future with the growing metastases of assisted suicide laws in many states. In fact, it was both to signal to other nations, and to prepare here in the US for the slippery slope reaching our psychiatric patients, that we passed our APA position statement. 

*Video: Why psychiatrists should oppose euthanasia (Link). 

I just want to remind you of the official position of the American Psychiatric Association:
The American Psychiatric Association, in concert with the American Medical Association’s position on euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.

The only way to stop the expansion of assisted death in the United States and other countries is by not legalizing it in the first place.

The euthanasia floodgates have opened in Canada. Based on fairness and "equality" the control of euthanasia for psychiatric conditions will be porous at best. Doctors won't deny euthanasia to one person when another person was lethally injected for the same or similar condition.

Canada's euthanasia law is not designed to be controlled. The approval procedure is designed to protect physicians from any prospect of being prosecuted and it uses a self-reporting system, whereby a physician who approves the death, can be the physician who carries out the death, and then be the same physician who reports the death. This system offers no effective oversight of the law and no prospect for control.

The question is, how can we put the genie back in the bottle?

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.

Our right to quality palliative care in Québec?

Aubert Martin

This article was published by Mercatornet on June 20, 2018

By Aubert Martin

The Act Respecting End-of-Life Care was sold to us as "first and foremost, a law of access to quality palliative care throughout the territory, at the patient's choice.” When it was adopted – not so long ago – its promoters insisted that it only legalized "medical aid in dying" (euthanasia) as an "exceptional measure for exceptional cases."

However it is now obvious that, almost four years since the day of its adoption and close to three years after its coming into effect, the public authorities have essentially concentrated their efforts on this famous "exceptional measure", giving the impression that the act of killing people to end their suffering – still very controversial – was a cool and trendy way of ending one’s life.

• Québec physicians: Shortage of palliative care is pushing people to euthanasia.

Recently, faced with this regrettable reality, several personalities in the health care community have publicly denounced the fact that, ultimately, the Act Respecting End-of-Life Care does not fulfill its main promise: to guarantee to all of the approximately 60,000 Quebecers who die each year the right to receive quality palliative care if it is needed.

Thus, after the heartfelt appeal of Quebec's two major palliative care associations denouncing the lack of efforts and resources to make quality palliative care accessible in all Quebec nursing homes (CHSLDs), or that of physicians who claimed that some patients are turning to physician-assisted suicide for lack of palliative care options, the Collège des médecins du Québec (CMQ) has also expressed its concerns by highlighting the disorderly application of the Act Respecting End-of-Life Care.

In a letter sent to Dr. Gaétan Barrette, the current Minister of Health, the Collège des médecins mentions that, in some cases, “patients, unable to benefit from [clearly identified palliative care], may have had no choice but to ask for [euthanasia] to end their days...".

Even worse, the College reports a disturbing fact that suggests that the exceptional measure may be imposing itself as a supreme: “The College has been told that patients seeking medical aid in dying were becoming the priority for access to available resources (...) to the detriment of other end-of-life patients with similar needs.”

In other words, those who choose euthanasia are entitled to the best support available in the last moments of their lives, while many others – the vast majority – do not receive the care promised to them in the law. Is that really the ideal of justice that we pursue as a society? Or is it for fear of making tomorrow’s headlines that the medical personnel are rushing to satisfy patients who choose euthanasia? Are they trying to avoid being publicly singled out for not immediately providing the act that has been promoted as the new way to die 2.0?

Meanwhile, instead of strengthening palliative care, the current situation threatens its very sustainability, as the College of Physicians also observes, reporting that “doctors are leaving and not being replaced in many palliative care settings, compromising access to such care.”

In conclusion, it is time to step back and reflect on the entirety of the commitments made in the Act Respecting End-of-Life Care. It is also time to listen carefully to what palliative care professionals have to propose as ways to make our end of life comfortable: after all, they are the experts. And it is time to claim the right that has been legally granted to us as citizens to have access to such care. Any delay in that respect abandons citizens to death without the support of the comfort care they were promised.

On the eve of the provincial elections in October, now is the time for the Quebec population to mobilize and demand that the future government finally listen to the vast majority of the electorate who wish to live with dignity until the end of their lives with the help of quality palliative care.

Aubert Martin is the Executive Director of Vivre dans la Dignité (Living with Dignity), a Quebec-based organisation.

Québec physicians: Shortage of palliative care is pushing people to euthanasia

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A group of Québec doctors held a press conference to explain that the lack of funding for palliative care in Québec is pushing people to seek death by euthanasia.

CTV news reported that the doctors stated that since MAiD was legalized access to palliative care has decreased. The doctors said that:

patients have told them that they’re choosing assisted dying because they can’t find adequate palliative care services.

Dr Paul Saba

Dr Paul Saba, was reported as saying that they want to provide the care and support that people need:

Dr. Paul Saba, a family physician who is leading the group said fewer doctors have entered the field of palliative care since the law came into effect and that patients are suffering as a result. 

“People really are feeling a burden, financial stress, psychological stress and lack of autonomy,” 

“So what we want do is we want to give people what they need, and they need care and support.”

Dr Laurence Normand-Rivest

Dr. Laurence Normand-Rivest, who specializes in  palliative care, told the press conference:

“We were promised that there would be a plan for the development of palliative care in Quebec and the [government] commission asked for five years to develop this plan,”

“We’re in 2018, and for now, there’s no plan.”

Dr Charles Bernard, the President of the Québec College of Physicians, told the Québec government at the end of May that more funding is needed for palliative care. CTV reported that Bernard wrote to the government stating:

“Patients, failing to benefit from such care, could have no other choice but to ask for medical aid in dying to end their days in dignity,” 

“Patients who ask for medical aid in dying are given priority access to available resources to the detriment of other patients at the end of their lives.”

The Canadian government will be receiving reports in December on the extension of euthanasia to children, people with psychiatric conditions and people who are incompetent.

• Québec Physicians Denounce Lack of Free Informed Consent & Safeguards of Euthanasia and Assisted Suicide Laws.

Québec Physicians Denounce Lack of Free Informed Consent & Safeguards of Euthanasia and Assisted Suicide Laws

MONTREAL, QUEBEC, CANADA, June 12, 2018 /EINPresswire.com/

10 Quebec doctors denounce the fact that the health care system is forcing people to accept “medical aid in dying” rather “than medical aid in living” in Canada.

Dr Laurence Normand-Rivest

According to the doctors, patients end up wanting to die because they do not have access to proper medical care. Each physician demonstrated how the lack of access to proper care deprived patients of free and informed consent and adequate safeguards in the euthanasia and assisted suicide laws.

Lisa d’Amico lives in Montreal and is the President of the Medical Errors Victims Fund. She lives with cerebral palsy since birth. Lisa argues that euthanasia and assisted suicide laws are abusive and killing people against their will. According to Mme d’Amico: 

"the lack of medical care and therapeutic incidents or accidents lead to unwarranted deaths."

Dr. Colavincenzo described a patient with congestive heart failure with many quality years to live being euthanized without free and informed consent because of overly pessismistic predictions by the physician unduly influencing family members. According to Dr. Colavincenzo this clearly shows that the laws are not protecting patients.

Dr Ron Olivenstein, former Director of the Montreal Chest Hospital, described how patients with severe lung disease can have many years to live, but whose lives are short-circuited because of lack of availability to pulmonary rehabilitation services. Without optimal care, some of these patients will decide to end their lives. For Dr. Olivenstein this is another example of lack of free and informed consent and inadequate safeguards.

Dr. Kass who is former Director of Surgery at Lachine Hospital and operates on woman with breast cancer, states that woman over 70 are not encouraged to have routine mammograms which could result in missing some early cancers. Patients who do not undergo timely screening and treatment cannot give a free and informed consent because of inadequate safeguards.

Dr Laliberté, former Director of Family Medicine at Lachine, considers that some patients may ask for assisted death without a free and informed consent. Lack of accessibility to adequate palliative care is a major issue, as recently reported by the Quebec College of Physicians. Consequently patients, in distress will be forced to ask for physician assisted death. This is not to be taken lightly as the decision is serious and and has irretrievable consequences, namely death.

Dr. Thierry Toledano is an internal medicine specialist. He stated that it is impossibile to give patients clear informed consent as to whether they are at the end of life. What does end of life mean : a few days; several months; less than 6 months; less than a year? The Canadian law is even less clear than the Quebec law since a prognosis does not need to be given to the patient. What does dying in the foreseeable future mean if prognosis is not to be included in the assessment? Does this mean the patient doesn’t even have to be dying? Most chronic medical conditions that physicians treat (for example, diabetes, chronic heart and lung problems) are “incurable” and progressive. Which of these patients are eligible under the current law?

For Dr. Toledano, the consent cannot be free and informed if the eligibility conditions are vague.

Dr. Liette Pilon, a family physician,deplores the fact that access to important care like pain control is long and difficult. Access for mental health, geriatric,disability, home and palliative care is lacking. Some patients end up asking for death because of inadequate care. « How can a patient have a free and informed choice when a lethal injection is more readily available than real care? » asks Dr. Pilon.

Dr. Sylvia Baribeau, a family physician described the pressures placed on patients who want home care but do not have access and are afraid to go to the hospital where the care often is suboptimal for basic hygiene. They talk about ending their lives rather than facing undignified living conditions at the hospital or nursing homes.

Dr. Peter Blusanovics is an AIDS hospice, palliative and geriatric physician. He decries the lack of access ot quality health care, delays in diagnosis and treatment and lack of hygienic care in institutions which may cause patients to: 

"rush into a hasty decision to end their lives by assisted suicide or euthanasia because of the fear of not receiving adequate medical care and fear of being alone or a burden to others."

Dr Laurence Normand Rivest who works in palliative care described that many patients in Quebec do not have access to the quality home palliative care services they need. At the end of life the choice is either going to the hospital where they do not want to spend their last days or ending their life quickly by a lethal injection.

Recently, the Quebec College of Physicians which is mandated to ensure the quality of medical practice, issued a letter to the Quebec Government expressing their concerns that physician assisted death may be causing patients to turn to lethal injections because of the lack of palliative care.

Dr Paul Saba

In this letter, the President of the College of Physicians informed the Health Minister that there are "difficulties with the accessibility of palliative care for many end-of-life patients" denouncing that "in certain well-identified cases, patients, not benefiting from such care, could have had no choice but to request medical assistance in dying to end their days "in dignity;" The College of Physicians also advises that "end-of-life care can not be limited to access to medical assistance in dying."

Dr. Paul Saba reminded us that the Quebec Commission in 2016 and 2017 reported many deaths that did not respect the law. For Dr. Saba, these findings confirm that the law is not being respected, that patients are not being properly informed and that the safeguards are inadequate.

Paul J Saba
Coalition of Physicians for Social Justice
514-886-3447
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