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
email us here

Québec doctors 'Complete' Suicides

This article was published by National Review online on November 27, 2017

Wesley Smith

By Wesley J. Smith

Euthanasia costs lives. Not only do doctors kill people who ask to die–generally without even attempting suicide prevention services–but the ethics-altering values of euthanasia/assisted suicide devalue despairing lives generally. 

For example, several years ago, a woman named Kerrie Woolterton in the UK swallowed anti-freeze and called an ambulance, the latest of several such suicide attempts. But she pinned a note to her blouse refusing treatment. Despite the medical ability to save her–which had succeeded with Woolterton on previous occasions–doctors honored her “choice” and just let her die (painfully) over a 24-hour period. 

In Quebec, which has legalized lethal injection euthanasia, some doctors have been letting people who attempt suicide die without treatment–even though they could be saved–thereby “completing” their suicides. From the National Post story: 

Quebec’s College of Physicians has issued an ethics bulletin to its members after learning that some doctors were allowing suicide victims to die when life-saving treatment was available.  

The bulletin says the college learned last fall that, “in some Quebec hospitals, some people who had attempted to end their lives through poisoning were not resuscitated when, in the opinion of certain experts, a treatment spread out over a few days could have saved them with no, or almost no, aftereffects.” 

How many of those people would have been glad their lives were saved, as sometimes happens when suicides fail? We’ll never know because they are dead. 

Even as they take action to save some suicidal patients, the College abandons others: 

From a moral point of view, this duty to act to save the patient’s life, or to prevent him from living with the effects of a too-late intervention, rests on principles of doing good and not doing harm, as well as of solidarity,” it reads. “It would be negligent not to act.” 

It says treatment should be withheld only in cases where a physician has “irrefutable proof” of a patient’s wishes in the form of an advance medical directive or a do-not-resuscitate order. 

Oh. In other words, another group of people abandoned to suicide, in addition to those whom doctors personally kill when asked due to illness or disability. 

Euthanasia corrupts everything it touches, including the basic ethics of medicine and common human decency.

Euthanasia slippery slope: a failure of memory and imagination

This article was published by Mercatornet on July 28, 2017

When the splash of assisted-suicide and euthanasia blinds us to their far-reaching ripples.

Margaret Somerville

By Margaret Somerville

Very recently, two senior physicians who have championed the legalization of euthanasia in their jurisdictions, Dr Boudewijn Chabot in the Netherlands and Dr Guy Robert in Quebec, have rejected current “appalling” developments in euthanasia in their countries. Yet, these developments should have been anticipated. So, why weren’t they?

Pro-euthanasia advocates focus just on individuals and only in the present – a combination of radical autonomy/ intense individualism and “presentism” - which blocks out considering both lessons from the past and likely future developments. In other words, the pro-euthanasia stance rests on a failure of people’s individual and collective human memory and imagination.

Those opposing euthanasia look to human memory – history and what the past can teach us – and imagination – what the future might hold – as well as the present. They also look beyond euthanasia’s impact just on individuals to the wide-ranging and multitudinous major issues and consequences it raises for medicine and law, for practitioners of these two professions, and for all of us as families, communities and a society.

Human memory

Human memory warns us of the “slippery slopes” euthanasia opens up: The “logical slippery slope”, the situations where euthanasia is allowed constantly expands, and the “practical slippery slope”, euthanasia is undertaken not in compliance with the law.

Once euthanasia becomes normalized slippery slopes are unavoidable, because, as British moral philosopher Dame Mary Warnock explains, “You cannot successfully block a slippery slope except by a fixed and invariable obstacle”, in the case of euthanasia, the rule that we must not intentionally kill.

Pro-euthanasia advocates dismiss the nearly 2,500 year history of the Hippocratic Oath’s guidance of medicine – cure where possible, care always, never kill – and, especially, any lessons from the Nazi regime. No one believes euthanasia will lead to a second Holocaust, but as the distinguished Canadian historian, Margaret MacMillan, has said, without knowing the past, we deprive ourselves of an important source of understanding.

Renowned Canadian disability rights advocate Professor Catherine Frazee, who says that what happened to people with disabilities in Nazi Germany is “part of my history as a person with severe disabilities”, explains “that one key to tackling complex problems is to ask the right questions, and history, through its cautionary tales and analogues, is a rich vein of 'right questions'” to ask about euthanasia.

We can also look to indigenous people’s practice of looking to Elders past and present, to argue it is wrong and dangerous to exclude human memory from informing our important societal decisions, and legalizing euthanasia is clearly such a decision.

Psychiatrist Dr Boudewijn Chabot, a very prominent pro PAS-E advocate in the Netherlands, who has been called the “patron saint of euthanasia”, is horrified at what is currently happening in his country.

He’s not anti-euthanasia (he is prepared to accept tens of thousands of euthanasia cases) but aghast at the rapid rise in the number of people with psychiatric illness or dementia who have been euthanized.

Writing in a leading Dutch newspaper, Chabot says that “legal safeguards for euthanasia are slowly eroding away and that the law no longer protects people with psychiatric conditions and dementia.”

He recognizes “we are dealing with a morally problematic act: how do you kill someone who does not understand that he will be killed?”. And he concludes bitterly, “I don’t see how we can get the genie back in the bottle. It would already mean a lot if we’d acknowledge he’s out.”

Why did the Dutch not look to the past for warnings? Why did they fail to use their imaginations to foresee these future consequences?

We need to ask these questions in relation to vulnerable Australians, those who are elderly and fragile, especially those with dementia, people with disabilities, including newborn babies, who can also be euthanized in the Netherlands.

Human imagination

A failure to look to the future is resulting in an extreme example of calls for expansion of euthanasia unfolding in Quebec.

Dr Yves Robert, the registrar of the College of Physicians and Surgeons of Quebec (the provincial medical licensing authority) was a major proponent of legalizing euthanasia and in 2009 the College was one of the main instigators of the movement to do so. Euthanasia was legalized in December 2015.

Robert adamantly rejected claims that effective safeguards were not possible, that euthanasia was not a medical act, and that it should be kept out of medicine. He constantly referred to a “continuum of good end-of-life care”, which included euthanasia as part of palliative care.

As in Australia, the claim it would be rarely used (about 100 cases a year in the province) was made. The first year saw over 400 cases. (In the first 7 months, 21 of 262 cases did not meet legal requirements: in two the patient was not terminally ill and in one not seriously ill – she probably had a urinary infection.)

But none of that seemed to raise any questions for the College, or I assume Robert, about whether legalizing euthanasia had been a good idea.

Here is what has, as he explains in a letter dated 10 May 2017, on College letterhead, entitled “Death a la carte”. That is, instead of food choices, it’s a menu of options for how one wants to die.

There are now calls and possibly the launching of a court case to have “death on demand” declared a constitutional right. The claim is that having to fulfil certain conditions to have access to euthanasia is a breach of the right to control one’s life and body and legally actionable discrimination.

Claiming a right to “death on demand” is consistent with and just an extension of the autonomy arguments used to legalize euthanasia.

The discrimination claim is unusual: It’s discrimination against people who do not have disabilities because those who do have access to euthanasia and those without disabilities cannot.

Robert notes opinion leaders and the media have denounced cases where people who do not fulfil the conditions for access to euthanasia in Quebec have been refused it. Such denunciations and the refusals being characterized as 'cruelty' are familiar pro-euthanasia strategies.

Robert recognizes the “paradoxical discourse” that calls for safeguards to avoid abuse of “medical aid in dying” (euthanasia) which are meant to limit its availability, while asking doctors to act as if there were no such restrictions.

He continues that if euthanasia is an unfettered right, then it’s not within the scope of “medical aid to die”, but simply “assisting dying” and society must consider other options than involving the medical profession in that.

He explains it’s to transform “medical aid in dying” to “legally authorized aid in dying”, a form of assisted suicide which, he says, could be provided by private enterprise as in Switzerland.

Indeed, if society legalizes euthanasia, all euthanasia should be kept out of medicine. Specially trained technicians could provide it.

Robert notes that the Quebec law was “a major opening” to euthanasia and expresses surprise at how quickly public opinion seems to have judged the opening insufficient, when testing the law is still in the “apprenticeship phase and the application and consequences of its provisions are not fully assimilated.”

In short, euthanasia has become normalized with astonishing rapidity and that has caused calls for access to it to be expanded, indeed, calls to have no restrictions at all on access.

Robert concludes: “Let us take the time to reflect deeply before going any further. There is no urgency to die.” I totally agree but, to use a common saying, “it’s too late to lock the barn door after the horse has bolted.”

As for me, after being heavily involved in the euthanasia debate over many years in Quebec, to use another common saying, “you could have knocked me down with a feather” when I read what Robert wrote. That said, I applaud his honesty and integrity.

Why did so many doctors (and likewise lawyers) of goodwill and professional integrity, such as Dr Robert so adamantly disagree that such expansion would occur – although none of us expected a proposed expansion to this degree?

I believe it was a total failure of individual and collective memory and imagination, including professional memory and imagination, resulting in “intense individualism” and “intense presentism” governing the decision making and leading it astray. Let’s avoid that in Australia.

Margaret Somerville is Professor of Bioethics in the School of Medicine at the University of Notre Dame Australia.

Dr Yves Robert concerned about evolving euthanasia laws in Québec.

This article was published by the Physicians Alliance Against Euthanasia on June 12, 2017.

Dr Yves Robert Secretary of the
Collège des Médecins du Québec

On May 10, 2017, Dr. Yves Robert, Secretary of the Collège des médecins du Québec, asked the following question in a thoughtful article published on the CMQ website:

“If the goal is euthanasia on demand based on a “right”, are we still talking about Medical Aid in Dying? Or simply Aid in Dying? And what, then, would the medical profession have to do with it?”

Considering the past positions espoused by the College and by Dr. Robert personally – “The debate is only beginning…” (words of Dr. Robert at 18 minutes 24), such a quote is reminiscent of the classic novel Frankenstein, where that high-minded scientific genius, having created a humanoid monster threatening to the human race, is forced to confront the reality of his acts and of his responsibility for them. Tragically, but also heroically, he feels obligated, in the end, to hunt and destroy that creature – loved by him as a son – which his imprudent skill had set loose upon the world.

This reading of the text may be well beyond the Secretary’s intention. However, he has raised a clear statement of principle: if there are no criteria for euthanasia other than client demand, then medical wisdom, medical art and medical science have no role to play.

Once we allow any person to choose state-assisted suicide, and any doctor to perform it, we are legitimizing a purely subjective choice of death. There remains no logical reason why the right to exercise such choices should be restricted to this or that medical condition, or to medical conditions at all. Whatever limits are set, someone will feel constrained by them; and the state will continually be called upon to justify a discriminatory regime (where group “a” is allowed subjective decision, but group “b” is not).

Dr Robert apparently believes (or at least did believe) that protection of the common good can perform a limited retreat before the pressure of unfettered individual liberty, and that stable compromise can be established between these two visions. But the legal and moral change, from euthanasia-as-criminal-homicide to “medical aid in dying”, is not a difference in degree; it is a difference in kind. No compromise is possible. There is only a clearly perceptible earth-moving shift towards a radically different medical paradigm based, solely, upon personal subjective choice – a shift which the Physicians’ Alliance, palliative care providers and many others have opposed from the beginning.

The politicians who promoted Bill 52 insisted it was “an evolution, not a revolution”. But, as we observe the public opinion shift that alarms Dr. Robert – “the paradoxical discourse that calls for safeguards to avoid abuse, while asking the doctor to act as if there were none” – it becomes obvious that it is indeed a revolution, planned as such by its authors, wilfully ignoring the opposition of those who care for the dying. The ink is barely dry on Bill 52 and euthanasia enthusiasts are already demanding further concessions. The interim demands were never an acceptable final destination, only legal waystations on the path to complete liberty of personal choice. As Dr. Robert calls it, death à la carte.

And so it is, that even Dr. Robert has begun to speculate publicly upon the medical significance of such an extreme outcome. And these are the logical implications which he has now had the honesty and rigour to bring forward: The medical profession has no duty (or competence) to define, staff or take any responsibility for a public regime of death on demand. Whatever form such fundamental social change might take, it is NOT a medical problem. And (we would add) the sooner we realise this fact, and act upon its wisdom, the better things will be for all concerned.

Indeed, simple prudence would suggest that we show restraint right now in the administrative implementation of the euthanasia regime. Decontamination is always easier in proportion as the contaminated area is smaller. Hubris-driven attempts to impose MAID upon all corners of the health care system should be abandoned. Refusal of individuals and institutions to collaborate in this practice should be scrupulously respected.

Dr. Robert ends his article with a simple and sober admonition:

“Let us take the time to reflect carefully before going any further… Death is not that urgent.”

It is a sentiment with which we entirely agree.

Translated from the original article in French by the Physicians’ Alliance against Euthanasia.

Euthanasia: When the suffering of one becomes the misery of others.

This article was published on the Vivre dans la Dignité blog on October 27.

Aubert Martin

Aubert Martin is the Executive Director of Vivre dans la Dignité

Recently, a lady told me that she had just lost her brother who died suddenly, three days after a fall on the sidewalk. Unfortunately, the circumstances of his death leave some doubt as to the exact cause of death. Is it due to his cancer, discovered a few days earlier? Is it related to his psychiatric problems? Is it a case of “strongly encouraged” euthanasia?

The lady has a lot of questions, but no answer will be given. Indeed, despite her legitimate doubts, nobody is able to enlighten or reassure her.

On one hand, Quebec’s College of Physicians asked not to include "medical aid in dying" on the death certificates of patients. Instead, doctors must identify the main disease of the deceased. Therefore, it is impossible, for those who survive the deceased, to find a paper trail if euthanasia is the actual cause of death.

On the other hand, the lady has been given the answer that her brother being dead, there is nothing they can do for her. This is the uncompromising truth of death: it is irreversible.

Thus, survivors like this lady find themselves left behind. Alone in their grief. They are set aside to preserve the supreme principle of the autonomy of individuals.

In legalizing euthanasia, society has crowned the splendor of individualism in balancing the weight of two pains: the suffering of an individual versus the suffering of their relatives. They have decreed that the suffering of relatives should not be considered in calculating the benefit of euthanasia.

To reinforce this point, the flattering and illusory portrait presented to the public always depicts the same picture: a family and an entourage who fully agree with the decision of their relative’s wish to die, and a medical team in total harmony with the family.

Of course, the reality is much more nuanced, and suffering is so much more widespread than the rosy photoshops offered by the promoters of euthanasia.

Imagine that your father was euthanized by a doctor without you having been consulted – as recommended by the law – and perhaps even without you being able to say one last goodbye. How would you feel: grateful or betrayed? How would you see this doctor who gave death to your father without consulting his own children? How would you mourn your father knowing he preferred the advice of two random doctors who judged, after meeting him briefly, that they approved of his desire to die?

The reality is that we may praise euthanasia with soft, buttered words, we may celebrate those who die with champagne and selfies, there will always be people who will have in their heart a painful sense of betrayal after the voluntary death of their relative.

But from now on, they will have to keep their pain to themselves until the end of their lives, since medical suicide is, more than ever, presented as the ideal way to die. Unfortunately, the story of the lady who lost her brother whom she loved so much illustrates the suffering that can result from euthanasia.

And it brings out a troubling question: where is the suffering of the relatives in the new equation of compassion?

Canadian Jewish News: Medical aid in dying is "madness."

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Michael Bouhadana (on right)

Dr Michael Bouhadana, who is a family practitioner and palliative and pain care consultant at the Jewish General Hospital in Montréal, as quoted in an article by Janice Arnold published in the Canadian Jewish News that at a national conference on aging, organized by the Jewish Federations of Canada, he said:

"requiring doctors to end the lives of patients who request it is “madness,” 

“A doctor’s job is to cure sometimes, relieve often, comfort always – kill never,”

Boudadana continued with his critique of the law that permits euthanasia:

No one knows how many JGH patients have undergone MAD or how many have done so elsewhere in the province, because the procedure is not being entered on death certificates as the cause, according to guidelines issued by the Collège des médecins du Québec. 

“Instead, you write the disease… This is a lie, because you provoked the death,”

Boudadana then stated that greater access to palliative care is needed:

Only 16 to 30 per cent of Canadians, depending on where they live, can get such care,

The average daily cost of keeping a patient in an acute-care hospital is $1,100. In a palliative care unit or hospice, it’s $770 and, if the care is provided at home, less than $100.

Boudadana said that in Québec, every acute-care hospital and long-term care facility is required to provide medical aid in dying, including the Jewish General Hospital. 

Forcing euthanasia in Quebec hospitals contravenes patient rights

The Québec government is now insisting that hospitals euthanize people promptly.

MONTREAL, Quebec - June 30, 2016 - PRLog - (Link to the Press Release)

Forcing euthanasia in Quebec hospitals
contravenes patient rights

The Québec government's insistence that hospitals euthanize people in Palliative care units contradicts the medical code of conduct of physicians, who have an obligation to provide the best medical care for their patients. Euthanasia does not meet the standards of best medical care for people who are at the end of life and require palliative care. Despite the Québec law and more recently the Canadian Law, no physician has an obligation to perform euthanasia or assisted suicide. The Québec law requires that the treating physician who receives a request for euthanasia and objects to administering it for personal reasons must refer the request to the medical director of the establishment. Nevertheless the Québec law and Federal law are being challenged in the Québec Superior Court. It is noteworthy that the World Medical Association advises physicians to actively refuse to abide by euthanasia or assisted suicide laws even in jurisdictions where laws have been passed.

Dr Paul Saba

Dr Paul Saba, who is contesting both the Quebec and Canadian euthanasia laws, states that euthanasia and assisted suicide are dangerous and will cause the needless loss of lives of people who may have many years to live. Palliative care is a place where only palliation must be practiced. Patients have a right to be protected and not pressured into ending their lives prematurely. The Québec government is acting recklessly and dangerously in transforming Palliative Care units into euthanasia units. Even the Québec law recognizes a distinction between Palliative care and euthanasia. People who want to live their lives to the end in dignity surrounded by loved ones deserve the respect and support offered by Palliative care units. They have the right not to live in fear of being killed prematurely by a lethal injection. Physicians also have the right to care for their patients according to the highest standards of medical care which includes palliative care but does not include euthanasia.

Dr. Saba questions the true motives of the Québec and Canadian governments. Is the pressure to euthanize due to the lack of health care for its citizens, including the lack of palliative care for those who truly are at the end of life? Is the Québec government creating a false debate in demanding faster access to euthanasia when Quebecers do not have access or prompt enough access to essential services like family physicians, cancer screening and even cancer surgery? Presently 52% of Montrealers cannot be operated within the 4 week window mandated by the government. 900 beds are being closed this summer. Is the government using euthanasia as a means of freeing up more beds? This goes against the will of Quebecers and Canadians as revealed by a recent Angus Reid Poll (April 1 2016). The poll reveals that the majority of Canadians are opposed to physician assisted suicide (PAS) and euthanasia because of lack of health care. Canadians oppose PAS because: "the cost of a patient's care is very expensive to the health care system (79%); "a person has no hope for the future and no meaning to their lives (69%); "a person has multiple health conditions and feels overwhelmed (64%); and "a person's care appears to be a burden to their family (74%)." A slim majority of 55% are in favour of PAS "because Canadians are unable to get access to medical care to treat their pain and suffering." http://angusreid.org/assisted-suicide-law/

"This reveals that Quebecers and Canadians want good health care and not euthanasia as the solution for the lack of access to medical care"- states Dr. Paul Saba, a family physician. "Many Canadians wait a long time for: physicians, specialists, screening, testing and treatments. Canadians' access to specialist and primary care is the lowest among 11 comparable countries."

Attorneys Dominique Talarico and Natalia Manole, who represent Dr. Saba in his legal challenge against euthanasia, state that "In the absence of appropriate medical care and services, it is impossible to give a free and informed consent to receive physician-assisted suicide. By not having access to the good care, a person may end his or her life prematurely."

Contact
Dr. Paul Saba M.D.
514-249-8541
514-886-3447
pauljsaba@gmail.com

Photo:
http://www.prlog.org/12569653/1

Groups opposing euthanasia warn Canadian government.

On April 11, 2016; Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, and Aubert Martin executive director of Living with Dignity Québec, held a press conference in Ottawa to warn the federal government about abuse of the law before it introduces euthanasia legislation. QMI reported on the press conference by publishing an article by Guillaume St-Pierre.

Aubert Martin & Alex Schadenberg 

The Quebec organization, Living with Dignity, warned the federal government, which is preparing to introduce a bill on medical help to die, against possible abuses. 

"After only four months since the start of the law that legalized euthanasia in Quebec, we are already witnessing the first slip," said the CEO of the organization during a press briefing in Ottawa on Monday, Aubert Martin. 

In early March, the Collège des médecins du Québec (CMQ) had to issue an opinion in which he reminded members that attempted suicide is not a refusal of treatment. 

The warning served to rein in doctors who chose not to resuscitate patients who have tried to kill themselves by poisoning when they came to the emergency. 

This example demonstrates, according to Mr Martin, that the health system needs to "relieve, not kill." 

"From the beginning the play on words, calling medical assistance to die that is actually human euthanasia," he added. 

The Trudeau government is drafting future legislation governing medical help to die for people with severe and irreversible diseases. 

Parliament has until June 6 to pass the legislation giving effect to a judgment of the Supreme Court, which invalidated sections of the Criminal Code prohibiting euthanasia. 

However, the Quebec organization to live in dignity continues to oppose any form of supervision of what he still considers to be a "homicide". 

"We're talking about a law that will allow in certain circumstances, another person to kill or help to someone to kill oneself. Instead of promoting assisted suicide, the provincial and federal governments should work to improve palliative care," insisted Mr. Martin.

We expect that the euthanasia legislation will be introduced next week.

Has euthanasia changed physician attitudes towards suicide in Québec?

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

On December 10, 2015; the province of Québec officially sanctioned euthanasia. The Québec government passed Bill 52 in June 2014 and over the next 17 months prepared their nation for doctors having the right to kill their patients.

Now we learn that some Québec physicians have been withholding life-saving treatments that could save lives with possibly no after-effects from suicide victims. In response, the Québec's College of Physicians have issued an ethics bulletin telling all physicians that there is an ethical and legal guideline to provide care even to patients seeking to end their lives.

Yves Robert, the secretary for the Québec College of Physicians told the National Post that:

an unspecified number of doctors were interpreting suicide attempts as an implicit refusal of treatment. They “refused to provide the antidote that could have saved a life. This was the real ethical issue,” 

“If there is a life-threatening situation, you have to do whatever is possible to save a life, then you treat the underlying cause.”

According to the article by Graeme Hamilton, published in the National Post, the four page ethics bulletin states:

“From a moral point of view, this duty to act to save the patient’s life, or to prevent him from living with the effects of a too-late intervention, rests on principles of doing good and not doing harm, as well as of solidarity,” 

“It would be negligent not to act.”

According to the National Post the ethics bulletin states that treatment can only be withheld when their is irrefutable proof that the patient does not want treatment. It then states:

Once stabilized, a survivor of suicide may require psychiatric treatment, the bulletin says. “Recognition of psychological suffering can allow a person who wants to kill himself to picture his life differently,”

But the Québec euthanasia law permits euthanasia for people with psychological suffering.

Is it possible that the confusion concerning the withholding of beneficial treatment is directly related to the legalization of euthanasia in Québec?

A survey of Québec doctors (April 2015) indicated that there is significant confusion concerning withholding and withdrawing treatment and an earlier survey of Québec medical specialists (October 2009) indicated that there was significant confusion concerning what constituted euthanasia and palliative care.

The fact is that the Québec euthanasia law insists that euthanasia is a medical act, which it is not, and that patients have the right to refuse treatment and autonomy. It should not shock people when Québec physicians respond to these edicts by medically abandoning suicidal patients.

Historically Québec has a very high suicide rate. In the past few years, suicide prevention programs have led to a decreased suicide rate. Let's hope that the legalization of euthanasia will not create a suicide contagion effect, leading to higher suicide rates in Québec.

Québec physicians group opposes referring patients for euthanasia.

Scientific Objection to Dr. Yves Robert’s Editorial

[“Referring the patient’s request to a health care professional who would follow through with it would then seem the ultimate compromise, respecting patient’s and physician’s rights.”][1] Dr. Yves Robert, Le Collège, November 10, 2015

Dr Robert,

The above statement that you made as Secretary of the Collège des médecins du Québec is absolutely false.

First, let’s recall this excerpt, from of the Superior Court ruling (par. 97): “The lawyer of the Attorney General of Canada also expressed her concern about article 31 of an Act respecting end-of-life care, obliging physicians who do not want to grant a request for physician-assisted dying, to participate, despite their objection, in the process of finding a willing physician. She sees in this fact itself an indication that even a physician, conscientious objector, would inevitably become involved in a process leading to the commission of a criminal act under the current state of the law”.

This summarizes without ambiguity the thoughts of the Attorney General of Canada and the Quebec Superior Court concerning your “ultimate compromise” on the subject of conscientious objection, also shared by the Collège des médecins du Québec.

This form of collaboration in killing a patient, with all due respect, is not the ultimate compromise. It is an obligation to collaborate — which can be experienced by a physician as complicity in an act he considers to be harmful to his patient, irrelevant whether the act is criminal or not (the crime evoked here only compounds the insult of the obligation).

As for me, I want to continue to offer care to my patient; not sever the relationship. I simply refuse to cause his death. What will you do against my medical judgment?

If you suspend me, you are the one severing the care relationship by depriving a patient of his physician, whereas I am willing to continue caring for him. I do not consider sending my patient to be killed as providing care because… to be killed is not a treatment, neither for me, nor for the overwhelming majority of physicians and medical associations all over the world. This then is a question of medical obligation, because I apply the international norm, while the Collège has decided unilaterally to disagree.

The issue here is much more a question of scientific objection than an objection of conscience because the purpose is to apply the international norms and standards the Collège decided to disagree with.

Given that most physicians will never agree to stop preventing suicide among their patients, we cannot compel them to stop this prevention because their medical judgement and expertise—that they have applied for years—tells them not to do it. Simply put, preventing suicide remains good medicine.

Likewise, a hospital director cannot force me to perform surgery on my patient if my medical opinion tells me the surgery would be harmful. It does not mean that I sever the professional relationship with my patient, only that I exercise my profession with my judgement and my competence, which means to say that I am not a simple technician who will only serve to be “someone else’s hands.”

In the same way, no patient can force me to perform surgery that I consider bad or harmful, and it is understood that the minimum degree of professional consistency would prevent me from referring him to someone who would perform it in my place. I would simply tell him that it is not recommended, and he would be free to go elsewhere. If however, I were to transfer him to a colleague or health care professional knowing that the procedure I consider harmful will be conducted, it would be as though I performed it through the hands of another.

The Collège needs to recognize this logical response from physicians (palliative and other) who do not want to collaborate in paving the way toward the medically assisted death of their patients. These physicians, who are neither fanatical nor arrogant, see this intention of the state (and of the Collège) to impose on them a forced collaboration like an abuse of authority. The use of the term “ultimate compromise,” in this context, sounds a lot like “this is my final offer.” That, would sooner be called an ultimatum—and the Attorney General of Canada did well to note the real intention behind the words.

In conclusion, if the Collège hopes to avoid unjust and unnecessary confrontation with qualified and attentive physicians of integrity, it should find a way not to compel them to assist in the death of their patients against their medical judgement and their professional conscience.

Even if the new exception measures (not to read “rule”) that will soon be established in the Canadian Criminal Code allows for euthanasia or assisted suicide under certain conditions, you must remember that forcing physicians to refer—moreover to threaten them—is a sure-fire way to cause unnecessary and damaging battles for all, to cause division and spoil the collegial environment in our hospitals.

If, one day, euthanasia or assisted suicide are decriminalized, a true compromise—one that would respect everyone’s autonomy — would be something like this: let patients carry out their own wishes by putting a voluntary system in place, forcing no participants to act against their will—neither their doctors nor anyone else involved.

Marc Beauchamp, MD, FRCSC, orthopedic surgeon, Montreal


With the support of the undersigned: