Queensland Australia report approves euthanasia with a condition that will cause death some day

Published by the Australian Care Alliance on April 1, 2020.

Queensland Australia Parliament

Legalising euthanasia for any Queensland adult with a medical condition that two doctors or nurses think “will cause death” someday has been recommended by a parliamentary committee.

The Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee of the Queensland Parliament has, in a report tabled on 31 March 2020, recommended that:

“the Queensland Government use the well-considered draft legislation submitted to the inquiry by Professors Lindy Willmott and Ben White as the basis for a legislative scheme for voluntary assisted dying.”

That draft legislation would legalise euthanasia and assisted suicide for any person over 18 years of age, with “an incurable, advanced and progressive medical condition that” two doctors say “will cause death”.

The Committee recommended also allowing two registered nurses to make the eligibility assessment and one of the nurses to administer the lethal poison to kill the person.

Unlike the Victorian or Western Australian laws the draft legislation would require a registered medical practitioner to be present if the prescribed lethal substance is self-administered.

There would, however, be no requirement for the medical practitioner (or nurse) to remain with the person after the lethal poison is administered either by the person or by the medical practitioner or nurse.

Interestingly, Willmott and White note:

Given that where choice is available, practitioner administration [i.e. euthanasia] is overwhelmingly chosen, these disadvantages [the inconvenience of requiring a medical practitioner to be present] are only likely to arise in the small number of voluntary assisted dying cases where a person specifically wants to self-administer [assisted suicide].

Section 10 of the draft legislation makes it clear that whether a person’s medical condition will cause the person’s death is to be determined by reference to available medical treatment that is acceptable to the person. This means, for example, that any insulin dependent diabetic would qualify simply by deciding no longer to take insulin.

The section also makes it clear that the suffering element is purely subjective and could be limited to existential suffering (such as feeling like a burden on others).

The draft legislation would require a medical practitioner with a conscientious objection to euthanasia to refer the person to a medical practitioner willing to perform it.

Like the laws in Victoria and Western Australia, the draft legislation would allow both an initial and final request for euthanasia to be made by a gesture.

Rejecting evidence presented by the Australian Care Alliance (see p. 22-24) about suicide contagion where assisted suicide has been legalised the Committee claims that:

temporary suicidal ideation is quite distinct from an enduring, considered and rational decision to end one’s life in the face of unbearable suffering. Given this distinction, the committee considers that a decision to legislate for the introduction of voluntary assisted dying [euthanasia and assisted suicide] is not inconsistent with suicide prevention campaigns and messaging.

The Committee does recommend adding a provision to the draft legislation that only the person may instigate a discussion about euthanasia or assisted suicide.

The Committee suggests that further consideration be given as to whether euthanasia by advanced directive should also be allowed.

The Greens member of the Committee, Mr Michael Berkman, favours the use of advanced directives as well as allowing children to request euthanasia.

The two LNP members of the Committee rejected the key recommendation:

This recommendation is not supported with any written assessment of the document. As the Report does not show the Committee undertook a detailed analysis it is very difficult to conclude that the “draft legislation” is “well considered.” There is also no evidence in the Report that the Bill was disseminated to stakeholders nor detailed evidence taken from them including professional bodies as to whether or not the Bill should be put forward as “draft legislation”. This is a fundamental breach of any Committee’s obligation. If it is to recommend a Bill, then the Report should and must provide a rigorous assessment undertaken with all stakeholders.

It seems unlikely that any Bill would be introduced before the Queensland State election which is due on 31 October 2020.

The Premier's office has said that Premier Annastacia Palaszczuk's focus was "100 per cent on the state's response to COVID-19".

Another Australian state on the verge of legalising euthanasia

This article was published by Mercatornet on December 6, 2019.

By Richard Egan

At 4:11pm on Thursday, 5 December 2019, the Voluntary Assisted Dying Bill 2019 passed its third reading vote in the Legislative Council of the Parliament of Western Australia by a decisive vote of 24 to 11.

Only one member changed her vote between the second and third readings: Labor MP Adele Farina.

Adele Farina MP

In her speech explaining her vote Ms Farina highlighted the defeat of a series of amendments designed to address the inherent problems with a law permitting the prescription of a lethal substance for a person to keep at home for self-administration at some later time.

These problems, as identified in Ms Farina’s speech, and during the consideration in detail, include:

• The experimental nature of the lethal substances which could be any Schedule 4 or Schedule 8 poison or combination of these poisons with no scientific assessment of their efficacy or of adverse side effects;
• The reported rate of complications from other jurisdictions of between 5 percent and 17 percent, including regurgitation, seizures, failure to be fully unconscious before asphyxiation or heart attack occurs, lengthy time from ingestion to death, and failure to die; 
• The lack of any requirement for a health practitioner or, indeed any witness, to be present at the time the poison is taken; 
• No system for reporting adverse outcomes even if a medical practitioner or other witness is present; 
• No assessment of the decision-making capacity of the person after the lethal poison is issued (even though it may be kept for months or even years); 
• No way of ensuring that the person is taking the lethal poison voluntarily – the person could be tricked, cajoled or even forced into ingesting it. 

Ms Farina also spoke about the pressure put on her to support the government’s position on the Bill. To her credit she resisted this pressure and voted according to her conscience.

Greens MP Alison Xamon expressed significant concerns with the Bill but was bound by Greens Party policy to support it. She said “I also remain concerned that the safeguards are insufficient. However, with all my heart I hope that my concerns are proven to be without foundation because it will weigh very heavily on my conscience if my concerns ever come to fruition.”

The Minister for the Environment and for Disability Services, Stephen Dawson, who had the carriage of the Bill in the Legislative Council, reported that it had taken 78 hours and 43 minutes to “consider and debate the 184 clauses contained in the bill”. This equates to just 25 minutes and 40 seconds per clause.

This detailed consideration did result in the passage of 55 amendments (25 moved by Nick Goiran, the leading opponent of the Bill; 18 by the government; 4 by Adele Farina and 8 by three other members), which, contrary to the characterisation of euthanasia lobby Go Gently as “mainly grammatical”, dealt with substantial matters. These included:

• Prohibiting a healthcare worker, other than a medical practitioner during a medical consultation, from initiating a discussion on euthanasia or assisted suicide with a person;
• Requiring a medical practitioner who initiates such a discussion to also discuss treatment options and palliative care; 
• Ensuring that medical or nurse practitioners involved in the process are not beneficiaries under the person’s will; and 
• In the case of euthanasia (ie, practitioner administration of a lethal poison) requiring the practitioner to report adverse events; 

However, many important amendments were defeated – in some cases by just one vote. These included:

• Requiring at least one of the medical practitioners involved to have some specialist qualifications or experience in the relevant condition;
• Ensuring equal access for Western Australians in rural areas to palliative care (as well as equal access to euthanasia and assisted suicide which the Bill guarantees) – defeated by one vote with Nationals voting against the amendment; and 
• Involving a psychiatrist or other relevant expert in assessment of decision making capacity; 

Hon Nick Goiran MP

In his third reading speech the Hon Nick Goiran summed up his reasons for opposing the Bill:

The desire of a significant proportion of confident people for ready access to lethal injections ought never override the rights of the quiet vulnerable to safety and protection.

Secondly, if we are intellectually honest and reason through the theory of a euthanasia regime, we should conclude that it is inherently unsafe. The insufficiency of the criminal justice safeguards informs us of this; the prevalence of medical negligence informs us of this; the ease of doctor shopping informs us of this; the reality of doctor bias informs us of this; and the evidence of elder abuse informs us of this.

When we engage with the lived experience of the very few jurisdictions that have legalised euthanasia or assisted suicide, we know that the theory of an inherently unsafe regime has resulted in casualties of wrongful deaths.

Ultimately, there is another way; there is a better way. There is a safe approach to end-of-life choices. However, it will require all of us to persistently insist that quality palliative care is made available to every Western Australian.

The Bill now returns to the Legislative Assembly where the 55 amendments made to it will be considered on Tuesday.

The government has repeatedly stated that it will be at least 18 months before the Bill comes into effect. As Ms Farina stated in her speech “We were told on no less than 77 occasions that [problems identified in the debate] will be sorted during the 18-month implementation phase.”

Western Australia will become the 18th jurisdiction in the world to enact a fatally flawed scheme for the State-sanctioned, extra judicial termination of the lives of its citizens by euthanasia and/or assisted suicide.

Richard Egan is a researcher who has studied euthanasia and assisted suicide laws for 35 years and is the author of Seventeen Fatally Flawed Experiments in Assisted Suicide and Euthanasia and Twelve Categories of Wrongful Death from Assisted Suicide and Euthanasia

Euthanasia for hip fractures in Québec

This article was published by the Australia Care Alliance on November 9, 2019.

Three people were euthanased in Quebec between April 2018 and March 2019 for a hip fracture. This is just one of the warnings about where legalisation of euthanasia leads that can be drawn from the latest report on euthanasia in Quebec.

* Québec - 1331 reported euthanasia deaths (April 1, 2018 - March 31, 2019) At least 13 deaths did not comply with the law.

Euthanasia in that Canadian province now accounts for nearly one out of fifty deaths (1.9%) with significantly higher rates in some health regions including the capital (3.38%) and Bas-Saint-Laurent (3.45%).

Although Canadian law requires "at least 10 clear days between the day on which the request was signed by the person and the day on which" euthanasia is provided unless "the person’s death, or the loss of their capacity to provide informed consent, is imminent" and the Quebec law requires the physician to verify “the persistence of suffering and that the wish to obtain" euthanasia "remains unchanged, by talking with the patient at reasonably spaced intervals given the progress of the patient’s condition" in a massive 40% of cases euthanasia was performed less than 10 days after a request was first made.

Canada euthanasia - The numbers game.

This article was published by Paul Schratz on his blog on May 17, 2019.

By Paul Schratz is editor of the BC Catholic

I’m indebted to Alex Schadenberg at Canada’s Euthanasia Prevention Coalition for this week’s column, since he not only did all the research but a fair chunk of the number crunching.

You may or may not know that it’s been frustratingly difficult to obtain information on euthanasia and assisted suicide since Canada legalized “medical assistance in dying” in June 2016. Trying to find out how many people are euthanized or “assisted” in dying is like trying to estimate how many traffic jams take place each day in Vancouver. It’s not at the top of anyone’s list of things to do.

News organizations have no interest in knowing how many Canadians are dying by assisted suicide. I wrote in March that the most recent data we had was from 2017 and it was still unclear how many people were legally killed in 2018.

So slow was the federal government in releasing data that the Euthanasia Prevention Coalition requested “Medical Aid in Dying” data from every province. Most of them refused to provide it.

So the EPC did its own investigative research. Based on a presentation for the Royal Society of Canada by Jocelyn Downie, an academic euthanasia activist, the EPC reported 4,235 “Medical Aid in Dying” euthanasia deaths in 2018, an increase of 50 per cent over 2017 and representing approximately 1.5 per cent of all deaths in Canada.

Schadenberg also examined data from Ontario and Alberta indicating a 78 per cent increase in Ontario euthanasia deaths and a 50 per cent increase in Alberta.

Finally, at the end of April, Health Canada released the Fourth Interim Report on Medical Assistance in Dying, which stated there were 2,614 assisted deaths in 2018.

Unfortunately, the data was short by two months (it only reported up to Oct. 31, 2018) and didn’t include four jurisdictions (Quebec and the three territories.) Based on that limited information, the report drew the conclusion that assisted deaths represented 1.12 per cent of all deaths in Canada.

Now it turns out Health Canada not only gave us inaccurate numbers, its analysis of them was wrong.

The Canadian data came under scrutiny by Richard Egan, a researcher with Australian Care Alliance, who said the report’s calculation of the percentage of deaths by euthanasia as 1.12 per cent was wrong and should have been quite a bit higher.

Egan explains: Health Canada used data for the total number of deaths in Canada, but only counted assisted suicide deaths in the jurisdictions it had data on … which excluded Quebec and the territories. An accurate percentage of deaths by euthanasia based only on reporting provinces is actually 1.47 per cent. That may not seem like much of a difference, but it’s a 30-per-cent error rate and represents hundreds of more dead people.

That figure also more closely matches the data reported by Jocelyn Downie, whose numbers put the euthanasia rate at 1.5 per cent.

Egan published further research on the data in an article published by Australian Care Alliance.

Among the provinces, euthanasia deaths as a percentage of all deaths varies widely, with British Columbia at 2.37 per cent of all deaths and as high as 3.6 per cent on Vancouver Island. That’s nearly three times as deadly as Saskatchewan (0.84 per cent of all deaths). But “Health Canada does not appear overly concerned about the quality of the Medical Aid in Dying report,” says Schadenberg.

And when some of its data is so wrong and outdated, how can we trust government to get its response – comprehensive palliative care – correct?

Euthanasia drops by 7% in the Netherlands in 2018.

By Richard Egan, researcher with the Australian Care Alliance  

The latest annual report on euthanasia and assisted suicide from the Netherlands shows that in 2018 the number of reported deaths by euthanasia decreased – for the first time since legalisation - to 6126 (a 7% decrease from 6585 cases in 2017).

Dutch deaths by euthanasia for 2018 include nine couples euthanased together; two persons with advanced dementia based on an advanced request; 205 elderly people with two or more problems of old age; 67 people with mental illness, including 10 aged between 18 and 40 years; and three children aged between 12 and 17.
 
This represents 4% of all deaths in the Netherlands in 2018.

• 2018 euthanasia deaths are lower. We are concerned about euthanasia for "completed life".

This data relates only to officially reported cases of euthanasia and assisted suicide. A more comprehensive picture is provided by the five yearly surveys by Statistics Netherlands on all deaths by “medical end-of-life decision”. The latest data reports on all deaths in the Netherlands in 2015.

In that year there were 7254 deaths caused intentionally by lethal medication – 6672 deaths by euthanasia with a request; 431 deaths by euthanasia with no explicit request; and 150 deaths by assisted suicide.

This represents nearly 1 in 20 (4.93%) of all deaths in the Netherlands.

More than 1 in 10 (10.5%) of all deaths (other than sudden and expected deaths) of 17-65 year olds in the Netherlands in 2015 were caused intentionally by euthanasia or assisted suicide.

For assisted suicide in the Netherlands the doctor is required to be present until death occurs. Attempts at assisted suicide regularly fail to bring about death in the desired timeframe. In these cases, under the Netherlands protocols, the doctor then administers euthanasia drugs. This occurred in between 7% and 13% of cases of assisted suicide in the years 2014 to 2018.

There were 67 cases in 2018 of euthanasia for psychiatric conditions, ten of these cases involved persons aged between 18 and 40 years.
 

There were 205 cases of euthanasia in 2018 for “a stack of old age disorders” such as vision, hearing disorders, osteoporosis, osteoarthritis, balance problems and cognitive decline. Of these cases 66 involved persons under 90 years of age. The remaining 139 cases accounted for 27.15% of all cases of euthanasia of persons aged 90 years or more.

A further three minors were euthanased bringing the total to fifteen children aged between 12 and 17 years euthanased between 2005 and 2018.

In 2018 nine couples were euthanased together. Case reports are available for one of these couples. The husband had oesophageal cancer. The wife had multiple sclerosis. Her reason for requesting euthanasia at the same time as her husband was “the prospect of having to be cared for entirely by strangers and unable to continue living independently”. While the case reports note that “In the event that partners make a request for euthanasia at the same time, it must be established that the request of one partner has not been influenced or has been prompted by that of the other partner” there is no discussion in the case report on the wife of any efforts being made to explore her fears of being cared for by others.

For a detailed report on seventeen years of legalised euthanasia in the Netherlands read here.

Health Canada publishes inaccurate and incomplete data on euthanasia in Canada.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

On March 21, I reported that there were 4235 "Medical Aid in Dying" euthanasia deaths in 2018, an increase of 50% over 2017, representing approximately 1.5% of all deaths. The data for my report was obtained from a presentation by Jocelyn Downie, an academic euthanasia activist, for the March 15th Royal Society of Canada luncheon in Ottawa.

I have also reported the provincial data from Ontario and Alberta. The 2018 Ontario data indicated a 78% increase in euthanasia deaths while the 2018 Alberta data indicated a 50% increase. Further to that, last week I published an another article concerning the number of euthanasia deaths in Ontario and Alberta in 2019 (Link to the article).

On April 25, Health Canada released the Fourth Interim Report on Medical Assistance in Dying which stated that there were 2614 assisted deaths between January 1 - October 31, 2018. The report indicated that the data was incomplete for Quebec and the three Territories. The report incorrectly stated that assisted deaths represented 1.12% of all deaths in Canada. (Link to the report).

Richard Egan, a researcher with Australian Care Alliance indicated that The Fourth interim Canadian report has wrongly calculated the percentage of deaths by euthanasia as 1.12% when it is actually 1.46%. Egan explains:

Using Statistics Canada’s available data for deaths per month in 2017 and projecting a 2% average annual increase in overall deaths (based on data trends from 2013 to 2017), we estimate that for the first 10 months of 2018, MAID has accounted for approximately 1.12% of the estimated total deaths in Canada during this reporting period.

The data source they refer to is at: (Link).

It gives a total of 276,689 deaths for all of Canada for 2017. Deducting the deaths for November 2017 (23,133) and December 2017 (25,141) gives a total of 228,415 for the 10 months Jan-Oct 2017. Applying the 2% increase the report suggests gives a presumed 232,983 deaths for all of Canada for the 10 months Jan-Oct 2018.

Health Canada does not appear overly concerned about the quality of the Medical Aid in Dying report. Basing percentages on an estimated, two percent increase in deaths is unacceptable. The data concerning the number of 2018 deaths in Canada does exist. Egan continues:

The report gives a total of 2,614 deaths by euthanasia for the same period Jan-Oct 2018 for Canada excluding Quebec. (And the NWT, Yukon and Nunavut for which there is also no data for 2017 deaths in the Statistics Canada death by months report.)

The report appears to have divided 2,614 into 232,983 to get 1.12%. However the correct calculation should use as its denominator the presumed number of deaths for Jan-Oct 2018 for Canada excluding Quebec.

There were 53,612 deaths in Quebec from Jan-Oct 2017. Subtracting these from the total for Canada of 228,415 for the 10 months Jan-Oct 2017 gives 174,803. Applying a 2% increase gives 178,299 presumed deaths in Canada other than Quebec from Jan-Oct 2018.

Dividing 2614 into 178,299 gives a percentage of deaths by euthanasia of all deaths in Canada excluding Quebec of 1.47%.

This more closely matches the data reported by Jocelyn Downie. She reports 4235 deaths by euthanasia for all of Canada (including Quebec) in 2018. The presumed number of deaths in all Canada in 2018 using the expected increase of 2% from 2017 data would be 282,222. 4235/282,222 = 1.5%.

Egan then published further research on the data and published the following information in an article published by Australian Care Alliance:

Euthanasia deaths as a percentage of all deaths varies by province with British Columbia (2.37% of all deaths) nearly three times as deadly as Saskatchewan (0.84% of all deaths).

Other provincial rates are: Quebec 1.54% [Jan-Mar 2018]; Ontario 1.39%; Manitoba 1.25%; Alberta 1.18% and the Atlantic provinces (Newfoundland & Labrador, Prince Edward Island, Nova Scotia, New Brunswick) 0.98%.

One fact the fourth interim report did get right is what is really involved in what the Canadians euphemistically call MAID - medical assistance in dying:MAID is "an exception to the criminal laws that prohibit the intentional termination of a person’s life."

MAID includes both euthanasia and assisted suicide. As of October 2018 there have only been six cases of assisted suicide under the Canadian law compared to 6743 cases of euthanasia.

This preference for euthanasia over assisted suicide has implications for Victoria (Australia) where both assisted suicide and euthanasia will be legal from 19 June 2019. While euthanasia is only permitted when a person is unable to physically self-administer or to digest the prescribed lethal substance this only requires one doctor to submit a form [Regulation 8 (b)] to the Secretary for Health making this assertion.

The Euthanasia Prevention Coalition requested "Medical Aid in Dying" euthanasia data from every Province since the Federal government has been deliberately slow in releasing data. Most of the Provinces have refused to provide the data. Further to that, Richard Egan's analysis, shows how the Health Canada report is inaccurate and incomplete.

Canadian woman seeks euthanasia from pelvic mesh pain

Published by the Australian Care Alliance on January 11, 2019.

A Canadian study that tracked more than 57,000 women has found patients with complications after pelvic mesh implants are at increased risk of depression, self-harm – even suicide.

The study published in the journal JAMA tracked more than 57,000 women in Ontario who had complications like pain and infections after receiving the polypropylene implants used to treat incontinence. The study found that:

• Of those referred for mesh removal surgery, 11 per cent were treated for depression
• Meanwhile, 2.7 per cent suffered from self-harm/suicidal behavior, almost double the rate in the control group

One woman from British Columbia, who asked not to be identified, has told CTV News that after being in agony for many months and unable to find a doctor willing to remove her implant she has “filled out paperwork for assisted dying due to the agonizing pain of mesh and the fact that I have no medical care regarding mesh.”

This story illustrates two important points.

Firstly, "assisted dying" - in the Canadian context this means euthanasia - is simply another form of suicide. This woman is seeking euthanasia for the same reason as other depressed women dealing with pain from pelvic mesh are committing suicide.

Secondly, euthanasia or assisted suicide can easily become the go-to solution when the health system fails a class of patients - in this case a failure to respond quickly by providing removal of pelvic mesh from women suffering from its adverse effects.

Canada: Recent History of Euthanasia Legalisation

By Richard Egan (with the Australian Care Alliance)

On 21 April 2010 the Canadian House of Commons defeated Bill C-384 An Act to amend the Criminal Code (right to die with dignity) by 228-59.

The Quebec National Assembly passed an “An Act respecting end-of-life care” by a vote of 94-22. It came into effect on 10 December 2015. This Act permits euthanasia on the request of an adult who is “at the end of life; with a serious and incurable illness; and in an advanced state of irreversible decline in capability”.

On 6 February 2015 the Supreme Court of Canada in Carter v Canada (Attorney General) declared that provisions in the Canadian Criminal Code making it an offence to aid or abet suicide “unjustifiably infringe” section 7 [“Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.”] of the Charter of Rights and Freedoms “and are of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” The declaration was suspended for a year, giving the opportunity for the Parliament to amend the offending laws by providing a scheme for physician assisted suicide.

The core paragraph in the judgement reads that: “The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable. The rights to liberty and security of the person, which deal with concerns about autonomy and quality of life, are also engaged. An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.”

The argument based on the right to life is specious as it takes no account of the inevitability that a law permitting euthanasia will result in wrongful deaths based on medical errors, coercion, discrimination against or differential treatment of the disabled and mentally ill and suicide contagion.

The argument from liberty, if pressed to its logical conclusion, would require a law permitting assisted suicide or euthanasia on request by any person, including a minor, with capacity.

The argument from security is based on a false claim that pain and other physical symptoms cannot be relieved by best practice palliative care.

In response to the Supreme Court judgment, the Canadian parliament passed Bill C-14 which came into effect on 17 June 2016 and legalised euthanasia and assisted suicide on request for any adult who has “a serious and incurable illness, disease or disability”; is in “an advanced state of irreversible decline in capability”; and whose “natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining”.

Increase in numbers

There have been three interim reports providing national data on euthanasia as well as reports on the data from Quebec, the most recent of which covers 1 July 2017 to 31 March 2018.

First report.

Comparing the data for the three six month periods covered by the national data reports - 17 June 2016-31 December 2016; 1 January 2017-30 June 2017 and 1 July 2017-31 December 2017 – the number of deaths by euthanasia almost doubled (189%) between the first and third six month periods from 805 to 1525 increasing from 0.6% of all deaths in Canada to 1.07% of all deaths.

Similarly the data for Quebec shows that official reports of euthanasia almost doubled from an average of 46 per month for the six month period 1 July 2016-31 December 2016 to an average of 90 per month for the three month period 1 January 2018-31 March 2018.

Reported acts of euthanasia in Quebec accounted for 1.18% of all deaths in 2017.

Unreported cases

There is a discrepancy of 171 cases of euthanasia between the number of official reports received (1493) and the number of cases reported by institutions (1664) in Quebec suggesting a failure by physicians to report in 10.3% of euthanasia cases.

Failure to comply with the legal processes

Quebec euthanasia

Six per cent of all forms reporting euthanasia in Quebec are received late and 42% off all forms received have insufficient information and require follow up requests.

Even after repeated requests for further information there is insufficient information to conclude whether or not the act of euthanasia complies with the law in 5% of cases.

In a further 5% of cases (62 cases out of 1374 for which a final assessment has been made) there was a failure to comply with the law, including:

• 29 cases in which the consulting physician was not independent from the physician who carried out euthanasia. However, this has been addressed by officially slackening the interpretation of the requirements for independence! 
• 9 cases in which the physician who performed euthanasia did not ensure that the request for euthanasia was voluntary, informed and persistent  
• 6 cases in which the consulting physician examined the person before a request for euthanasia was formally made
•  5 cases in which the approval was countersigned by an unqualified person  
• 5 cases in which the person did not have a serious and incurable illness  
• 4 cases in which the person did not have the required Quebec health insurance  
• 2 cases in which the person was not at the end of life  
• 2 cases in which the physician failed to verify that all the conditions for euthanasia were met.
  

In summary of these 62 cases at least 23 could be characterised as possible wrongful deaths.

Underlying conditions

Very limited data is provided on the underlying condition for which euthanasia is performed. In the last reporting period 9% of cases involved either an unreported condition or a condition other than cancer related, neurodegenerative or circulatory/respiratory system.

Some of the “other” conditions have included osteoarthritis, rheumatoid arthritis and “age-related frailty”.

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

Additionally there are the 5 cases from Quebec in which the person did not have a serious and incurable illness and the 2 cases from Quebec in which the person was not at the end of life.

Short time between initial request and euthanasia being performed

Section 29 (c) of the Quebec law requires that before performing euthanasia the physician must verify “the persistence of suffering and that the wish to obtain medical aid in dying remains unchanged, by talking with the patient at reasonably spaced intervals given the progress of the patient’s condition”.

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

Nonetheless according to a recent study of euthanasia at three institutions in Quebec the median number of days between the request for euthanasia and the patient’s death was just 6 days.

This study also found that in 32% of cases a palliative care consultation only took place less than 7 days before euthanasia was requested and in a further 25% of cases it took place on the same day or AFTER euthanasia was requested. This suggests that euthanasia is being routinely provided to people before they have had a chance to experience the full effect of palliative care to relieve their suffering and concerns.

Reasons for requesting euthanasia

A study from an Ontario hospital reported that those who received euthanasia tended to be white and relatively affluent and 95% of them indicated that loss of autonomy was the primary reason for their request. Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life. Few patients cited inadequate control of pain or other symptoms.

Disability – the story of Candice Lewis

Candice Lewis with her mother.

Candice Lewis is a 25 year old Canadian woman who happens to have been born with cerebral palsy.

In September 2016 Candice went to the emergency room at Charles S. Curtis Memorial Hospital in St. Anthony after having seizures.

Dr. Aaron Heroux told her she was very sick and likely to die soon. He offered her assisted suicide. The doctor also proposed assisted suicide for Candice to her mother Sheila Elson.

This offer was repeated despite both Candice and her mother making it clear that this was not an option Candice would consider. Dr Heroux told Sheila she was being selfish by not encouraging her daughter to choose assisted suicide.

Candice describes how bad it made her feel that a doctor was offering her assisted suicide.

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

Candice and her mother Sheila have been interviewed by Kevin Dunn, who produced a film on euthanasia and assisted suicide called Fatal Flaws. The film of the interview can be viewed here.

There are several take home lessons from Candice’s experience:

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

Roger Foley

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