Canada’s euthanasia legislation: From the perspective of a Canadian with disabilities

The following article was published by Ottawa Life Magazine on July 23.

Peter McGrath, a Counsel in the Department of Justice, gives
his opinion from the perspective of a Canadian with a disability.

By Peter McGrath

On Feb. 6, 2015, the Supreme Court of Canada struck down Canada’s assisted suicide law, opening the door to physician-assisted suicide. This is an incredibly complex topic, one fraught with moral and ethical issues. Peter McGrath, a Counsel in the Department of Justice, gives his opinion from the perspective of a Canadian with a disability:

There are valid points to both sides of the debate on Canada’s euthanasia legislation. Steven Fletcher — a Member of Parliament from Winnipeg with a disability — is the most visible proponent of physician-assisted suicide in Canada. Some would argue his position has merit. Many people with disabilities live in fear of not being able to control the end of their lives. Poorly funded palliative care combined with the possible inability to make one’s wishes clear has led to many people living painful lives.

The occasional media horror story has magnified those fears tenfold. But isn’t the answer to fix the system, rather to provide people with a lethal end? Isn’t the answer to think beyond causing death and provide all of us — including people with disabilities — with dignified lives?

People with disabilities live far from inclusive lives in Canadian society. With low levels of education and employment, inadequate housing and transportation services, and even a medical system that is not designed to handle our needs, people with disabilities have a long way to go to be considered equal members of our society.

The new euthanasia legislation is intended to provide some level of control over ending our lives, yet it’s sad that we’ve achieved equality in death before we’ve achieved equality in life. In Canada, like much of the world, people with disabilities do not have sufficient access to education, transportation, housing, medical care, employment, or recreation and leisure activities.

First and foremost, what Canadians with disabilities seek is an end to inequality and an end to the lack of access to the basic quality of life enjoyed by average Canadians.

The positioning of people with disabilities in euthanasia legislation is somewhat off-putting. It is as if to say we define people with disabilities as suffering, and now they can have the option to end their life. People with disabilities are as much or more interested in their rights to life, because being disabled means living with a disability; it doesn’t necessarily mean dying with a disease.

All too frequently, people with disabilities can recount a time when a well-intended medical professional said to their parents that the disabled life of this baby or injured child would be one of suffering and perhaps not worth living. In effect, we have provided those children with disabilities the means to die before they have the means to live.

Physically and/or developmentally Canadians with disabilities remain a marginalized segment of Canadian society. Our interests lie far more in rights to leading productive lives of equality, rather than achievement in ending of life options.

• Catherine Frazee: There can be dignity in all states of life.

Assisted suicide ruling warps the perception of people with disabilities

This article was published in the Ottawa Citizen on February 6, 2015. Taylor Hyatt was a spokesperson for the Euthanasia Prevention Coalition at the Supreme Court on February 6.

Taylor Hyatt

By Elizabeth Payne - Ottawa Citizen.

 

Link to the video interview with Taylor Hyatt.

Carleton University student Taylor Hyatt has long looked up to Manitoba MP Steven Fletcher.

“Young people with disabilities have fewer role models to show them that they can dream, they can aspire to many of the same things as people without disabilities,” she says.

But when student and role model met briefly last October at the Supreme Court of Canada, where arguments were being heard in advance of Friday’s landmark ruling on assisted suicide, they found themselves on either side of a sharp ideological divide. Fletcher, a quadriplegic, is among the highest-profile Canadian supporters of physician-assisted death; Hyatt, who has cerebral palsy and relies on a wheelchair, opposes it and finds Fletcher’s position “shocking.”

On Friday, a shaken Hyatt called the Supreme Court of Canada’s ruling allowing doctor-assisted death both disappointing and worrisome, especially for its inclusion of “disability” among “grievous and irremediable” medical conditions that might be included in physician-assisted suicides. The court did not limit physician-assisted suicide to people whose condition is terminal, but instead referred to “a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual.”

Hyatt said she was expecting the ruling would be strictly for people with terminal conditions.

“Instead, people with disabilities were mentioned and this means that anyone who feels that they are suffering in their current condition could request help ending their life, and that includes me.”

Hyatt says she believes the ruling will change Canadian society. 

“This ruling warps the perception of people with disabilities. It paints it as very negative and hopeless and I would like to know why people are being invited to end their lives rather than being given resources they need to truly live and thrive.”

Bill S-225 isn’t good

This article was published on December 11, 2014 on the Living with Dignity blog.

Bill S-225 was recently introduced in the Senate of Canada. This bill aims to legalize euthanasia and assisted suicide. It would do this by amending sections 14 and 251 of the Criminal Code of Canada. We oppose the legalization of euthanasia and physician assisted suicide because they are not needed. Efforts should go towards improving proper access to pain and symptom management to everyone who needs it. Efforts should also go towards improving suicide prevention and appropriate access to services for people with disabilities.

It is important that we all speak to our Senators to ask them to vote NO and reject Bill S-225.

Senate Bill S-225 is based on MP Stephen Fletcher's own bills in the House of Commons (C-581 and C-582). While neither C-581 nor C-582 is likely to be reach First reading in the House, Bill S-225 will be debated in the Senate early in 2015. The language on the bill is open to interpretation and opens the door for abuse. Safeguards don't protect people from abuse of euthanasia or physician assisted laws, but this bill is particularly bad news.

It would be easy, although erroneous, to think the so-called safeguards in the bill are solid. A closer look and analysis show significant problems.

Some of significant problems with Bill S-225

A critique of Canadian Senate Bill S - 225 - An Act to Amend the Criminal Code (physician-assisted death)

By Alex Schadenberg, 

Executive Director - Euthanasia Prevention Coalition

Alex Schadenberg

Senate Bill S - 225 is designed to legalize euthanasia and assisted suicide by amending Section 14 and Section 251 of the Criminal Code of Canada.

The Euthanasia Prevention Coalition (EPC) opposes the legalization of euthanasia and assisted suicide for several reasons including the fact that legalizing physician-assisted death gives physicians, in law, the ultimate power to cause or assist the death of their patients. When abused, the result is the death of a vulnerable Canadian.

EPC supports measures to improve: disability rights, pain and symptom management and suicide prevention.

The bill was originally written by Stephen Fletcher MP for his own potential death, and thus it is written for a person who is not terminally ill, who requires a wide application for euthanasia and assisted suicide.

• The bill specifically allows euthanasia and assisted suicide for people with disabilities. 
• The bill is not limited to terminal illness. 
• The bill allows euthanasia or assisted suicide for "psychological suffering," which is not defined.
• The bill requires physicians to self report the death after it has occurred. This assumes that physicians will self-report abuse of the law and it does not provide protection for the patient. 

Bill S-225 is particularly concerning because it specifically focuses on intentionally causing the death of people with disabilities who already lack equality and acceptance within Canadian culture.

Our concerns related to the conditions in Bill S-225 are:

Section 3(a) be eighteen years of age or more;

• This is only a temporary “safeguard.” It will be considered a form of discrimination to deny assisted death to someone because of their age if the person claims to be physically or psychologically suffering. 

Section 3(c) have been diagnosed by a physician as having an illness, a disease or a disability, including a disability arising from traumatic injury,

• The language in this section will be widely interpreted. Many people have an illness, a disease or a disability. The UN Convention on the Rights of Persons with Disabilities recognizes that disability is an evolving concept. 

Section 3(c)(i) that causes the person physical or psychological suffering that is intolerable to that person and that cannot be alleviated by any medical treatment acceptable to that person,

• This section provides uncontrollable access to euthanasia and assisted suicide. Physical or psychological suffering that is intolerable to that person and cannot be alleviated by any medical treatment acceptable to that person is completely subjective. This section offers no objective reasons for a physician to say no to a lethal injection.
• The term psychological suffering was interpreted in the Netherlands to enable a 63-year-old healthy man who had worked all of his life, who never married, to die by euthanasia because he was retiring, depressed and lonely.
• The term psychological suffering was interpreted in Belgium to enable a healthy 70-year-old woman to die by euthanasia because she became very depressed after a long-term relationship ended.
• Psychological suffering is not defined and no “safeguard” can protect people from the abuse that may occur and from the expansion of the law that will occur, as is the case in the Netherlands and Belgium.

Section 3(c)(ii) that results in the person being in a state of weakened capacities with no chance of improvement;

• This section is so wide that you can drive a hearse through it. What does it mean to be in a state of weakened capacities with no chance of improvement? Many people with disabilities and other frail people fulfill this criteria.

Section 3(d) be of sound mind and capable of fully understanding the information provided to him or her under subsection (6)

• a study from the Journal Clinical Oncology (September 20, 2005) found that people in the Netherlands experiencing feelings of depression were 4.1 times more likely to request euthanasia. The study found that depression is a primary risk factor for requests for euthanasia.

Section 3(e) be acting voluntarily, free from coercion or undue influence.

• Elder abuse and the abuse of other vulnerable persons are growing problems that are under-reported. You cannot assume that all assisted deaths will be voluntary and free from coercion or undue influence.
• A study published in the CMAJ (June 2010) found that people who died by an assisted death without request tended to be over the age of 80, in a hospital and incompetent to make decisions for themselves. The study stated:

“Our finding that the use of life-ending drugs without explicit patient request occurred predominantly in hospital and among patients 80 years or older who were mostly in a coma or had dementia fits the description of “vulnerable” patient groups at risk of life-ending without request.”

Section 13 An assisting physician must, not later than 30 days after the death of a person to whom the physician has provided assistance with dying, submit to the Minister of Health, for the purpose of data collection and analysis, a report in the form prescribed by the regulations that includes the following information:

• The reporting system requires the doctor who does the act to report the death after the person has died. This does not represent a “safeguard” for vulnerable persons. Since the person has already died when the report is submitted, if an abuse of the law occurred, it is too late to protect the person.

Doctors will not self report abuse. The information gathered by the reporting system will only have statistical value.

• You cannot assume that every assisted death will be reported. The Lancet (September 8, 2012) reported that 23% of all assisted deaths in the Netherlands (2010) were not reported. The BMJ (October 5, 2010) reported that 47% of the assisted deaths in the Flanders region of Belgium (June - November 2007) were not reported.

This bill gives physicians the power, in law, to directly and intentionally cause the death of their patients. People need support and protection, not lethal injections. People with disabilities seek equality in living not more ways to die.

This bill is written with language that can be interpreted widely. We do not live in a utopian society, a place where elder abuse does not exist, coercion is unheard of, and people with disabilities do not experience discrimination. 

Whether or not you support euthanasia or assisted suicide, this bill is deadly. 

Please vote no and reject Bill S - 225.

Links to more articles on this topic:

• Canadian Senate to debate dangerous euthanasia bill.
• Legalizing euthanasia and assisted suicide is not safe. Patient safety must come first.
• Death is not preferable to living with a significant disability.
• Why I'm afraid of Stephen Fletcher's assisted suicide bill.
• Euthanasia undermines protections in law for me.
• Wesley Smith comments on Stephen Fletcher's euthanasia bill.

Canadian Senate to debate dangerous euthanasia bill

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A critique of Canadian Senate Bill S - 225.

Senator Nancy Ruth and Senator Larry Campbell introduced Senate Private Bill S 225, a bill that legalizes euthanasia by lethal injection and assisted suicide by lethal prescription. This bill is based on the private members bills that were introduced by Stephen Fletcher MP earlier this year.

The Euthanasia Prevention Coalition (EPC) welcomes an open debate based on the facts.

Canada has debated euthanasia and assisted suicide on many occasions with the most recent vote in parliament (April 2010) where bill C-384 was defeated by a vote of 228 to 59.

The language of Senate Bill S 225 is intentionally permissive. The bill is designed to protect physicians who act by lethally injecting or assisting the suicide of their patients. It is not designed to protect the patients. 

• The bill specifically allows euthanasia and assisted suicide for people with disabilities. 
• The bill allows euthanasia or assisted suicide for "psychological suffering." Psychological suffering is not defined. 
• The bill is not limited to terminal illness.
• The bill requires the physician to self report the death after it has already occurred. This assumes that physicians will self-report abuse of the law. Since the patient is dead, when the act is reported, therefore no actual protection exists for the patient.

People with disabilities generally oppose euthanasia and assisted suicide. The Council of Canadians with Disabilities (CCD) intervened at the Supreme Court of Canada case concerning euthanasia and assisted suicide. In its media release CCD spokesperson, Catherine Frazee stated:

In jurisdictions where assisted suicide/euthanasia is legal the leading reasons given for dying are not pain related, but rather “losing dignity and autonomy” and “becoming burdensome for family and friends”. 

To endorse these as valid reasons to die can only reinforce and entrench fear of disability and prejudice about the value of disabled people’s lives

Since bill S 225 does not define "psychological suffering" we must consider how this term has been applied in the Netherlands where euthanasia for psychological suffering already occurs. For instance:

• A healthy blind woman died last year by euthanasia in the Netherlands.
• A healthy 63 year-old man who had worked all of his life, was depressed and died by euthanasia.
• The 2013 Netherlands statistics indicate that there were 4829 euthanasia deaths, of which 97 were people with dementia and 42 were people with psychiatric problems.

Professor Theo Boer, a 9 year member of a Regional Euthanasia Review Committee in the Netherlands, changed his mind and now opposes euthanasia. In a recent article, Boer stated:

I used to be a supporter of legislation. But now, with twelve years of experience, I take a different view.  

At the very least, wait for an honest and intellectually satisfying analysis of the reasons behind the explosive increase in the numbers. Is it because the law should have had better safeguards? Or is it because the mere existence of such a law is an invitation to see assisted suicide and euthanasia as a normality instead of a last resort? Before those questions are answered, don’t go there. Once the genie is out of the bottle, it is not likely to ever go back in again.

EPC welcomes an open debate on euthanasia and assisted suicide, so long as it is an open debate. Ignoring the facts will be at Canada's peril. 

Links to further information.

Man, 27, battles Froedtert Hospital to remove ventilator

Dan Crews

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have just received a link to an article by Tia Ghose and published in the Milwaukee Journal Sentinel. The article is about a very difficult case in Antioch Illinois concerning Dan Crews (27), who was paralyzed in a car crash at age 3 and reportedly wants to die by the withdrawal of his ventilator.

Crews is ventilator dependent and has been petitioning the Froedtert Hospital to withdraw his ventilator.

Crews states that:

He is physically incapable of ending his life.

But the facts of the case are a little different.

First: Crews has the right to refuse medical treatment, including the withdrawal of the ventilator.

The story states that:

"Hospital psychiatrists and mental health professionals say he is depressed and must be treated for it before they will consider such an irrevocable step, according to his medical records. Crews said his desire to die stems not from his depression, but from his poor quality of life and the low odds that it will ever improve."

Concerning the right to refuse treatment the story correctly stated:

"Courts have nearly universally recognized that right," said Laura Leitch, general counsel to the Wisconsin Hospital Association.

But Crews isn't a cancer patient in hospice care. Other than needing a ventilator to breathe, he is young and has no other life-threatening conditions.

Legally he still has the right to discontinue treatment, Leitch said. But in practice, it can be difficult for non-terminal patients to refuse lifesaving treatment.

Before doctors honor a patient's wishes, they must determine whether the patient is competent, and hospitals have broad leeway in determining competency,

The issue of Dan Crew's quality of life can change.

Hon. Steven Fletcher

Steven Fletcher, is the Member of the Canadian Parliament and cabinet minister in the Harper Conservative government from Winnipeg (Charleswood - St. James - Assiniboia riding).

Fletcher, at the age of 22, had a car accident. His car hit a moose resulting in a broken (severed) neck leaving him a quadriplegic with no sensation below his neck.

Fletcher has been able to become a respected and important political leader, not by regaining his physical ability but by overcoming his physical limitations. He is truly a remarkable person.

Fletcher is not the only person who has lived a successful life with limited physical capacity.

Dan Crews has the right to refuse treatment. If the psychiatric team considered him mentally competent, his request to have his ventilator turned off would be honoured.

Another concern that needs to be addressed is the fact that the:

Illinois Medicaid often denies requests for the 24-hour care he needs to stay in his home, so he risks being put in a nursing home,

The article is also connected to a suspiciously written poll. The poll states: Should people with high-level disabilities be given the right to terminate their lives? The poll question appears to be asking whether or not euthanasia should be legal for people with high-level disabilities, but this is not an article about euthanasia, but rather the right to refuse medical treatment.

I suggestion that people who read this article should vote NO on this online poll.

We do not oppose the right to refuse medical treatment but because the online poll question can be construed as supporting the legalization of euthanasia, it must be opposed.

Dan Crews needs to be treated for depression. He needs to become active and live outside of the hospital. Just because he is ventilator dependent doesn't mean that his life is not worth living.

Theresa Ducharme

Theresa Ducharme was a friend of mine who died in 2004, at the age of 59. She founded the disability group - People in Equal Participation. Ducharme contracted polio at the age of 8 and lived her life ventilator dependent, requiring a wheel chair for her mobility.

Ducharme was partially responsible for changing how people with disabilities were treated in Canada. She also got married, was politically active, and brought disability cases to the Supreme Court of Canada.

The better answer is to enable Crew to become all that he can be. He is capable of achieving great things in spite of his physical limitations.