Harvey Chochinov: Patient centred care - not death hastening.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition.

Dr Harvey Chochinov

Dr Harvey Chochinov is a leading Canadian medical researcher who is known for his studies on the Will to Live and the development of Dignity Therapy to ensure a true death with dignity. The Euthanasia Prevention Coalition recognizes the importance of Dignity Therapy.

On February 25, Chochinov wrote a paradigm shifting article that was published as a guest editorial in the Journal of Palliative Medicine titled: The Platinum Rule: A New Standard for Patient-Centred Care. 

In his article Chochinov suggests that The Platinum Rule, which would have us consider doing unto patients as they would want done unto themselves, may be a more appropriate standard for achieving optimal person-centered care than the Golden Rule.

Chochinov provides this story to illustrate his point:

Bert was a kind 74-year-old happily married gentleman and father of five children. He had smoked cigarettes for a few decades, but had quit years ago, yet had presented with a cancer in his mouth. He underwent a large surgery that left him hoarse and disfigured. He was unable to swallow and depended on a gastrostomy tube for his feedings. Chemotherapy and radiation took their turns in causing more difficulties with nausea and some painful radiation effects.

Eventually the cancer recurred. More chemotherapy did not affect the tumor, and radiation was given with palliative intent. He began to have more pain, and at that point, one of his oncologists sat down with him and his wife and told them that he likely had little time to live, that his tumor was most likely going to progress quickly, and that his last days would become much more difficult, with increasing pain. The oncologist suggested that he might consider Medical Assistance in Dying (MAiD), to avoid what was sure to be a time of significant suffering.

Bert and his wife were a religious couple who had relied on prayer and the community around them to get them through over the years. They could not agree to MAiD. It was just not on their list of potential options. When he met with the palliative care consultant, he was having increasing pain, which was felt to have a large neuropathic component. A mix of gabapentin and small doses of methadone helped to reduce his pain to a very manageable level. The addition of immunotherapy by another oncologist resulted in a surprisingly good outcome, and now six months later, although still depending on gastrostomy feedings, he is frequently out in the garden, watering and weeding, and hoping to take part in harvest. He recently indicated his quality of life was excellent (C. Woelk, pers. comm.).

Bert was offered MAiD (euthanasia) because the physician percieved his quality of life to be poor, that Bert was better off dying than suffering or even attempting to find a way to keep Bert comfortable in his remaining days.

Chochinov explains how the Golden Rule may have weaknesses in our ethically diverse culture:

The Golden Rule—do unto others as you would have them do unto you—conveys deep wisdom, which can be found in some form in many religious and ethical traditions. In medicine this means treating patients and families the way we would want to be treated or would want our loved ones to be treated in similar circumstances. The Golden Rule is based on the idea of reciprocity and being able to see ourselves in others. If I were that patient, how would I want to be treated? What if this was my spouse, my child, my parent or sibling, how would I want them to be treated? In most instances adherence to The Golden Rule leads to health care decisions and clinical attitudes that are compassionate and embrace the essence of person-centered care.

The Golden Rule, however, has its limitations, as it requires some overlap between how we see ourselves and how others see themselves. So long as the patient's values and priorities align with our own, we can infer their needs based on how we would want to be treated in their situation. The more our worldview and lived experience deviates from theirs, the more the Golden Rule begins to unravel. How would I want to be treated it I were that old? If I were that dependent? Or that disabled, disfigured, marginalized, or disease ridden? Our own biases and perceptions of current, and the possibility of future, suffering can lead to attitudes that are tone deaf and decisions that are discordant with patients' perceptions, values, and goals.

Chochinov acknowledges that people who are very old, dependent, disabled, disfigured, marginalized or disease ridden may not be well served by the Golden Rule. Medical care-givers have their biases, perceptions and attitudes that lead to decisions that do not fit the patients values and goals. People with disabilities have often experienced this form of discrimination.

Chochinov continues by recognizing how the perceptions of the medical team will affect the patient.

Unconscious bias can influence the way we process patient information, affecting our behavior, interactions, and decision making. A sense of therapeutic nihilism and clinical passivity can set in, a feeling that nothing is worth trying and certain lives may not be worth preserving, leading us to withhold treatment, perhaps forgo diagnostic tests and let nature take its course. Inferring we would not want to live this way, distorted compassion—that is compassion based on tainted or inaccurate perceptions of another person's suffering—can lead to ostensibly well-intended advice, actions, or inactions that may be completely at odds with what the patient really wants. Rather than feeling that they have been heard, distorted compassion can result in patients feeling devalued, misunderstood, and further demoralized at the very hands of those who are meant to help.

Catherine Frazee

To provide greater clarity, Chochinov quotes disability rights advocate Catherine Frazee:

Catherine Frazee, a pre-eminent disability rights advocate, who lives with spinal muscular atrophy says, “having to wear diapers and drooling are highly stigmatized departures from what is expected of adult bodies. Those of us who deviate from these norms experience social shame and stigma that erodes resilience and increases vulnerably. The more deeply these stigmatized accounts are embedded in our discourse and social policy, the more deeply virulent social prejudice takes hold within our culture.

Chochinov then explains how the Platinum rule leads to better patient care. He writes:

The Platinum Rule, which would have us consider—doing unto patients as they would want done unto themselves—offers a standard that is more likely to result in treatment decisions that are consistent with patients' personal needs and objectives. Doing unto as per the Platinum Rule implicates not only clinical decisions, but treating patients—as in acting toward them—as they would want to be treated. This means establishing a care tenor that is informed by asking what we need to know about them as a person to take the best care of them possible.

Chochinov concludes by referring back to his Bert's story:

...one can easily imagine Bert's physician recommending MAiD from a position of wanting to mitigate current and future suffering. One can also easily imagine, based on the Golden Rule, that he offered a solution for a clinical situation he could neither fathom himself nor those he loved being able to bear. Distorted compassion, however, represents a failure of the imagination. Perceptions of suffering can obstruct our ability to imagine patients experiencing life as having sustained meaning, purpose, and value, despite even overwhelming challenges. The Golden Rule has its place in medicine, given it provides an initial gauge in our response to patient suffering. But if we are truly intent on offering patient-centered care, consistent with their values, preferences, and goals, consideration of the Platinum Rule is required: doing unto patients as they would want done unto themselves.

More articles related to Dr Harvey Chochinov (Link).

A wish to die is most often linked to loneliness and depression.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An Irish longitudinal study examined the wish to die (WTD) among 8174 patients who were over the age of 50. The study that was published in February 2021 followed the participants for 6 years and it determined that people who had a (WTD), almost three-quarters reported being lonely and 60% had clinically significant depressive symptoms. Other factors that led to a WTD was functional disability and chronic pain.

When the WTD was reassesed two year later, 72% of the people indicated that loneliness and depression had receeded, which re-affirmed previous studies that prove that a WTD fluctuates.

The study was conducted to inform legislators who were considering a bill to legalize euthanasia in Ireland. The study states:

In order to inform discussion around this complex issue (euthanasia and assisted suicide), this report examines the prevalence of WTD in a large population-representative sample of people aged ≥50 years. We specifically examine factors associated with WTD; the longitudinal course of WTD and the relationship between WTD and death.

The study found that 3.5% (279 out of 8174 participants) had indicated that they had a WTD within 30 days of the interview. Participants with a WTD were more likely to be female, separated or divorced, and were 7 times more likely to have depressive symptoms and four times more likely to have been previously diagnosed with depression than people without a WTD.

The wish to die fluctuates.

Since this is a longitudinal study, some participants were interviewed several times. 72% of the participants did not indicate a WTD two years after their first interview while 175 who did not indicate a WTD in the first interview did have a WTD two years later. A person who indicated a WTD at the first interview but then did not have a WTD two years later were much less likely to be lonely or to be experiencing depressive symptoms.

Clearly a WTD fluctuates and it is closely connected to loneliness and depressive symptoms.

The study also found that studies from other jurisdictions have similar results. A study from the Netherlands (2011) indicated that 3.4% of people aged 58 - 98, had a WTD which is nearly identical to the 3.5% in this study.

The study further examines the issues of loneliness and depression and stated:

WTD appears to be closely linked to loneliness and depressive symptoms. Almost three-quarters of participants with WTD also reported loneliness, while almost one fifth reported that they were lonely all the time. 60% of participants with WTD also had clinically significant depressive symptoms.

Importantly, only half of those with WTD and co-existing depressive symptoms report an established diagnosis of depression. Prior work has highlighted the potential burden of undiagnosed and therefore untreated population with depression within the TILDA cohort. It is not surprising therefore that less than one-sixth of those with WTD and co-existing depressive symptoms have accessed psychological or counselling services given this apparently high rate of undetected depression.

This last paragraph proves that most of the people who had a WTD and depressive symptoms that the depressive symptoms were nearly always undiagnosed and the person was not receiving treatment for their depressive symptoms.

Very few people who request euthanasia or assisted suicide are sent for a psychiatric evaluation. The Oregon 2020 report indicates that of the 370 people who received a prescription for a lethal assisted suicide drug cocktail, only three of them received a psychological or psychiatric evaluation. The Oregon 2019 report indicates that of the 290 people who received a prescription for a lethal assisted suicide drug cocktail, only one received a psychological or psychiatric evaluation.

This study proves that people with a wish to die are most often living with loneliness or experiencing depressive symptoms. The study also proves that most of the people who are experiencing depressive symptoms, that the depression is not diagnosed and the person is not receiving treatment for depression.

Finally the study re-affirms the conclusion of previous studies which proves that a wish to die fluctuates. I would encourage people who are interested in this topic to read the articles and studies by Dr Harvey Chochinov concerning Dignity Therapy and how the Wish to Die fluctuates.

Sadly many people who die by euthanasia or assisted suicide are experiencing a wish to die which is closely associated with loneliness and depression. Most of those who are experiencing depressive symptoms are not being treated for their condition and they are not sent for a psychological or psychiatric evaluation.

I was frustrated with the lies told during the New Mexico assisted suicide HB 47 legislative hearings.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

New Mexico legislature

Yesterday was the second time that I presented (by zoom) before a New Mexico legislative committee hearing concerning HB 47 the bill to legalize assisted suicide.

My concern with the legislative committee hearing was not the one minute for every regular witness. Not much can be said in one minute.

My frustration related to the lies told by the "expert" witnesses, who had more time, concerning the bill.

1. The "expert" witnesses claimed that HB 47 is one of the tightest assisted suicide bills anywhere.

Reality: HB 47 is the widest assisted suicide bill being considered in America.

All current assisted suicide laws require physicians to approve and prescribe lethal drugs. HB 47 allows non-physicians defined as "health care providers" which includes physicians, or licensed physician assistants, or osteopathic physicians, or nurses registered in advanced practice to approve or prescribe lethal drugs.

All current assisted suicide laws require a psychologist or psychiatrist to counsel a person, when a "health care provider" questions the ability of a person to consent. HB 47 defines counselors as: state-licensed psychiatrist, psychologist, master social worker, psychiatric nurse practitioner or professional clinical mental health counselor.

Unlike existing assisted suicide legislation, HB 47 does not require a 15 day waiting period but only requires a 48 hour waiting period that can be waived if the health care provider believes that the person may be imminently dying. Therefore HB 47 technically allows a same day death. A person could request assisted suicide on a "bad day" and die the same day. Studies prove that the “will to live” fluctuates.

HB 47 Section 3 (G) waives the requirement that a person's condition be confirmed by a second health care provider if the person requesting assisted suicide is enrolled in a hospice program. This is the only assisted suicide bill that waives the requirement that a second health care provider assess the requester.

2. They claimed that HB 47 has iron clad conscience protections for health care providers.

Reality: HB 47 tramples on conscience rights.

HB 47 states that health care providers who are unwilling to carry out a request for assisted suicide shall inform the individual and refer the individual to a health care provider who is able and willing to carry out the individual's request or to another individual or entity to assist the requesting individual in seeking medical aid in dying.

Therefore a conscientious objector must participate in the act by referring the patient for assisted suicide to a health care provider who is willing to prescribe lethal drugs.

Remember, in 2019 New Mexico State Rep Deborah Armstrong, sponsored assisted suicide bill, HB 90, which was the most extreme assisted suicide bill that I had seen in America. Among other concerns, HB 90 allowed assisted suicide for psychiatric conditions, to be done to someone with an undefined "terminal prognosis," to be done by nurses and physician assistants, and it even allowed it to be approved via telemedicine.

Deborah Armstrong wants to legalize assisted suicide to make it an option for her daughter who is battling cancer. I understand their fear of a bad death. But giving doctors the right in law to be involved with killing people is a dangerous public policy.  

Who do they think they are fooling. We are all capable of reading HB 47 and recognizing the lies, lies and more lies from the assisted suicide lobby "experts."

Who really wants to die? Part VII: The justification of Canadian-style euthanasia cannot be found in any rational dynamic of market economics

Gordon Friesen

Gordon Friesen, EPC board member
http://www.euthanasiediscussion.net/

As a general principle, the means taken to address an issue should be proportional to the issue itself. We do not, for instance, use a baseball bat to swat a fly.

The specific point of this series of articles has been to demonstrate that there is very little organic consumer demand for euthanasia as compared to the scale as it is currently being developed and marketed in Canada.

Let us briefly resume our evidence:

A great deal of literary romance has been created around the idea that survivors of catastrophic injury, and particularly those paralysed by damage to their spinal cords would naturally rather die than live in such a diminished state. In actual fact, however, only about one percent of these people will really commit suicide (in the entire first critical five years following injury) and subsequent suicide rates for this group are statistically normal.

In the worst phase of the AIDS epidemic, that is in the late eighties and early nineties (before effective treatments were available), a literary romantic ideal of voluntary death arose within the homosexual community which sparked the most powerful suicide trend ever seen. Assisted suicide became a community ritual. Universal approval was shown throughout the literary class. However, in actual fact, only somewhat less than two percent of people living with AIDS died by suicide during that period, and following that time, suicide rates among this group have returned, essentially, to normal (when adjusted for other factors such as high suicide among intravenous drug users who also belong to this cohort).

In sum, spinal injury and AIDS were the two most important areas where it was claimed that assisted suicide must be provided in order to satisfy a genuine (and justified) demand. “Normal” people were universally groomed to believe that “they”, also, would wish to die should they be injured, or become ill, in such ways. But none of that literary work of idealized voluntary death was based upon reality.

More recently, we have been assailed with literary depictions of death in circumstances of excruciating and unmanageable suffering. Euthanasia, we are told is the only route to humane end-of-life care. Terminal cancer, in particular, was described as a condition which could only rationally end in euthanasia. “Normal” people, once again, were groomed to believe that they would, indeed, wish to be euthanatized at such a time.

(It is mysteriously omitted from this portrait that the control of discomfort is now infinitely superior to anything ever known before; that people had been dying in much worse circumstances since the beginning of time; and that, far from hastening death, the development of humane society had been characterized by a growing recognition of the need to protect the dying from the murderous instincts of their entourage).

In actual fact, however (once again), we noted that in the most euthanasia-prone area of the world (the Netherlands and Flemish Belgium), after twenty years of wide-spread access to legal euthanasia, only approximately ten percent of terminal cancer patients currently die in that manner.

And therefore, bringing all of this information together, we see that the maximum organic demand for euthanasia (absent the powers of suggestion and institutional normality) would be: one percent of catastrophic injury survivors (spinal cord paralysis, amputees, etc.); perhaps two percent of degenerative illness sufferers (AIDS, ALS); and ten percent of terminal cancer patients. While for clarity, the corresponding rates of euthanasia refusal would be: 99, 98, and 90 percent respectively.

On the other hand, in order to provide euthanasia service in Canada, it has been decided: that the practice of medicine should be fundamentally altered by declaring euthanasia as a benign form of medical care; that all patients possess a universal, state-guaranteed right to that care; that all doctors and other medical staff be granted a literal “licence to kill” in the institutional context; that euthanasia providers not even require individual selection or certification; that euthanasia be performed in all medical institutions; that, going forward, euthanasia be emphasized in training as a normal expectation of students and professionals; that the new culture of euthanasia attain institutional dominance through the suppression and replacement of euthanasia opposition in positions of medical leadership; and finally: that the imperative need for universal euthanasia access justifies the correspondingly inevitable development of therapeutic environments (hospitals and clinics) which will become increasingly (and predictably) more hostile to those patients (the vast statistical majority) who will still refuse to voluntarily receive the “assistance” in dying that has been so reasonably provided for them.

And all of this (the popular romantic literary pornography of “intolerable suffering” notwithstanding) done in order to address an organically expressed demand from one, two, or in some specialties, perhaps, a maximum of ten percent of the clientele.

In other words: conceived merely as a consumer-driven economic phenomenon, euthanasia (as currently provided through the Canadian public healthcare system) makes no sense whatsoever!

This is indeed an astonishing but largely unstated fact which is of the greatest importance for Canadian citizens; because nothing in the realm of public policy happens for nothing; and therefore: If the reason for maximizing euthanasia availability is NOT economic – is NOT meant to satisfy consumer demand -- then what on earth IS it for?

And with that question in mind, I now intend (with the reader’s permission), to begin a new series of articles entitled: What is the “Good” of Euthanasia? Which will examine exactly what place (if any) assisted death might more appropriately claim to occupy among us; in consideration of the various moral (and other) justifications currently offered for providing (or restraining) this practice.

This article is the seventh in a series of articles:

1. Who really wants to die? Part 1: A brief quantative analysis of the purported "need" for euthanasia (Link). 
2. Who really wants to die? Part 2: The popular impact of celebrity suicide (Link). 
3. Who really wants to die? Part 3: Life choices of the common person (Link).
4.  Who really wants to die? Part 4: The true scale of demand for euthanasia in Canada (Link). 
5. Who really wants to die? Part 5: The absence of suicidal desire amongst the survivors of catastrophic injury. (Link).  
6. Who really wants to die? Part 6: Aids in the Eighties and Nineties and the literary ritual of assisted suicide. (Link).

Gordon Friesen, November 19, 2020

Who really wants to die? Part VI: Aids in the Eighties and Nineties and the literary ritual of assisted suicide.

Gordon Friesen

Gordon Friesen, EPC board member
http://www.euthanasiediscussion.net/

A fundamental discrepancy between appearance and reality

Without a doubt, the historical and cultural phenomenon which most influenced public perception of the “right to die” movement, was the horrendous AIDS epidemic of the eighties, and nineties.

Great sympathy was felt towards the victims of this atrocious disease, and great solidarity was expressed for those who chose to take their own lives. However, as we shall see, only two percent of people with Aids actually resorted to suicide, assisted or otherwise. And thus, as with the victims of catastrophic injury, the public vision of an ideal and noble suicidal response to the apprehended loss of physical function and control, was wildly at odds with real choices observed among those personally affected.

AIDS and the homosexual community: a perfect storm

To understand the collective reaction of homosexuals to the original Aids epidemic (which affected them in such a massive and specific way), it is first necessary to recall the social conditions in which this culture existed at that time. For today, thanks to the extraordinary cadence of recent social change, it is becoming increasingly difficult to communicate (or even to credit) the legal, social, and psychological conditions which were commonly imposed upon the members of this group, barely forty years ago, and that, even for those of us who remember these events at first hand.

Let us merely recall, in this connection, that the behaviors typical of male homosexuality were entirely prohibited, as criminal offenses in Canada, until 1969 (while only then permitted, subject to residual conditions); and the homosexual orientation, itself, was defined in terms of mental pathology, by the American Psychiatric Association, as late as 1973.

Frequently met with hostility, the homosexual community was understandably animated by a powerful sense of injustice. These feelings, in turn, were embodied in a shared cultural mood which combined a traditionally resigned resentment, with a newer and politically articulated combativity -- doubted by many, while desired by all – which still remained to bear conclusive legal fruit. And then suddenly, into this complex mix, came the terrible scourge of Aids.

The primary epidemic of Aids

In 1992, Aids was recognized as the greatest cause of death among American (and Canadian) men between the ages of 25 and 45. Aids had no cure; Aids ended inevitably in death; advanced patients could expect to suffer atrocious symptoms. Collectively, moreover, in a culture deeply imbued with erotic ideals of youth and beauty, this was a disease which seemingly delighted in attacking precisely the most youthful, and the most beautiful.

A secondary epidemic of suicide

Even without any consideration of Aids, the risk of suicide has always been a danger for young men, and even more so among homosexual youth. Indeed, much of the traditionally shared autobiographical and fictional representation of homosexual experience -- while often romantic and even defiant – also demonstrated a strong tendency towards the tragic tone. With the arrival of this apparently ineluctable violence of fate, however, a new vision of reality emerged, of almost apocalyptic urgency, in which it seemed that only the choice of the time and of the manner -- of his own death -- remained as the inalienable right of the encircled hero.

And thus, in the continuing wake of the post-war countercultural revolution: where political consciousness was already coalescing around the notion of sexual identity, enshrined as a civil right in the image of race and gender; where the word “choice” was found on the lips of all: it became inevitable that this last ultimate “right”, of voluntary death, should be revendicated with an ardor never matched before, or since. And so it is, that the conjugation of Aids and “right-to-die” produced the most far-reaching suicide trend ever witnessed.

Assisted suicide as spectacle and ceremony

Euthanasia laws show that there will always be more reasons to kill.

This article was published by Mercatornet on Oct 19, 2020

Legislation in the Netherlands and Canada continues the relentless expansion of legal killing

Alex Schadenberg

Executive Director, Euthanasia Prevention Coalition

On Monday, October, 13, Dutch Health Minister Hugo de Jonge announced that the Dutch government will amend or re-interpret its euthanasia law to permit child euthanasia — an announcement that came only three days after the news that the issue of child euthanasia had divided the Netherlands coalition government.

Article: The Netherlands to extend euthanasia to children (Link).

The NL Times reported that de Jonge said the change was planned for after the March 17 election, next year.

The Netherlands law already permits euthanasia for children as young as 12 (when parents or guardians consent). People over the age of 16 can consent to euthanasia as adults and the Groningen Protocol permits euthanasia for disabled newborns. The change would expand the law to include children from one to 12 years of age.

Earlier this year, a bill to extend the Netherlands euthanasia law to people who are healthy, but “tired of living” was submitted by a member of the D66 party, Pia Dykstra. An article in the NL Times reported that:

The legislative proposal allows people over the age of 75 who feel that they have come to the end of their life and have a persistent wish to die to ask for euthanasia.

Article: Dangerous "completed life" bill would extend euthanasia in the Netherlands to healthy people (Link).

This proposal is obviously a starting point. People can be “tired of living” for many reasons and it can be argued that it would be discriminatory and unfair to limit such a law to people over the age of 75.

It appears that the Netherlands has decided to ignore the mantra that euthanasia is limited to those who are capable of consenting and suffering. Children cannot effectively consent and people who are “tired of living” would not be required to be “suffering”.

Meanwhile, in Canada a new bill known as Bill C-7, seeking to expand Canada’s euthanasia (MAiD) law, was introduced in February this year in response to a Quebec Court decision striking down the provision in Canada’s law that a person’s “natural death must be reasonably foreseeable”. Striking down this provision in the law is problematic, even though the reference to natural death needing to be “reasonably foreseeable” was not defined in the law.

Article: Stop Bill C-7 from expanding Canada's euthanasia law (Link).

Bill C-7 does not limit itself to the provision of the Quebec Court decision. It also expands Canada’s euthanasia law primarily by eliminating the 10-day waiting period when a person’s death is deemed to be reasonably foreseeable. Because Bill C-7 does not define “reasonably foreseeable”, a person could make a request for death by euthanasia when having a “bad day” and die the same day even though studies prove that a person’s “will to live” will fluctuate.

Creating a two-track law

A person whose death is deemed to be reasonably foreseeable would have no waiting period, while a person whose death is deemed to not be reasonably foreseeable would have a 90-day waiting period before being killed. Once again, “reasonably foreseeable” is not defined in the law, permitting a doctor or nurse practitioner to lethally inject a person who is incapable of consenting, if that person was previously approved for MAiD.

Therefore a person who is approved to die by MAiD, if they become incompetent, will lose his or her right to change their mind. This is a similar situation to the Netherlands “coffee euthanasia” death where a doctor put a sedative in the coffee of an incompetent woman who resisted during the euthanasia, but when the woman continued to resist, the doctor had the family hold her down.

To add insult to injury, Bill C-7 falsely claims to prevent people with mental illness (alone) from dying by euthanasia. Canada’s euthanasia law permits death by lethal injection when a person is physically or psychologically suffering in a manner that is intolerable to the person and that cannot be relieved in a way that the person considers “acceptable”. However, mental illness is already considered a form of psychological suffering and the bill does not define psychological suffering.

If the Canadian Government actually wants to exclude euthanasia for mental illness (alone) it needs to define psychological suffering in a manner that excludes euthanasia for mental illness.

It is true that the Netherlands has not changed the language of its euthanasia law since legalization, but it has expanded euthanasia by continually changing the interpretation of the law.

Canada has become the world-wide example of how incremental extensions quickly expand the scope of euthanasia laws. Since 2016 the language of the law has been continually re-interpreted and, less than four years after legalization, the Government is eliminating many of the “safeguards” in the law.

Once a society has decided to legalize killing, there will always be another reason to kill, and based on equality and fairness, death, once approved for one group, will eventually be accepted for all other groups.

The reality is that, once killing is legalized, there will never be enough.

Bill that seeks to expand euthanasia (Bill C-7) sparks debate.

This article was published by the Epoch Times on October 14, 2020

By Lee Harding

Court-ordered legislation to expand euthanasia in Canada is welcomed by advocates but condemned by opponents who say the bill is poorly crafted and too permissive.

Legislative changes were ordered by Justice Christine Baudouin of the Quebec Superior Court in September 2019. Beaudouin agreed with plaintiffs Jean Truchon and Nicole Gladu that euthanasia should be allowed to end their persistent and intolerable suffering, even though their death was not “reasonably foreseeable.”

Bill C-7 was introduced before Parliament was prorogued and then reintroduced with the same name and wording on Oct. 5. Under the legislation, someone who is not terminally ill can receive medical assistance in death (MAiD) 90 days after they request it, provided a medical professional has explained “the reasonable and available means to relieve the person’s suffering” and “the person has given serious consideration to those means.”

Sign the petition: Reject euthanasia Bill C-7 (Link).

Alex Schadenberg

Alex Schadenberg of the Euthanasia Prevention Coalition told The Epoch Times that the legislation removes important safeguards.

“They went much further than the court actually required them to go,” he said.

If the bill passes, the terminally ill will only need one independent witness to verify the conditions for euthanasia were met, instead of two as is currently required. The legislation also eliminates the 10-day waiting period between consent for MAiD and its execution.

“I have no waiting period. I can show up at the doctor’s, be evaluated by a doctor, be evaluated by a nurse practitioner, they can say, ‘Yes he’s definitely terminally ill,’ then sign me off. I can be dead the same day now,” Schadenberg said.

Schadenberg calls that “really, really, really bad policy.” In Quebec, at least 323 patients who requested MAiD in writing changed their mind later, according to two 2019 reports by the Quebec Commission covering the period December 2015 to March 2019, and available Canadian data suggests that at least 7 percent of patients making a written request for MAiD subsequently change their mind.

“If you look at all the studies that have been done on the question of one’s will to live, that fluctuates,” Schadenberg said. “Because I’m having a really bad day today, it means I’ll never get a chance to experience a good day tomorrow because I could die the same day, according to this legislation.”

Helen Long, CEO of Dying With Dignity Canada, welcomes the legislation. She told The Epoch Times: “In terms of the 10-day wait period, what we know, what we heard from clinicians over the years is, by the time someone makes their MAiD requests, they’ve generally given it quite a lot of thought and there has been a lot of careful consideration put in.”

“There’s still clinician involvement in the entire process though,” she added. “I think there’s safeguards. It’s a change but there’s still a safeguard in place.”

In addition, currently a person must renew his or her consent shortly before euthanasia is administered. Bill C-7 waives that requirement if the person has lost the ability to consent “except if they demonstrate signs of resistance to or refusal of the procedure.”

Long supports that provision. “That’s something … we’ve advocated for years, so we were pleased to see that change as well.”

The Christian Legal Fellowship says passage of Bill C-7 “will fundamentally redefine the nature and role of euthanasia by making it available to individuals who are not dying, and who may have years left to live.”

“[E]xpanding euthanasia in these ways will severely undermine society’s commitment to the equal worth of all people, including those with disabilities,” it says in a news release. “If passed, euthanasia will no longer be an exceptional remedy to hasten a painful death, but a widely available and state-sponsored means of ending a patient’s life.”

More information on Bill C-7

• EPC: Stop Bill C-7 from expanding Canada's euthanasia law. (Link).

Who really wants to die? Part V: The absence of suicidal desire amongst the survivors of catastrophic injury.

Gordon Friesen
http://www.euthanasiediscussion.net/

A fundamental truth

Cutting directly to the chase: survivors of catastrophic injury (such as those suffering from paralysis due to spinal cord injury), have no greater desire to die than anybody else. There is, therefore, no rationale for facilitating access to assisted death on their account.

In crude figures: only somewhat less than one percent of the victims of spinal chord injuries will despair, renounce, and end their lives during the first crucial five years of recovery (and after that time, their specific suicide rates become statistically identical to those of the general population). That is, of course, a huge number of individual suicides (and roughly twenty times the normal expectation). But it remains, none-the-less, only one percent of the whole.

These facts may come as a surprise to many. But such is the incontrovertible truth.

Once again, as with celebrity suicide, and with the general euthanasia rates observed around the world: we see that the “service” of euthanasia has been grossly oversold in proportion to the scale of voluntary organic demand on the part of its’ intended clientele. And even more importantly, this demand has been energetically misrepresented over the years, by suggesting that certain specific categories of ill and disabled individuals, including (especially) major injury survivors, people with AIDS or persons experiencing progressive neurological decline, and those diagnosed with terminal cancer, do indeed wish to die, when, by the dispassionate measure of statistical evidence: such is clearly not the case.

To what, then, do we owe this false, dangerous, and all too popular misconception?

At the heart of pro-euthanasia messaging: the ideal notion of “suffering”

Fully -- and confidently -- imbued with the early twentieth century spirit of progressive scientific utilitarianism, the Voluntary Euthanasia Society (UK) was formed in 1935 (four years before the onset of war), dedicated to the following principle: 

“incurable sufferers should have the right to choose a Merciful Death”

Ten years later, however, when the Second World War had ended the fascist dream of a “new social order” (and faced at Nuremberg with the appalling evidence of what can really happen when the medical profession is instrumentalized in the pursuit of utilitarian public policy), support for euthanasia virtually disappeared.

As a result, those few creative and powerful personalities who, for whatever reason, remained deeply attached to this ideology, found themselves in a similar situation to that of anti-euthanasia activists today, which is to say, firmly on the back foot and comprehensively obliged to reinvent their goals and methods.

In this extremity (and at the price of a deep fracturing within the Society itself), the immediate goal of access to euthanasia was abandoned; and what was left of the movement transitioned (in the post-fascist period) to a more modest set of objectives, beginning with the first and most basic patient prerogative on the road to full access euthanasia: the right to refuse treatment.

Refusal of treatment, and the original slippery slope

Today, of course this principle is universally accepted. We should, however, frankly realize that refusal of treatment has crucial suicidal implications: that by accepting refusal of treatment we are also deemed to have credited the idea that suicide need not be, by definition, a wrongful act; that we do not have an unconditional duty to prevent suicide; that suicide is not necessarily “bad”; that suicide can, in fact, be “good”; and ultimately, that we might be morally required to provide assistance in suicide. In other words, from the first formal acceptance of “refusal of treatment” (and with far greater effect from the later refusal of “care”), the road became clearly laid out -- through the logical falling of successive legal dominoes -- to that situation in which we find ourselves today.

For clearly: categorical interdictions can not be (formally) breached without inviting far-reaching consequences.

A required moral consensus on the desirability of (at least) some suicides

Perhaps the most brilliant and effective aspect of the strategy outlined above lies in this fact: that the entire collective and utilitarian justification for euthanasia -- previously quite obvious but now unavowable -- had been displaced by this one remaining principle of unfettered individual choice.

And yet there still remained a crucial obstacle to this plan. We must understand, I believe, how difficult it was for people, at that time, to openly promote the idea of suicidal choice. It was not enough, three quarters of a century ago, to simply fall back (as one might today) on the sovereign personal right of capricious subjective desire. Those who wished to enable suicide, assisted suicide, and ultimately euthanasia itself, faced the very real challenge of convincing a democratic majority that suicide can be (and is in fact), objectively “good” (in specific instances).

In practical terms, of course, this would mean convincing the common man that there were situations in which, he -- or anyone else -- would naturally wish to die. And to achieve this goal, euthansia promoters began with a truly ingenious linguistic tool, for soliciting agreement with their underlying thesis. This involved a minute, almost invisible change, introducing the notion, no longer of merely “incurable” suffering, but that of a suffering which was incurable and “unbearable”! For in this case, IF we accept at the outset that there is (in fact) such a thing as “unbearable suffering”, THEN by definition, anybody so afflicted would automatically wish to die, and the argument is carried without further demonstration.

The only task remaining, therefore, was to sow this treacherous conceptual seed in collective consciousness (appealing, also, to pre-existing popular prejudice), by presenting ideal images of people “suffering” in seemingly “unbearable” circumstances. Unfortunately, as we shall see, this challenge was actually undertaken with great success over a period of fifty years (in spite of clear statistical proof to the contrary), by mere literary representations of fictional suffering, involving notably (among others) the paralysed survivors of spinal cord injury.

An outstandingly successful instance of fictional misrepresentation: spinal cord injury

As early as 1972, a television drama championing the right to die, intitled “Whose Life is it Anyway”, by author Brian Clark (1932 - ), appeared in UK (once again), which was subsequently brought out on the stage (London 1978, Broadway 1979) and was ultimately produced as a Hollywood film starring Richard Dreyfuss (MGM 1981).

The subject of this film concerned the suicidal desires of a young man (Dreyfuss) who was rendered quadriplegic in a car accident. The point of the film however -- it’s purpose -- was to convince the average sympathetic spectator, that a life of paralysis is objectively unworthy of living; or at least, that if he or she were to find themselves in such a case, that they would not wish to live. The fundamental goal, therefore, lies in soliciting the spectator’s agreement with that essential euthanistic premise identified above: that there do indeed exist extraordinary instances of “suffering” which are objectively “unbearable” (and for which the act of suicide -- and indeed of homicide also -- must be postulated as a positive “good”).

Unfortunately however – incidentally and unforgivably -- it was also grossly (and falsely) intimated through this fictional imagery, that the typical paralysed survivors of spinal cord injury are indeed “suffering” in that mythically “unbearable” fashion so artfully evoked, and naturally desire death in consequence!

Never mind that this is a bald-faced lie. Never mind that ninety-nine percent of catastrophic injury survivors will show no more suicidal tendency than anybody else! People of the author’s ilk have no interest in such distractions: In fact, it would surprise me greatly to learn that Brian Clark actually cared if real spinal cord injuries wished to die. He might easily have discovered that they do not (And perhaps knew this perfectly well)!

Even the spinal cord issue, itself, (as choice of subject) was probably a mere happenstance. Apparently, Clark simply picked the worst infirmity he could think of (while still getting aesthetically photogenic shots). His one simple goal, for whatever reason, was to convince “normal” people that their “suffering” neighbors should be allowed to die. And if that demonstration depended on a completely fallacious description of reality, advanced unselfconsciously through a work of political fiction, then so be it.

A personal, indignant resentment, evoked at the view of this film

The reader may have detected a particularly warm tone in my treatment of this particular subject. And the reason for that “warmth”, is because, coincidentally, “Whose Life is it Anyway” appeared as a film only two years after I myself became paralysed in circumstances very similar to those depicted in the movie.

The terrible nature of such literary assault

Without the will to live, even the strongest man, in the most favorable circumstances, will soon disappear. For that is the inflexible rule of all life, which has governed evolution from the very start: Life must be desired; life must be nurtured; life must be defended; life must be striven after. Among humans, indeed, the capacity for adaptation is virtually limitless, and the will to live, therefore, is not a secondary, but the first and determining predictor of outcome: for almost any situation is livable to the person who desires life; but no situation will suffice for the one who does not.

Generally speaking, then: How could anyone fail to understand the mortal danger posed by such a work, to people at grips with these intimate and personal adjustments? In those first crucial four, or five years? In that first devastating year? How could anyone ignore the terrible implications of telling such people (at that most delicate of times), that their lives were (objectively) not worthy of life?

As concerns myself personally: forty years ago, my survival teetered on the knife’s edge. My life depended, quite simply, on the confidence required to make positive choices; and the suggestive force of Clark’s propaganda, with its nihilistic view of disabled life (whether wittingly or no) posed a direct threat to my existence.

I do not hesitate to affirm, therefore: that the production and distribution of this film (and the still very popular stage-play from which it sprang) were (and remain) acts of criminal assault upon real people; some of whom, sadly, will not succeed in repulsing this poisonous ideation.

And yet most happily: the human powers of recuperation (from psychic no less than from physical assault), are much greater than we might intuitively expect (and certainly much greater than the shameless pornographers of “unbearable” suffering would have us believe).

A more faithful portrait of real life

People who have lived through these sorts of difficult adaptations, and those also, who have been the intimate witnesses to such feats, naturally see them as unique, heroic, victories over misfortune. And they definitely are. But the superb level and intensity of the efforts made – and of the satisfaction achieved -- does not change their equally ordinary nature. It is simply a lie (albeit a nearly universally credited lie) that only a very few superior individuals can possibly overcome the challenges of catastrophic injury. In reality – and this is a truth which cannot possibly be over-stated: this kind of amazing adaptive power reveals itself as a standard characteristic of humanity. Especially where it is expected and embraced.

A conclusion of infantile simplicity

Once again, let us remember the main thesis of this present series of articles: that observed demand for euthanasia is wildly below what we would expect as a justification for the scale of the service offered (and for the sacrifices demanded of both typical patients and typical doctors) in the satisfaction of what little demand there is.

What is the reason for that? Why is this dishonest (and clearly false) nihilistic messaging (epitomized by the film “Whose Life is it Anyway”), still allowed to stand? Where are the ninety-nine other films logically required to faithfully portray observed proportional reality? Where are the popular commentators, eager to “set the record straight”?

Whatever answers might be found for these intriguing questions, something has clearly gone wrong with the scenario imagined seventy-five years ago by post-fascist euthanasia apologists suddenly recycled as apostles of personal choice: Doors to the “service” have been thrown wide open. Doctors are now instructed to be on the lookout and to recruit as many clients as possible. Yet to their enduring frustration (and, I believe, entirely predictably): As long as euthanasia depends on choice it can never prevail over the normal human instinct of survival. Or to recall the familiar Children’s Tale:

Then said the Little Red Hen:

“I have convinced the general population that “suffering” is worse than death;

I have changed the law to allow doctors to kill their patients;

I have transformed the public healthcare system along utilitarian lines in order to maximize access to euthanasia;

And now, who wishes to die?”

“Not I”, said the Pig.

“Not I”, said the Cow.

“Not I”, said the survivors of catastrophic injury...

How long will it take (and how much damage will be done to our medical establishment) before judges, administrators and opinion-makers realize that they are attempting to force a “product” upon us, for which there is no corresponding market organically expressed?

And how long will we – patients and taxpayers – allow this abuse of our trust?

This article is the fifth in a series of articles.

• Who really wants to die? Part 1: A brief quantative analysis of the purported "need" for euthanasia (Link). 
• Who really wants to die? Part 2: The popular impact of celebrity suicide (Link).
•  Who really wants to die? Part 3: Life choices of the common person (Link). 
• Who really wants to die? Part 4: The true scale of demand for euthanasia in Canada (Link).

The true scale of demand for euthanasia in Canada (Who really wants to die? : Part IV)

This is the fourth in a series of articles by Gordon Friesen.

• Who really wants to die? Part 1: A brief quantative analysis of the purported "need" for euthanasia (Link).
• Who really wants to die? Part 2: The popular impact of celebrity suicide (Link).
• Who really wants to die? Part 3: Life choices of the common person (Link). 

Gordon Friesen

By: Gordon Friesen
http://www.euthanasiediscussion.net/

 -- What is really at stake here ?

Faced with the complete up-ending of the Canadian medical industry which has been forced upon us by the unprecedented legislative redefinition of medicalized suicide, as benign “care” – and presented, in fact, as a universal right;

Faced with the resulting obligatory and omnipresent intrusion of this practice into every corner of our public healthcare system;

Faced with a duty imposed upon every doctor to inform each eligible patient of their “right” to die by euthanasia (whether said doctor believes the procedure to be appropriate in a particular case or no, and notwithstanding the negative burden of inflicting such informational aggression upon those typical patients who have demonstrated no autonomous desire to be euthanized);

Faced, moreover, with an actual obligation (duty) to perform the act of euthanasia (when requested by an eligible patient) which can only be avoided by the affirmation of an “objection of conscience” founded in “deeply held” (ie, religious) beliefs;

Considering, that this exemption explicitly excludes the invocation of professional, medical, or scientific motives of refusal (because the legislative definition of euthanasia, as benign care, automatically denies any such pretension);

Considering, also, that even in the event that a physician exercises this restrictive “privilege of conscience” (to refuse to perform a specific euthanasia contrary to his or her best professional judgement), that such doctor must STILL collaborate, to the extent of providing an “effective” referral to a more willing colleague;

Faced, then, with all of these extraordinary circumstances, and with the extraordinary burdens they place upon the typical non-homicidal doctor (and the typical non-suicidal patient): We would, I believe, be entitled to expect the demonstration of an overwhelming patient demand for this service; entitled to expect, that is, that the ill and the disabled would accept this proffered clinical death, in near-unanimous fashion.

But such is simply not the case.

As a matter of fact, the true figures which represent the real choices statistically embraced by actual patients facing the prospect of medical “aid” in dying, diverge to an astonishing degree from the officially sanctioned narrative to which we have become so accustomed in recent years. May the reader be the judge.

The instructive cases of Belgium and the Netherlands

Let us stipulate, to begin with, that it would be little enlightening to begin this analysis in the Canadian context, because the arrival of euthanasia practice, in this country, is still too recent to permit accurate forecasting of future trends. Luckily, however, we do dispose of a large body of data -- much more informative – originating from two countries (and immediate neighbors), Belgium and the Netherlands, which are fairly similar to Canada culturally and economically, and which have now encouraged the practice of legal euthanasia for nearly twenty years.

Without any doubt, as concerns Europe (and perhaps the world), it is the Dutch, along with their cultural-ethnic Flemish cousins (living just across the Belgian border), who have shown the greatest enthusiasm for euthanasia. And much more, to be precise, than even their immediate Franco-Belgian (Walloon) neighbors. In fact, prior to the arrival of Canada (and the deliberately radical “Canadian model”) the systematic insistence of the Netherlands, and Belgium, on true euthanasia (rather than mere assisted suicide) represented a sort of singularity among nations permitting different forms of assisted death. The least we can say, however, is that our policy and attitudes, in Canada, were strongly influenced by the Dutch experience and intended, even, as an extension thereof.

Nothing but the facts...

Naturally, in the reporting of statistics, there is a journalistic tendency to deliberately present figures under their most dramatic aspect. And in the present case, the desire for journalistic hyperbole was further aided by a perception, on the part of both adversaries and promoters of euthanasia in Canada, that their respective causes would be assisted by the most extreme possible interpretations of Belgian euthanasia growth rates.

And objectively, also, we must admit that both were correct. For those who believe that even one act of euthanasia is wrong (categorically or medically) will also consider ever greater numbers, of euthanasia deaths, to be ever that much more wrong. And therefore, reference to rising death counts is a certain way of generating increased and continued outrage among those of us who share the required ethical reference points.

But on the other side, for the promoters of euthanasia -- for those who would wish to espouse a contrary moral position: a rapid expansion of recently legalized euthanasia practice, in Belgium, would seem to indicate a strong and growing demand. And this, they believed, would support the pretension that legalized euthanasia is a necessary service -- desired and desirable -- rationally provided in response.

The growth and stabilization of euthanasia rates in Belgium and the Netherlands

To take a particularly egregious example, journalistic reports in 2018 still made generous reference to the fact that the yearly number of Belgian euthanasia deaths had increased tenfold in the first 15 years of legality (up to and including 2017). Certainly, that does seem like prodigious growth! However, a more prudent analysis would remind us that ten times nothing remains nothing still, or in this case: that ten times 0.2% (of all deaths in Belgium) became only 2.2% at the end of that 15 year period.

Now it is true, that 2.2% of all deaths in that country would make a lot of bodies were they all brought together in one place. But it is also the property of large numbers and proportional relations that 2.2% is only a marginal fraction of the whole. And while it should, quite naturally, dismay the unconditional defenders of life, it is not a number which, I submit, should bring any comfort to the apologists of assisted death.

“But wait a minute”, some might exclaim, “at that pace of growth, the euthanasia rate would be 22% in another fifteen years, and ALL deaths would be due to euthanasia approximately 25 years out.”

Yes, of course. If we were talking about a straight-ahead exponential curve, there can be no doubt, that would indeed be so... But we are not. The greatest proportion of growth was observed in the first years, and has steadily declined thereafter, such that the Belgian rate has now been stable at the 2% level for several years. Nor is there any reason to believe that this rate will grow (unless new presently excluded client groups are subsequently granted access).

In the Netherlands, the portrait is similar. The rate of growth was slower, but the final proportion was actually much larger because of a higher starting point. To make the relation between the two countries easy to understand : after the first five years, the Belgians showed about half the Dutch number, and the two grew in lockstep thereafter, so that, as the Belgians stabilized at approximately 2 % of all deaths being due to euthanasia, so the Dutch number plateaued at 4% or a little more.

“And that”, as they say, “is that !” : 96 % of all Dutch deaths are NOT euthanasia ; 98 % of Belgian deaths are the same ; and barring changes in euthanasia policy in those countries, these numbers may be expected to remain constant. 

I recognize that several studies have indicated a large number of un-reported euthanasia deaths in Belgium and the Netherlands, nonetheless, the same issue with under-reporting may exist in Canada.

A return to the Canadian experience

My point here, with regards to the Canadian experience, is the following: Our policy was formed in the initial years of Belgian legalization when the numbers were soaring. In the minds of Canadian euthanasia enthusiasts, at that time, it seemed giddily clear that we would be required to prepare for a veritable tidal wave of euthanasia demand, from the very moment that the floodgates of legislation were broached. In fact, Canadian policy was obviously designed to maximize euthanasia supply, as an “improvement” on the framework of our European cousins, and intended to remove certain “barriers” denounced by their most radical practitioners, in a progressive display of legislative “leap frog”.

However, as we have seen, all of this was based merely upon fanciful statistical interpretation, similar to that of the eager stock broker who is willing to blindly follow the projected rising curve of his holdings, all the way out of his 50th floor window. Moreover, the error is not blameless. Because euthanasia was legalized in Belgium in 2002, but the Quebec law (Bill 52) was only passed in 2014, Carter vs Canada was rendered 2015, and the Canadian law (c-14) passed as late as 2016. By the first of those dates the Dutch-Belgian growth curve was clearly “flattening”, and by the last, that curve already appeared stable. Unfortunately, however, it now appears that the Canadian judicial-legislative juggernaut was decisively in movement at that time, and impossible to stop, even if there were no underlying data (in 2016) to support the extreme implementation of euthanasia that was finally embraced.

Canada by the numbers

If we look now at the little we do know of Canadian trends, after three full years of legality, we see the following proportions of euthanasia as a fraction of all deaths in Canada: 2016, 0.38 %; 2017, 0.99 %; 2018, 1.49%; 2019, 2.0%

Clearly, even though the data is scant, we already seem to notice, here, the same pattern as that observed in the Netherlands and in Belgium. The rate of the second year is more than twice that of the first, but the third year is only half again that of the second. Apparently, the curve is flattening in Canada as well.

Belgium. we remember, began at 0.2% and stabilized at 2.2%. Netherlands began at 1.5% and stabilized at 4.2%. Canada began at 0.38% and has now arrived at 2% after four years. What could be more natural than to speculate on a final stabilization, somewhere between our two overseas companions, in the 2% to 4% range?

And if that is the case, what conclusion can we draw concerning current Canadian policy?

A sad portrait of quantitative over-reach

The opening paragraph of this piece consisted of what I believe to be a very substantial list of negative consequences stemming from the definition of euthanasia as basic medical care, and from the formal state promise of universal accessibility that accompanied it. This policy stands in stark contrast to that of a country like Switzerland which, by comparison, only permits assisted suicide and makes no formal declaration on the medical ethics of that practice. Our policy, obviously, is based on the projected satisfaction of a much greater patient demand than that imagined by the Swiss. But, once again: on what evidence is such a demand postulated?

It is simply not rational, I would submit, for our entire traditional practice of medicine to have been turned upside down in this way, on the basis of a maximum client demand evaluated only at something between 2 and 4 percent. Nor can that life-centered medical care, which is required, and desired, by 96% (to 98%) of patients, be rationally fragilized in such an uncompromising, obsessive resolve, to maximize the access and recourse to euthanasia. Clearly, as the expression goes: “Mistakes were made...”.

Terrible mistakes, in fact, that must now be rectified.

Gordon Friesen is a member of the Euthanasia Prevention Coalition board.