Surprising New Test for Predicting Recovery after Coma

This article was written by Nancy Valko and published on her blog on August 25, 2020.

Nancy Valko

By Nancy Valko

An April 29, 2020 Nature Journal article titled “Olfactory sniffing signals consciousness in unresponsive patients with brain injuries” found that nasal response to odors (sniffing) by 43 severely brain-injured patients predicted the likelihood of recovery and long-term survival.

According to Noam Sobel, PhD, of the Weizmann Institute of Science in Rehovot, Israel, one of the authors of the article and speaking to MedpageToday:

“If you sniff at an odorant, then it’s 100% you will regain consciousness to at least a minimal level, and you will likely live for years,” he told MedPage Today. “If you don’t sniff at an odorant, that is a bad sign, but not all hope is lost.” (Emphasis added)

Amazingly, he said that 37.5% of the unresponsive patients who didn’t sniff did eventually regain consciousness.

Dr. Giacino, PhD of Harvard Medical School who helped write the 2018 American Academy of Neurology guidance on disorders of consciousness told Medpage that this study is “a cleverly and carefully designed study that adds another much-needed tool to the consciousness-detection toolbox” even though “Between 30% and 60% of patients who sustain severe TBI (traumatic brain injury) have diminished or complete loss of smell due to the mechanics of the injury.”)

He also noted that, based on available evidence, about four in 10 patients who are deemed unconscious on bedside examination actually retain conscious awareness and that “A significant portion of these patients have covert consciousness — preserved cognitive function that cannot be expressed through speech or movement.” (Emphasis added)

Why Is This Study So Important?

As Dr. Giacino said in the Medpage article:

“Published evidence from Canada in a large cohort of ICU patients with traumatic brain injury [TBI] found that approximately 70% of the deaths were due to withdrawal of treatment and in about 60% of cases, the decision to stop treatment was made within 72 hours,” he said. “It’s possible that a positive sniff test might delay this decision, which is important since we know that about 20% of TBI patients who survive what appears to be catastrophic injury recover to a functionally-independent level by 5 years post-injury.” (Emphasis added)

As we have seen over the past decades, whether or not a severely brain-injured person is or can become conscious has become a life and death matter. We have seen this in the cases of Nancy Cruzan, Terri Schiavo and Zach Dunlap even though, as I wrote in my August 18, 2018 blog, “Medical Experts Now Agree that Severely Brain-injured Patients are Often Misdiagnosed and May Recover”.

This Issue Has Been Close To My Heart For Decades.

Just before Drs. Jennet and Plum invented the term “persistent vegetative state” in 1972, I started working with many comatose patients as a young ICU nurse. Despite the skepticism of my colleagues, I talked to these patients as if they were awake because I believed it was worth doing, especially if it is true that hearing is the last sense to go. And why not do it to respect the patient as a person?

Then one day a 17 year old young man I will call “Mike” was admitted to our ICU in a coma and on a ventilator after a horrific car accident. The neurosurgeon who examined him predicted he would be dead by morning or become a “vegetable.” The doctor recommended that he not be resuscitated if his heart stopped.

But “Mike” didn’t die and almost 2 years later returned to our ICU fully recovered and told us that he would only respond to me at first and refused to respond to the doctor because he was angry when heard the doctor call him a “vegetable” when the doctor assumed ‘Mike” was comatose!

After that, every nurse was told to treat all our coma patients as if they were fully awake. We were rewarded when several other coma patients later woke up.

Over the years, I’ve written about several other patients like “Jack”, “Katie” and “Chris” in comas or “persistent vegetative states” who regained full or some consciousness with verbal and physical stimulation. I have also recommended Jane Hoyt’s wonderful 1994 pamphlet “A Gentle Approach-Interacting with a Person who is Semi-Conscious or Presumed in Coma” to help families and others stimulate consciousness. Personally, I have only seen one person who did not improve from the so-called “vegetative” state during the approximately two years I saw him.

Conclusion

But I never even thought to give any of my patients a sniff test. What a simple test for medical professionals to do!

And even though this study is small and needs to be replicated and validated, I believe it is further evidence that we need to reevaluate our current medical ethics and laws that allow life-sustaining treatment to be withdrawn from people with severe brain injuries on the premise that such brain-injured people have no “quality of life” and that such injuries are routinely hopeless.

And I hope that the sniff test can become a standard part of all medical evaluations of people with severe brain injuries.

Euthanasia drug can cause excruciating death.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An autopsy revealed that Wesley Purkey, who died by capital punishment on July 16, 2020, died an excruciating death. 

This article does not focus on capital punishment but rather the evidence that lethal injection death by pentobarbital (nembutal), a drug used for euthanasia and assisted suicide, is not a peaceful death.

According to an article by Candace Sutton and published by News.com.au:

An autopsy performed on Purkey, it was revealed today, revealed he suffered “severe bilateral acute pulmonary oedema” and “frothy pulmonary oedema in trachea and main stem bronchi”.

This means fluid quickly entered Purkey’s lungs and trachea, causing “a near-drowning” sensation which a medical expert described as “among the most excruciating feelings known to man”.

The information from the autopsy has become public by the legal team that is trying to prevent the capital punishment death of Keith Nelson. Sutton reported:

Dr Gail Van Norman, a medical expert retained by Nelson’s lawyers to interpret Purkey’s autopsy, said the flash flood-like filling of Purkey’s lungs could only occur when a person was still alive.

“It is a virtual medical certainty, that most, if not all, prisoners will experience excruciating suffering, including sensations of drowning and suffocation from (the drug) pentobarbital,” she said.

I am concerned about the many people who die excruciating assisted deaths with Pentobarbital. 

In the past few years I have published several articles explaining how death by euthanasia or assisted suicide is not necessarily quick and is often painful.

Nembutal is also promoted by euthanasia activist, Dr Philip Nitschke, who promotes the sale of lethal drugs via the internet. Nitschke is connected to suicide websites and he is known to be importing suicide kits into the United States. Many people are purchasing, through Nitschke, lethal drugs via the internet and then die an excruciating death. No matter how its justified, this is not a dignified death.

• Prolonged painful assisted suicide deaths (Link).
• The connection between lethal injection and capital punishment (Link).
• Many assisted suicide deaths are slow and painful (Link). 
• Is lethal injection inhumane? (Link).
• Euthanasia drug execution drug controversy (Link).

The slippery slope is real says Dutch euthanasia doctor.

This article was published by Mercatornet on August 24, 2020. (edited for focus).

This article focuses on comments by Dr Bert Keizer, a euthanasia doctor in the Netherlands.

Michael Cook

By Michael Cook, editor of Mercatornet
 
Anti-euthanasia lobbyists want the public to believe in the inevitability of the slippery slope, but their fears are unwarranted, wrote a Canadian doctor earlier this year.

Where better to test this than the Netherlands?

In 2019, according to the official figures, there were 6,361 cases of euthanasia – 4.2 percent of all deaths. In other words, one out of 25 people are killed by doctors in the Netherlands. And those are just the official figures. It is widely accepted that a good number of euthanasia deaths are not reported, mostly because doctors don’t like the extra paperwork involved.

How do Dutch euthanasia doctors feel about this?

Pretty good, actually.

Writing in the NTGV, the Dutch Medical Association Journal, Dr Bert Keizer reflects on the history of Dutch euthanasia. Somewhat surprisingly, he endorses the notion that euthanasia is a “slippery slope”. Better said, he embraces it.

Dr Keizer is a Grand Old Man of Dutch euthanasia. A philosopher and a geriatrician, he now works for Expertisecentrum Euthanasie, the new name for Levenseindekliniek (the End of Life Clinic). It was born as a project of the NVVE, the Dutch Right to Die Society. He writes:

“After the turn of the [last] century, what our British colleagues had predicted years earlier with unconcealed complacency happened: those who embark on euthanasia venture down a slippery slope along which you irrevocably slide down to the random killing of defenceless sick people.”

He describes the progress of euthanasia in the Netherlands.

“And so it was with euthanasia. Every time a line was drawn, it was also pushed back. We started with the terminally ill, but also among the chronically ill it turned out to be hopeless and unbearable suffering. Subsequently, people with incipient dementia, psychiatric patients, people with advanced dementia, (high) elderly who struggled with an accumulation of old-age complaints and finally (high) elderly who, although not suffering from a disabling or limiting disease, still find that their life no longer has content. The unfortunate term ‘completed life’ was used for the problem of the latter group.”

What Dr Keizer has witnessed in his long career is the gradual but inevitable change in what doctors are willing to do for their patients. Perhaps “slippery slope” sounds too harsh, because it evokes the image of a headlong tumble down a cliff. He prefers to think of it as a gradual erosion of boundaries.

“In retrospect, it is true that we now provide euthanasia to people to whom we had said, a little indignantly, 20 years ago, ‘Come on, that is really impossible’. And looking ahead, there is no reason to believe that this process will stop in case of incapacitated dementia. What about the prisoner who has a life sentence and desperately longs for death? Or doubly disabled children who, although institutionalized, suffer unbearably and hopelessly according to their parents as a result of self-harm? I don’t believe we are on a slippery slope, in the sense of heading for disaster. Rather, it is a shift that is not catastrophic, but it does require that we continue to get involved as a community.”

This passage from Dr Keizer’s article suggests that the two sides of the euthanasia debate have zeroed in on the wrong word. Instead of arguing about whether a slippery slope exists – because they agree on that — they should focus on the meaning of “disaster”.

Obviously, if one takes the nihilistic view that death is a good thing, the more euthanasia, the better.

• Assisted death for people with dementia paves the way for non-voluntary euthanasia (Link).
• Five reasons to oppose euthanasia and assisted suicide (Link).

Woman goes to court to stop husband from assisted death

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Avis Favaro, the Medical Correspondent with CTV news, reported on the case of a woman who is trying to prevent the euthanasia death of her husband. Favaro reports:

For the first time since assisted death was legalized in Canada in 2016, a judge has ordered that a request for medical help in dying be put on hold.

(Link to the CTV video report) 

A Nova Scotia man wants to die because of a lung disease that he says has left him near the end of his life. Katherine, his wife of 48 years, is fighting that wish in the courts, calling her husband a hypochondriac who is not mentally capable of making the decision to end his life. 

The 83-year-old man has chronic obstructive pulmonary disease, which he was diagnosed with in 2003. He says he was given three years to live at that time. He also suffered a series of small strokes decades ago and was diagnosed with dementia in 2019.

On August 14 I published the article EPC needs your help to prevent a euthanasia death where I explained that EPC is financing a precedent setting court case of a woman who is attempting to prevent the euthanasia death of her husband.

Favaro explains why the case was launched:

Katherine says her husband first applied for medically-assisted death in April and was turned down, because some assessors felt he did not have the mental capacity to make that decision or that his death was not imminent. 

Katherine says the initial rejection came as a relief to her. Although she knew her husband was talking about ending his life, she felt he was operating under anxiety and delusions. 

In July a new and different group of assessors approved the man for assisted death – setting the date for August 3, which prompted Katherine to contact a lawyer and get an injunction to put her husband's death on hold. 

The issue is now before the Nova Scotia Court of Appeal. A judge set aside the injunction last week, clearing the way for the man to end his life. Katherine is appealing this decision, arguing that more psychiatric tests should be ordered before her husband is found to have a sound enough mind to request assisted death.

Hugh Scher

Favaro interviewed Hugh Scher, Katherine's lawyer, who stated:

"There's real question, based on the very conflicting medical evidence within a matter of weeks from different practitioners … as to whether or not this person truly does meet the criteria or not," 

Seven different medical assessors offered differing opinions about the man’s mental and physical state between April and July. Some found him suffering from depression and cognitive decline. Others deemed him as mentally competent. 

"I think to put somebody effectively to death … when we don't have that answer, and where the request can be made truly based on a delusion, is simply a complete violation of the rule of law in this country. I don't think it's what the Supreme Court of Canada or Parliament had in mind when it decriminalized euthanasia and ultimately required that safeguards be put in place to protect those who are vulnerable from the risks of serious abuse."

The next hearing in this precedent-setting case is August 26. Scher suggests that this case may be appealed to the Supreme Court of Canada.

"What I think this court case speaks to fundamentally is the need to have a dispute resolution process through the courts in those rare cases where there is a fundamental disagreement or conflict between multiple experts that needs to be resolved, because they're coming to completely alternate positions about the question of whether the person meets the criteria or not,"

Alan Nichols (left) with his brother.

Favaro referred to a similar situation last year in British Columbia, when Alan Nichols was found fit to request medically-assisted death despite his family arguing that he was depressed and unable to properly give consent.

Favaro asked the Helen Long from the euthanasia lobby group Dying with Dignity who stated that:

partners and other relatives do not have final say in end-of-life decisions.

Favaro also spoke to University of Toronto ethicist, Trudo Lemmens who said that this case raises questions about the safeguards in the MAiD law. He continued:

a person who “may suffer from depression, and who has an application for MAID refused for that reason by medical experts, can shop around and find more lenient physicians to get MAID.” 

“It would be an occasion for the Supreme Court to tighten the criteria and to confirm that there should be appropriate limits on the practice,”

Katherine could not have carried out the legal proceedings or filed an appeal without the financial support of the EPC. She stated that she loved her husband and that she wanted to launch a legal action to prevent her husband's wrongful death, but she could not do so without help.

EPC agreed to pay for the legal bills, but in turn, we need your financial support.

Donate to the Euthanasia Prevention Coalition by:

• Paypal (Link),
• Call the EPC office at: 1-877-439-3348 to donate by credit card, 
• Send a cheque to the Euthanasia Prevention Coalition, Box 25033, London ON., N6C 6A8.

EPC needs your donation in this precedent setting case.

Now that Canada's parliament is prorogued, what will happen to euthanasia Bill C-7?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

To protect the government from recent scandals and to prepare for a possible fall election Prime Minister Justin Trudeau announced, on August 18, that he was Proroguing parliament. The government will return on September 23 with a throne speech. 

Technically proroguing parliament "kills" the legislation that has not yet passed. Canadian tradition permits the government, after prorogation, to receive approval to return legislation to the legislative track that it was on before. The government may abandon certain legislation that they have decided does not fit within their legislative direction.

As reported by Charlie Pinkerton for IPolitics, Bill C-7 will return as a government bill after the September 23rd throne speech.

Why is Canada expanding its euthanasia law?

In September 2019, Justice Baudouin, from Quebec, struck down the requirement in Canada's euthanasia law that a person's natural death must be reasonably foreseeable. The federal government did not appeal the decision.

I reported that striking down the "terminal illness" requirement in the law opened the door to euthanasia for psychiatric conditions (Link).

On February 24, Canada's federal government introduced Bill C-7 to expand the euthanasia law. 

Bill C-7 goes much further than the Quebec Superior Court decision.

What does Bill C-7 do?

1. Bill C-7 removes the requirement in the law that a person’s natural death be reasonably foreseeable to qualify for assisted death. Therefore, people who are not terminally ill can die by euthanasia. The Quebec court decision only required this amendment to the law, but Bill C-7 goes further.

2. Bill C-7 would permit a doctor or nurse practitioner to lethally inject a person who is incapable of consenting, if that person was previously approved for assisted death. This contravenes the Supreme Court of Canada Carter decision which stated that only competent people could die by euthanasia.

3. Bill C-7 waives the ten-day waiting period if a person's natural death is deemed to be reasonably foreseeable. Thus a person could request death by euthanasia on a "bad day" and die the same day. Studies prove that the “will to live” fluctuates.

Recent statistics indicate that in 65.7% of MAID deaths, the 10-day waiting period was followed. In the 34.3% of MAID deaths where the waiting period was shortened, most practitioners (84.4%) cited imminent loss of the patient’s capacity to consent as the primary reason, with imminent death cited in 45.4% of these cases.

Bill C-7 does not need to eliminate the 10 day waiting period because the current law allows the doctor or nurse practitioner to waive the waiting period.

For instance, in November 2016 EPC reported the case of a woman who may only have had a bladder infection who died by euthanasia. Even in this case, soon after legalization, the doctor waved the 10 day waiting period.

4. Bill C-7 creates a two track law. A person whose natural death is deemed to be reasonably foreseeable has no waiting period while a person whose natural death is deemed to not be reasonably foreseeable would have a 90 day waiting period. This provision in the law will be challenged in court.

5. Bill C-7 falsely claims to prevent euthanasia for people with mental illness. The euthanasia law permits MAiD for people who are physically or psychologically suffering that is intolerable to the person and that cannot be relieved in a way that the person considers acceptable. However, mental illness, which is not defined in the law, is considered a form of psychological suffering.

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

The Canadian government must reject Bill C-7 and begin the promised 5-year review of the euthanasia law with an open view to what is actually happening rather than continuing to expand euthanasia and making Canada the most permissive euthanasia regime in the world.

• Five reasons to oppose euthanasia and assisted suicide (Link).

Other articles on this topic:

• More than 15,000 Canadians have died by euthanasia (MAiD) (Link).
• Euthanasia deaths continue to increase in Ontario Canada. (Link).
• Does Bill C-7 prevent euthanasia for mental illness? (Link).
• Stop the extension of euthanasia by Bill C-7 (Link). 
• Physically healthy depressed man died by euthanasia in BC (Link).
• Ontario doctor experiences abuse of euthanasia law (Link).

Delta BC Hospice continues legal battle to prevent euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In February 2018 the Board of the BC Delta Hospice Society was given an edict from Fraser Health to provide euthanasia (MAiD). At that time, the board of the Delta Hospice did not comply with the edict and continued its good work.

In December 2019, the Delta Hospice was then ordered to do euthanasia or lose it's government funding.

In February 2020, Adrian Dix, BC Minister of Health, gave notice that funding for the Delta Hospice would cease in February 2021 unless the Delta Hospice permitted euthanasia.
 
The Canadian Hospice Palliative Care Association and the Canadian Society of Palliative Care Physicians have stated that: Euthanasia is not consistent with the philosophy, intent or approach of hospice palliative care.

• Sign the petition: Hospice organizations must NOT be forced to do euthanasia (Link).
  

Yesterday, the Epoch Times published an article by Lee Harding concerning the current plight of the Delta Hospice Society. Harding interviewed Angelina Ireland, the chair of the Delta Hospice Society (DHS) board who stated:

The B.C. government mandated that all hospices without a religious affiliation must provide medical assistance in dying (MAiD) on-site if more than half of their funding comes from taxpayers.

The DHS, which governs the privately operated Irene Thomas Hospice in Delta, is not affiliated with any religion but is opposed to physician-assisted suicide on moral and philosophical grounds. It offered to forfeit $750,000 in annual public funding in order to continue operations without providing MAiD on-site.

However, its offer was rejected by the provincial government and the Fraser Health Authority, which has jurisdiction over publicly funded health care in the region where the hospice is located. Instead, they said funding would continue until Feb. 25, 2021, after which the hospice would lose its licence and be unable to continue operations.

The Delta Hospice

The euthanasia lobby got involved by working with local activists to sell DHS memberships to people who support euthanasia. This group were also able to obtain an injunction to prevent the DHS from having a meeting to amend their statutes to recognize the Christian beliefs of the DHS founders and its board. The BC government does not force religious institutions to participate in euthanasia.

Harding reported that on June 12, Justice Sheila Fitzpatrick ordered DHS to accept all membership applications, even though the DHS is a private institution. Harding explains:

Lawyers for DHS argued before the B.C. Court of Appeal that the hospice was a private institution, not a public one, and that if B.C.’s Societies Act permitted such an order, it would violate the Charter freedoms of association and conscience.

On Aug. 17, the court announced it would allow the appeal, but no date has been set for hearings.

The legal question concerning a private institution being required to accept all memberships goes beyond the issue of the DHS itself and is a concern for many private institutions.

Harding interviewed Alex Muir, the co-chair of the Vancouver chapter of Dying With Dignity, a euthanasia lobby group, that indicated that euthanasia access at the Delta Hospice is important. Harding reports:

“Faith-based organizations are allowed to exempt themselves from providing medical assistance in dying if it’s against their beliefs. We don’t believe that should be allowed when they are publicly funded, and we don’t believe the government should be using taxpayer dollars to allow that to happen,” Muir said.

Dying With Dignity has launched a petition signed by over 1,500 people that calls on the province to end the MAiD exemption given to publicly funded faith-based facilities. The Euthanasia Prevention Coalition has launched its own petition against forcing hospices to perform euthanasia, which has been signed by over 27,000 people.

Angelina Ireland

Harding reports that the DHS upholds that euthanasia (MAiD) and hospice care are different. Ireland stated:

“You’d think that these were 10 magical beds the way that everybody has been after us, and the government. It’s 10 beds that we’re trying to protect for palliative care in this province, and that is all we’re trying to do,” she says.

“We don’t want to battle with anybody. And we’re being forced to battle not only with the provincial government but with a campaign of euthanasia activists trying every which way they can to get into our hospice and force us to kill our patients. And that’s what we refuse to do.”

Sign the petition: Hospice organizations must NOT be forced to do euthanasia (Link).

Should Massachusetts legalize assisted suicide - (NO).

The Boston Globe published, on August 19, a Yes and a No response to the question: Should Massachusetts adopt the proposed physician-assisted suicide bill? Dr David Clive argued Yes while Dr. Laura A. Petrillo argued No.

Dr Laura Petrillo

Dr Laura Petrillo
Palliative care physician at Massachusetts General Hospital; Newton resident

Although the United States is in the throes of the greatest health and economic crisis of our era, a bill to legalize physician-assisted death has advanced through the Massachusetts Legislature, drawing on our lawmakers’ valuable time and attention.

As a palliative care physician, I wish we were focused on just about anything to improve care for seriously ill patients and their families besides this polarizing issue.

Even before COVID-19, it was clear our health care system fails people as they die. The 2014 Institute of Medicine report, “Dying in America,” revealed that patients experience fragmented care and that families are the backbone of caregiving, with limited support. Even when patients are insured, health care is expensive, driving people to ration their medications and forcing families into bankruptcy.

There is also enormous societal bias connected with aging that leads to over- and under-treatment of older adults. Ageism in turn exacerbates discrimination on the basis of socioeconomic status, since inequality leads to earlier and greater effects of aging among patients from disadvantaged groups.

Our flawed health care system, steep medical costs, and ageism all contribute to interest in physician-assisted death, which proponents term “death with dignity.” The implicit message is that being sick is pitiful and burdensome. Indeed, in Oregon, where physician-assisted death has been legal since 1997, 59 percent of those who ended their lives in 2019 cited as one reason concern about being a burden to family and friends. In addition, 7.4 percent of patients mentioned financial implications of treatment as a motivating concern.

We have an urgent responsibility to improve the experience of dying so no one feels the only option to maintain their dignity is to hasten their death. In an optimal system some may still make that choice, but we are a long way away from an optimal system, and COVID-19 has only worsened financial strain and stigmatization of older adults as a burden on society. I hope the proposed bill is not adopted and that instead we focus more broadly on fixing our current health care system and providing relief and protection to individuals and families in this time of crisis.

Nova Scotia woman seeks to prevent her husband's death by (MAiD) euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Nova Scotia media has reported on the case of the woman who is trying to prevent the euthanasia death of her husband of 48 years.

The Euthanasia Prevention Coalition needs your help to pay the legal expenses in this precedent setting case. (Link).

A few weeks ago, EPC received a call from a woman who was upset that her husband of 48 years had been approved for MAiD (euthanasia), even though he was not seriously ill or dying. Her husband has a chronic condition (COPD) and a few other health concerns that are not uncommon for an older man. She is also concerned that her husband claims to have other health issues, but in fact there is no proof that he has these conditions.

Taryn Grant reporting for CBC news Nova Scotia wrote:

A Nova Scotia woman has gone to court to intervene in her husband's plans to die. 

While he says he's suffering and near the end of his life because of advanced chronic obstructive pulmonary disease (COPD), she says his wish to die is not based on physical illness, but anxiety and mental delusions. 

The man was approved and scheduled for medical assistance in dying (MAID) in July, but his wife applied for a permanent injunction from Nova Scotia Supreme Court, forcing him to pause his plans. She also applied for an interlocutory injunction, which would bar him from a medically assisted death until the final ruling on a permanent injunction.

The injunction was denied last Friday.

Hugh Scher, a lawyer representing the woman, told CBC he's already filed an appeal, which is to be heard in the high court next week (August 26). The man's plans to die will be forestalled at least until the appeal proceedings are complete. 

There is no publication ban tied to the case, but (Justice) Rosinski does not name the couple or give full names of the medical professionals involved in the case. 

CBC is also not naming those involved in the case at this time.

Grant reports on the conflicting medical and expert reports:

The man in this case was assessed by two nurse practitioners, a psychiatrist, a respirologist and three physicians between April and July to consider his request for MAID. 

Rosinski considered reports from those seven medical professionals, as well as an affidavit — submitted by the woman — from a person who diagnosed her husband with hypochondria. 

That person graduated from Dalhousie University's medical school in 1993, but he is no longer a licensed physician, and so Rosinski said he gave his affidavit "minimal weight" compared to the opinions and observations of licensed doctors. 

While none of the licensed medical professionals cited in the case suggested hypochondria, they did bring up mental illness including depression, anxiety and  dementia. 

Some of them said that despite signs of those conditions, he was still perfectly capable of consenting, while others said he should not be allowed to make the decision to die. 

The man's physical condition was similarly disagreed upon, with some saying his lung disease was relatively stable and others saying they would not be surprised if he were to die within the next month.
But the three physicians who provided the man's final assessments agreed that he was fit to decide his fate, and that he he was frail and ill enough to qualify for MAID. 

Scher said the conflicting reports show the need for a fulsome judicial review of the man's request to die. 

Rosinski noted that this hearing did not see all the evidence in the case "in a full and robust fashion," because it was not the final stage of hearing. But, he said, the evidence he did see didn't meet the threshold for an interlocutory injunction. 

While it's a serious matter that could cause irreparable harm, Rosinski wrote, the balance of harm weighed more heavily on the man, should the injunction be granted, than it would on his wife if it were not.

Grant reports that a full-hearing of the case will likely occur in the Spring of 2021.

Rosinski said the full hearing hadn't been scheduled and an early and optimistic start date would be late fall, likely to carry into spring 2021. 

Rosinski said the case may be the first of its kind disputed in Nova Scotia, Scher said it could set an important precedent for judicial oversight in MAID.

EPC needs your financial help to pay for the costs in this precedent setting case.

This woman could not have launched the legal proceedings and file an appeal without the financial support of the Euthanasia Prevention Coalition. She loves her husband and she launched the legal action to prevent her husband's wrongful death.

EPC agreed to pay for the legal bills, but in turn, we need your financial support.

Donate to the Euthanasia Prevention Coalition (Link) by:

• Paypal (Link),
• Donate by credit card by calling the EPC office at: 1-877-439-3348, 
• Send a cheque to the Euthanasia Prevention Coalition, 
• Box 25033, London Ontario Canada N6C 6A8

Thank you for considering EPC in this precedent setting case.