Disabled Lives Are Worth Living!

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition (EPC)

The New York Center for Disability Rights is a disability-led service and advocacy organization that works with people with disabilities, of all ages, who live in the community.

The New York Center for Disability Rights is raising money to develop to hire an advocate who will work to organize the disability community response in opposition to assisted suicide in New York and to develop a public awareness campaign.

Link to the Go Fund Me - We Want to Life campaign.

Why does the New York Center for Disability Rights oppose assisted suicide?

Assisted suicide is a deadly expression of ableism -- the belief that people with disabilities are less than non-disabled people. Less worthy of care. Having less dignity. Less worthy of life. These beliefs are all around us. Whether we are old or young, terminal or not terminal, when assisted suicide is legal, these discriminatory beliefs will cause people with disabilities to be killed against their will and without their consent.

Link to the Go Fund Me - We Want to Life campaign.

EPC urges people to support this worthy campaign and to support the important campaigns organized by Not Dead Yet and Toujours Vivant - Not Dead Yet in Canada.

Wesley Smith: Why we cannot reach compromise

This article was published by First Things on December 11, 2015.

Wesley Smith

By Wesley Smith

The other day, I read a column in the National Post that made my stomach turn. It wasn’t the quality of the writing, which was quite good, but the content. The writer celebrated a recent Canadian Supreme Court ruling that determined lethal-injection termination is a charter right. As a result, euthanasia will soon be bureaucratized and normalized—made banal—in Canada:

Sooner or later, death will become a civil servant. He will operate in the open, during business hours, with a budget and a boss. His work will be humanized and bureaucratized. Death will be licensed, regulated and empowered by law to solve a public policy problem—the unacceptability to certain people of certain types of dying.This marks a major shift in the meaning of death, from ineffable human destiny to legislated human right....

This argument elevates absolute personal autonomy and the prevention of suffering to the highest purposes of human society. That such a value system includes eliminating the sufferer is seen not as a vice, but as a virtue.

This positive view of euthanasia is antithetical to everything I believe. I first described my views about medicalized killing in a 1993 Newsweek column, in reaction to the suicide of my friend Frances under the influence of the Hemlock Society’s pro–assisted suicide literature:

It is a cause I now deeply despise. Not only did it take Frances, but it rejects all that I hold sacred and true: that the preservation of human life is our highest moral ideal; that a principal purpose of government is as a protector of life; that those who fight to stay alive in the face of terminal disease are powerful uplifters of the human experience.

My purpose in today’s column isn’t to convince readers to adopt my opinion. Rather, I intend to illustrate why the West is increasingly incapable of engaging in true debate, achieving broad consensus, and reaching compromises about our most important controversies.

A debate, it seems to me, requires a baseline commonality of fundamental values and desired goals. Sharing a common ethical understanding and seeking mutually compatible ends, debaters contest the best means to attain the mutually desired goal. For example, in my youth, there were many debates—some of them quite bitter—between liberals and conservatives, “doves” and “hawks,” over how to win the Cold War. But there was no fundamental disagreement about the imperative of our prevailing over the Soviet Union.

Contrast those Cold War debates with the current discord over euthanasia. Where is there room for debate or compromise between two incompatible worldviews? Those arguing about euthanasia are speaking two different moral languages.

Let me give an illustration of what I mean. Several years ago, I was invited to an international bioethics conference as a panelist on euthanasia. My co-panelist was a Dutch ethicist who supported his country’s liberal legalization regimen. We sparred courteously for an hour, and although the discussion remained cordial, we found no points of agreement, either on means or ends.

At the end of the convention, one participant—a UN bureaucrat—told me angrily that many people were upset because I was not willing to engage in “conversation.” I was surprised. “I flew 6,000 miles to engage in conversation,” I replied. “I have respectfully listened to opposing views and been civil in presenting my own opinions.”

“But you refuse consensus,” he complained. That’s when I realized that I hadn’t been invited to discuss and defend my viewpoint. Instead, I was brought there to reach an agreement, to find a compromise, by accepting “a little euthanasia” as the middle ground. But that was a fool’s errand—for me, a little euthanasia is still euthanasia.

Give-and-take is possible when the subject is something technocratic, like tax rates or the proper speed limit, or when the debaters agree on ends. But for matters involving bitter differences over fundamental values, or, to borrow a term, issues that derive from or impact “first things”—abortion, religious liberty, sexual and gender controversies, the death penalty, terrorism and war—“compromise” is unachievable, because accord would require one side to surrender its moral views to the other.

That leaves us tolerating different opinions—increasingly our default setting—rather than engaging in fruitful debate as a true community. But we aren’t that community anymore. This does not mean that our estrangement will last indefinitely, but it does mean that society will have to choose between contesting and incompatible worldviews. As Lincoln put it so well about the slavery crisis that roiled his time: “I do not expect the house to fall—but I do expect it will cease to be divided. It will become all one thing or all the other.”

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism. His next book, Culture of Death: The Age of “Do Harm” Medicine, which will be published in 2016.

Korean has not legalized euthanasia or assisted suicide

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The Korean Times reported that the National Assembly Health and Welfare Committee voted in favor of a "death with dignity" bill.

In the western world "death with dignity" is a euphemism for euthanasia or assisted suicide.

Korea has not legalized euthanasia or assisted suicide but rather Korea is passing a law outlining the rules for withholding or withdrawing of medical treatment. The Korean Times reported:

The bill addresses the needs of dying patients. Life-sustaining treatment, such as CPR, artificial respiration and cancer-fighting drugs, will be withheld from such patients. 

Such treatments could be stopped if a patient expresses the clear intention of not being willing to receive them while still being sentient. The patients can write orders for their physicians about life-sustaining treatments (POLST) or advanced directives (AD). 

If the patients become unconscious, doctors can check their POLST and stop treatment. Or at least two members of a family can testify that a patient prefers death with dignity and at least two doctors should confirm it. 

When it is impossible to figure out what the patient thinks about life-sustaining treatment, it requires parental consent in the case of minors, and consent from all family members when adults are the patients. 

If a patient is without family, the bill said the hospital's bioethics committee could make the decision.

The article refers to the withholding or withdrawing of medical treatment as passive euthanasia. This is an unfortunate use of a false and confusing term.

The withholding and withdrawing of medical treatment has been debated in Korea for many years.

To withhold or withdraw medical treatment from a person who is dying is not euthanasia or assisted suicide. When treatment is withheld or withdrawn, the patient may or may not die, but if the patient dies they die of their medical condition, which is a natural death. 

Important: The withholding or withdrawing of medical treatment must be differentiated from the withholding and withdrawing of basic care from a person who is incompetent and not otherwise dying. To intentionally deny basic care to a person who is not otherwise dying (such as food and water) is ethically the same as euthanasia. The person dies from intentional dehydration rather than dying from their medical condition.

Is the Québec law euthanasia or assisted suicide.

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Those who follow the Euthanasia Prevention Coalition (EPC) newsletters and blog will know that in June 2014 the Québec government legalized euthanasia, not assisted suicide in a manner that is similar to the Belgian euthanasia law, by claiming that lethal injection is a form of medical treatment.

Many Canadians remain confused about the Québec euthanasia law. Graeme Hamilton, the National Post's Québec corespondent, explained in his December 11th article what Québec's "Medical-aid-in-dying" law (Bill 52) actually says. Hamilton wrote:

Is it euthanasia or assisted suicide that Quebec has legalized? 

Under the Quebec law, physicians will administer lethal injections to consenting patients. Quebec calls this “medical aid in dying,” but it is more commonly known as euthanasia. Assisted suicide, which is currently legal in three American states, occurs when a physician provides a patient with lethal medication that the patient uses to end his or her own life. Quebec considered but rejected the legalization of assisted suicide, concluding that it was preferable to have the physician administer the medication. 

How might a federal law differ from what Quebec has done? 

Ottawa has been spurred to action by last February’s Supreme Court of Canada ruling, which invalidated the Criminal Code prohibition of physician-assisted death. The high court gave the federal government and provinces one year to come up with new legislation, but Ottawa has requested a six-month extension and it has not indicated whether it will opt for euthanasia or assisted suicide.

Clarification: The dangerous Supreme Court decision struck down Canada's assisted suicide law (Section 241b of the Criminal Code) and offered limited reasons as to when euthanasia could be legal.

Therefore, "medical-aid-in-dying" in Québec is euthanasia. The Québec government published euthanasia guidelines, that disability rights leader, Amy Hasbrouck, explains are clear as mud.

On December 4, Canada's federal government requested a six-month extension to enable them to legislate on the issues of euthanasia and assisted suicide. 

EPC intervened in the Carter case at all levels and has submitted its legal analysis to the Supreme Court whereby EPC agrees with the six-month extension and we oppose the request by the Québec government that they be exempt from the six-month extension.

Status of Québec Euthanasia Law Remains in Flux

Press Release - December 10, 2015

On December 9, 2015 the Québec Court of Appeal granted permission for Québec to appeal a declaration rendered by the Québec Superior Court on December 1, 2015, which rendered inoperable the euthanasia provisions set out in the Québec euthanasia law, finding that they were in conflict with existing Criminal Code prohibitions against homicide. 

The Court of Appeal made it clear that it was not making any decision on the merits of the case, but did note that the issues raised by the case are of significant public importance and should be addressed swiftly. A hearing has been scheduled for December 18, 2015 to address the appeal, putting in flux the status of the Québec law, which was to come into effect on December 10, 2015.

As such, a doctor in Québec can still be prosecuted if they participate in an act of euthanasia.

In February 2015, the Supreme Court of Canada in Carter v. Canada (Attorney General), found that existing laws against homicide and assisted suicide to be unconstitutional, but kept those laws in effect and gave Parliament one year to enact a new law that provides for a regime of effective oversight and safeguards.

The Euthanasia Prevention Coalition (EPC) was an intervenor at all levels of court in the Carter case and is also an intervenor before the Québec Court of Appeal in D’Amico c. Procureure générale du Québec.

EPC's position in the D'Amico litigation is that Québec's euthanasia law goes beyond the jurisdiction of the Province of Québec and falls under the jurisdiction of the Parliament of Canada. The intentional killing of patients by doctors is not medical treatment or health care, and the lack of before the death oversight represents a fatal flaw in the proposed Québec law that puts the safety of the public at risk, contrary to s.7 of the Charter.

EPC Counsel, Toronto Constitutional Lawyer, Hugh Scher states:

A national approach to the regulation of assisted suicide is the only way to avoid an inconsistent patchwork quilt of regulation of assisted suicide laws across Canada, which could leave Canadians at risk.

EPC Executive Director, Alex Schadenberg states:

The Federal Government could take a very different approach to regulation than the much riskier regime of euthanasia that has been endorsed in Québec, which is similar to the Belgian regime, where deaths without request have occurred, and where a lack of compliance with the enacted safeguards is evident.

EPC Vice President, Amy Hasbrouck notes that:

The Supreme Court’s conclusion that assisted suicide could be legalized safely is predicated on the notion of strong federal regulation. The lack of a comprehensive national response to these issues risks sowing incoherence, an approach that would put all Canadians at risk.

The Federal Government has indicated its intention to hold all-party Parliamentary Committee hearings to study and respond legislatively to the Supreme Court’s ruling in Carter.

For more information contact:

Hugh Scher (Toronto), EPC Legal Counsel (416) 816-6115 or hugh@sdlaw.ca

Alex Schadenberg (London), EPC Executive Director (519) 851-1434 or info@epcc.ca

Amy Hasbrouck (Montreal), EPC Vice President (450) 921-3057 or tigrlily61@gmail.com

Quebec's attempt to oust federal govt over assisted suicide troubling

This article was published by Advocate Daily on December 10, 2015

Hugh Scher

A national approach to the regulation of assisted suicide is the only way to avoid an inconsistent patchwork quilt of assisted suicide laws across the country, which could leave Canadians at risk, says Toronto health, human rights and constitutional lawyer Hugh Scher.

The Quebec Court of Appeal has said it will hear arguments from all sides later this month on a provincial law allowing euthanasia following a recent Quebec Superior Court decision — D'Amico c. Procureure generale du Quebec — suspending key aspects of the legislation.

The Quebec euthanasia law is now in a state of flux until the Dec. 18 appeal hearing.

News of the appeal came just days after Justice Michel Pinsonnault ruled that key pieces of the Quebec law, which were adopted in June 2014, clash with existing federal criminal laws against homicide. In permitting the appeal to proceed next week, the Court of Appeal was clear it was making no ruling on the appropriateness of the order of the Superior Court to suspend its operation.

The judge noted that last February’s Supreme Court of Canada decision carving out exceptions to the Criminal Code prohibitions that ban physician-assisted suicide — Carter v. Canada (Attorney General), 2015 SCC 5 — gave Parliament one year to legislate new rules to give effect to the ruling. Ottawa has since asked for an extension, which would bump the response time from one year to 18 months.

Scher represents the Euthanasia Prevention Coalition, which acted as an intervener at all levels in Carter and is also an intervener before the Quebec Court of Appeal in D'Amico.

“Quebec's attempt through its euthanasia law to oust the federal government’s jurisdiction — which has been clearly and historically recognized by the Supreme Court of Canada to regulate the area of euthanasia and assisted suicide — is a troubling abuse of Canadian constitutionalism,” says Scher, a well-known voice in the end-of-life care debate.

Scher has acted as counsel to the Euthanasia Prevention Coalition in several high-profile cases including Rasouli v. Sunnybrook Health Sciences Centre, 2011 ONCA 482 (CanLII); Cuthbertson v. Rasouli, 2013 SCC 53, [2013] 3 S.C.R. 341; Bentley v. Maplewood Seniors Care Society, 2014 BCSC 165 (CanLII); Bentley v. Maplewood Seniors Care Society 2015 BCCA 91; Carter v. Canada (Attorney General), 2012 BCSC 886 (CanLII); Carter v. Canada (Attorney General) 2013 BCCA 435 (CanLII); and Carter v. Canada (Attorney General), 2015 SCC 5.

“The Supreme Court of Canada has ruled that an exception should be carved out of criminal law with respect to assisted suicide for people experiencing incurable conditions and intolerable suffering who choose assisted suicide," says Scher. 

“It has indicated that the federal government should seek to implement a series of carefully tailored safeguards in order to protect against the serious risk of abuse to all Canadians in the event that assisted suicide or euthanasia are left unchecked.” 

Scher says, “Quebec now seeks through its euthanasia law to occupy the entire sphere of regulation related to assisted suicide and euthanasia and through its actions, attempts to exclude the federal government from occupying and regulating the jurisdiction over euthanasia and assisted suicide, which the Supreme Court acknowledged was appropriate, as Parliament has done for more than 150 years.”

The fact that the federal government is seeking to take appropriate time to review and respond comprehensively to the Supreme Court decision, says Scher, “does not give the Province of Quebec or any other province licence to exclude the jurisdiction of the federal government merely because of the fact that the province acted first.”

Scher will be asking the Supreme Court of Canada and the Quebec Court of Appeal to recognize and allow Parliament to exercise its proper jurisdiction over this subject matter, particularly with regard to the need for before-the-fact adjudicative oversight to assess and identify vulnerability and ensure compliance with federally-established safeguards.

Belgium: Experts call for the removal of euthanasia on the grounds of psychological suffering

This week 65 Belgian professors, psychologists and psychiatrists signed the open letter below. It has been translated from the Flemish version published in De Morgen and informed by the translation by Trodo Lemmens.

Open letter: Death as therapy?

Remove euthanasia on the ground of purely psychological suffering from the law

Ariane Bazan (clinical psychologist, Free University of Brussels), Gertrudis Van de Vijver (philosopher, University of Ghent) and Willlem Lemmens (ethicist, University of Antwerp) wrote this open letter on behalf of 65 professors, psychiatrists and psychologists.

8 December 2015

We, representatives of various relevant occupational groups, are alarmed about the increasing trivializing of euthanasia on the ground of psychological suffering only.

For the first time since the law was put into effect in 2002, a decision to allow euthanasia – the case of Dr Marc Van Hoey – has been challenged by the evaluation committee and forwarded to the judiciary. The Australian broadcaster SBS made a documentary about this euthanasia case and the conversations between the patient and the doctor. The Economist also published a poignant video report (24 and Ready to Die) on a 24-year-old young lady from Bruges who was granted euthanasia on grounds of psychological suffering, but ultimately declined its execution.

In our open letter in the Artsenkrant “Doctors’ Newspaper” (September 2015) we noted the legal uncertainty of a doctor approving euthanasia based solely on psychological suffering. In this opinion piece we want to draw attention to its specific problematic character, and in particular the fact that it’s impossible to objectify the hopelessness of psychological suffering.

One would expect that this incurability is founded on indications of for example, organic injury or tissue damage – in other words, factors that are independent of what is subjectively felt and thought about the illness. Such objectification is problematic in relation to psychological suffering.

Let’s be clear: psychological suffering is real and can be at least as severe as physical suffering. However, specific to mental suffering is the fact that you can rely only on the word of the sufferer to estimate it. And this is a good thing, because he or she is the only one who knows how much it hurts at that moment. At that moment… because when we suffer psychologically, we are often convinced that no other future is possible anymore. It is often precisely this thought that pushes a person into an abyss, because as long as there is perspective, a person can usually tolerate much.

We see that some who are at first declared incurably ill, eventually abandon the notion of euthanasia because new perspectives appeared. In a paradoxical way, this proves that the illness cannot be called incurable.

Nowadays depression is the most common mental illness: the World Health Organization estimates that one in seven people experience serious depression at some point. If we connect these figures to the fact that hopelessness is one of the central characteristics of a depressive phase, it is clear that feelings of hopelessness are not in any way in proportion to the actual hopelessness of a situation.

In contrast to illnesses that are the consequence of tissue damage, mental suffering is associated with a change in functioning – not a deterioration of tissue. This difference is essential, because such dynamic changes, by definition, can revert and do so sometimes quite suddenly. Thus we see that some who are at first declared incurably ill and granted permission to receive euthanasia on that basis, decide they don’t want euthanasia anymore because new – albeit fragile – perspectives have appeared.

In a paradoxical way, this proves that the illness cannot be called incurable. The subjective assessment of one’s own perspective with regards to mental suffering is therefore no reliable ground for making an “incurable” verdict.

The conclusion is clear: the current law assumes wrongly that there are objective clinical criteria with regard to psychological suffering that could justify euthanasia. It is for this reason that euthanasia on the grounds of psychological suffering alone cannot be regulated by law.

Some also defend the proposition that the mere offering of death as an option can lead to a positive change and that it could therefore be considered a component of good care. In our view, it automatically means the radical failure of the mental health sector. The use of ‘death as therapy’, possibly up to the actual execution of euthanasia, implies an a priori renunciation of what therapy still can and should be: the inexhaustible opening up of new perspectives.

As representatives of the various directly-involved professional groups, from different parts of the country and across classic ideological fault lines, we are alarmed by the increasing trivialisation of euthanasia on the grounds of psychological suffering alone. We believe that this situation is intrinsically linked to the fact that the law is based on subjective criteria.

Therefore we urge that euthanasia based on purely psychological suffering be removed from the current legislation.

Signatories:

Code Black: Québec Euthanasia - Kill and Conceal

By Jean Echlin 
President - Euthanasa Prevention Coalition

Quebec’s euthanasia experiment that was scheduled to begin on December 10, 2015 is the only law in the world which attempts to coerce physicians and palliative programs into providing euthanasia. Thankfully, a Québec Superior Court Justice prevented the launch of euthanasia in Québec based on its conflict with the federal Criminal Code. 

The methods used by the Quebec government and the Quebec College of Physicians are bullying, threatening and abusive to doctors and agencies providing palliative care. These words come from a report that was written after the recent “Euthanasia Symposium: Theory and Reality about Euthanasia” held in Montreal October 31, 2015, sponsored by The Physicians’ Alliance Against Euthanasia; Living with Dignity network and the Euthanasia Prevention Coalition. Included in the report:

• Physicians around the world have always rejected euthanasia as a public safety hazard driving people to throw away years of their lives.
• It provides caregivers and heirs with enormous power. The illusion of control will erode medical diligence in the care of people chronically disabled and acutely disabled by illness. 
• Suffering is feared by most people at the end-of-life. We must find less dangerous options to constant availability of “death on demand.” For the small minority of patients for whom other options are not completely effective, palliative sedation can answer all symptom control problems.

The existing 29 palliative care centres in Quebec said NO to medically assisted death. The University of Montreal Hospitals (CHUM) stated that euthanasia will not be provided in its’ palliative care department.

Following refusals to euthanize by doctors and palliative care agencies, Dr Gaétan Barrette, the Québec Minister of Health and Social Services suggested that the government would cut subsidies to all palliative care centres in Quebec after all decided not to offer euthanasia.

The most significant feature is that the Quebec College of Physicians “Practice guidelines for medical aid in dying” orders the doctors to falsify the cause of death on the official death certificate required by the Public Health Act, for patients who die by euthanasia called “medical aid in dying” (MAD). Instead doctors must write the disease/condition which justified the MAD. This runs contrary to the Public Health Act Regulations that stipulates “the cause of death must be indicated in the most accurate manner possible.” This practice constitutes a breach of ethics and will lead to serious abuse and distort official statistics on actual causes of death in Quebec.

Euthanasia is homicide not medical care. We must listen to the majority of physicians and our hospice palliative care programs. We can ill afford to lose either.

Jean Echlin, RN, MScN
Nurse Consultant-Palliative Care & Gerontology
Adjunct Associate Professor, Faculty of Nursing
University of Windsor, Windsor, Ontario

Alberta Physicians group supports assisted death for minors and forcing doctors to refer patients to death.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Trevor Theman

The College of Physicians and Surgeons of Alberta approved a advisory document for doctors who participate in assisted death. The new document is based on a consultation document that was circulated in September 2015. 

According to Global News, advisory document approves assisted death for minors and it forces doctors to refer their patients to death.

CPSA Registrar Dr. Trevor Theman said there’s no strict age limit on the requirement for consent, suggesting medical procedures aren’t typically based on age. 

“It’s somebody who would not yet be of adult age, who is fully capable of understanding the options and the choices that are available–and the consequences of each–and is understood to have the capacity to make that decision,” he said. 

Theman said doctors will still be able to opt out of providing assistance to patients who wish to die, but must provide patients with access. 

“If I, as a physician, choose not to assist my patient, I need to make sure my patient has access and is not disadvantaged from gaining access to legally available procedures,” Theman said.

The slope is slippery. Canada has not yet decriminalized assisted dying and the federal government has asked the Supreme Court for a six-month extension to legislate and yet the Provincial College's of Physicians and Surgeons are already expanding the criteria for killing and throwing doctors who oppose killing their patients "under the bus" by requiring them to refer their patients to death. 

The College of Physicians and Surgeons of Alberta is now seeking input concerning standards of consent.

Killing by lethal injection or prescribing lethal concoctions of drugs is not and will never be healthcare.

Canada's Minister of Justice asks Supreme Court for extension on assisted suicide legislation.

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Minister of Justice and Attorney General of Canada, the Hon Jody Wilson-Raybould, yesterday, asked the Supreme Court of Canada for a six-month extension to enable the government to legislate in response to the Supreme Court of Canada Carter decision.

The Euthanasia Prevention Coalition (EPC) supports the request of the federal government for a six-month extension on Canada's euthanasia and assisted suicide laws. We question whether six-months is a sufficient time-frame to accomplish its legislative task?

The Supreme Court of Canada, on February 6, 2015, gave parliament 12 months to legislate, or fill the void created by their decision. The Department of Justice News Release states:

Following through on its commitment to Canadians, the Government will establish an all-party special parliamentary committee to make recommendations on a federal government response. 

While it is true that an extension of the suspension will mean that some Canadians will have to wait to access physician-assisted dying, it is necessary - and responsible - to ensure that sufficient protections are in place across the entire country.

The extension, if granted by the SCC, will allow all parliamentarians to study the issue and engage with Canadians in a meaningful way. The Government's response will follow quickly, and will be informed by the extensive work of the federal external panel, the work undertaken by the Quebec government in developing its own important legislation, the provincial-territorial expert advisory group, and medical colleges and associations, as well as by all parliamentarians and their essential consultations with Canadians.

On December 1, Justice Michel Pinsonnault, of the Québec Superior Court, prevented the December 10th launch of the euthanasia law. Justice Pinsonnault found that as long as the provisions of the Criminal Code are in place, a Québec physician administering euthanasia under the provincial law would be committing a crime. Based on this decision, Québec cannot launch its euthanasia program until the Federal government has legislated on the issues.

The Québec government has stated that it ask the Supreme Court to request that the Québec euthanasia law be exempt from the extension.

EPC opposes the Québec government receiving an exemption from the six-month extension.

The Québec law defines euthanasia (lethal injection) as a form of 'medical aid in dying.' Justice Pinsonnault correctly stated that 'medical aid in dying' is a euphemism for euthanasia.

• Québec Superior Court decision stops December 10 launch of Québec euthanasia law.
• Medical aid in Dying in Québec is euthanasia.
• Québec's assisted dying law in conflict with Criminal Code, Judge.
• Québec's euthanasia regulations are clear as mud.

Quebec’s assisted dying law in conflict with Criminal Code: judge

This article was published by Advocate Daily on December 3, 2015

Hugh Scher

A Quebec Superior Court justice has rightly found that a provincial law allowing medically assisted suicide in certain circumstances contradicts provisions in Canada's Criminal Code and therefore cannot take effect as planned, says Toronto health, human rights and constitutional lawyer Hugh Scher.

Justice Michel Pinsonnault ruled that key pieces of the Quebec law, which was adopted in June 2014 and set to come into force Dec. 10, conflict with existing federal criminal laws against homicide, reports the National Post.

The judge noted that last February’s Supreme Court of Canada decision carving out exceptions to the Criminal Code prohibitions that ban physician-assisted suicide — Carter v. Canada (Attorney General), 2015 SCC 5 — gave Parliament one year to legislate new rules to give effect to the ruling.

The deadline for Parliament to respond to the ruling was Feb. 6, 2016, but a six-month extension has been requested.

Pinsonnault found that as long as those provisions are in place, a Quebec physician administering euthanasia under the provincial law would be committing a crime, says the Post.

The judge ordered the suspension of the articles of the Quebec law concerning euthanasia until the Criminal Code is changed, the report continues.

“In essence, the ruling states that the present situation around palliative care in Canada renders informed decision-making impossible in Quebec,” says Scher, who has argued against the Quebec law while representing the Euthanasia Prevention Coalition. 

“Our position is that this law is clearly in conflict with existing federal laws and that health care and medical treatment do not include the intentional killing of patients by doctors. This is a matter that falls under federal criminal law — it is not a provincial issue.”

Pinsonnault’s ruling came in response to a request by two individuals — the head of the Quebec Coalition of Physicians for Social Justice and a woman living with life-threatening disabilities — for an injunction to contest the provincial law.

The judge did not grant the injunction, reports the Post, but instead ruled that the provincial law must be in line with federal laws, which take precedence, and since those have not yet been changed to reflect the Supreme Court ruling on assisted-suicide, the Quebec law cannot take effect.

“The notion that a provincial government should be able to trample on what has historically been federal jurisdiction and in effect unilaterally declare that the intentional killing of patients by doctors is health care is extremely problematic,” says Scher, a well-known voice in the end-of-life care debate.

Scher has acted as counsel to the Euthanasia Prevention Coalition in a myriad of high-profile cases including Rasouli v. Sunnybrook Health Sciences Centre, 2011 ONCA 482 (CanLII); Cuthbertson v. Rasouli, 2013 SCC 53, [2013] 3 S.C.R. 341; Bentley v. Maplewood Seniors Care Society, 2014 BCSC 165 (CanLII); Bentley v. Maplewood Seniors Care Society 2015 BCCA 91; Carter v. Canada (Attorney General), 2012 BCSC 886 (CanLII); Carter v. Canada (Attorney General) 2013 BCCA 435 (CanLII); and Carter v. Canada (Attorney General), 2015 SCC 5.

“The federal government has been called to action by the Supreme Court of Canada in order to regulate these matters and impose a level of national standards and safeguards aimed at preventing abuse and risk to vulnerable Canadians that would inevitably ensue in the event of legalization,” says Scher. “As such, Quebec’s attempt to take over the entire area of jurisdiction under the health-care rubric is problematic and contrary to Canadian constitutional principles.”

It is imperative, says Scher, that the provincial legislation be put on hold until the federal government has an opportunity to respond to the Supreme Court decision in Carter.

Superior Court calls the Government of Québec to Order

This article was published by Living with Dignity on December 3, 2015.

In a decision rendered on December 1st, the Superior Court of Quebec calls to order the Quebec government that attempted to have "medical aid in dying" recognized as a medical care while in practice, as highlighted by the Court, it is indeed euthanasia of human beings.

Consequently, it declares inoperative all the articles of the Act respecting end-of-life care (the "Act") related to "medical aid in dying" that were to come into force on December 10 until the effective date of the Declaration of invalidity of Articles 14 and 241b) of the Criminal Code issued by the Supreme Court of Canada in the Carter decision.

As the Superior Court said, "the fact of qualifying assisted suicide and euthanasia of a human being with another name, a euphemism, namely medical aid in dying, could not have the effect of automatically exempting from the application of a federal law a gesture or an act specifically prohibited by Articles 14 and 241 b) of the Criminal Code and to confer immediately to Quebec jurisdiction over medical aid in dying under the pretext that it was therefore health care that would be part of the continuum of other health care administered to a patient. " (at para. 122). The Court recalls that in Carter, "the Supreme Court did not rule that assisted suicide was in some cases medical care..." (at para. 129).

Furthermore, the Court continues: "... to add the word medical to the term aid in dying cannot have by itself the effect of sheltering provincial legislative provisions that are incompatible with federal legislation in criminal matters, a jurisdiction conferred exclusively to the federal Parliament by the Constitution. "(at para. 139). And the Court states that from the patient's perspective, he or she may not request medical aid in dying without infringing Article 14 of the Criminal Code and, from the point of view of the physician administering medical aid in dying, he may be guilty of a criminal offense and the simple refusal by the physician to provide medical aid in dyingis insufficient since he or she has the obligation to transfer the request to ensure its realization (at paras. 146, 147, 152).

And the Court finally added some very scathing words about the position taken by the Government of Quebec: "To deny this glaring inconsistency is to deny the obvious" (at para. 167). The Court recalls that Quebec participated in the hearing of theCarter case, and that the Supreme Court did not accept Quebec's position to the effect that "the provincial power over health excludes the power of the federal Parliament to legislate on physician-assisted dying". (at para.170 quoting para. 53 of the Carter decision)

This is also the first court decision that corrects this manipulation of language that was purposely committed by the Quebec government in order to evade its euthanasia program contained in the Act from the context of criminal law that must apply everywhere across Canada.

Thus, the Court agrees with Dr. Paul Saba and the Coalition of Physicians for Social Justice, Living with Dignity, the Physicians’ Alliance against Euthanasia, the Euthanasia Prevention Coalition and the vast majority of palliative care doctors who have always stated publicly that "medical aid in dying" was a euphemism to legalize euthanasia.

With this clarification by the Quebec Superior Court, one cannot hide behind the obligation to provide "medical care" in order to force Quebec physicians to participate, directly or indirectly, in the euthanasia of human beings, as provided by those provisions of the Act dealing with “medical aid in dying” which were to come into force on December 10.

The Attorney General of Canada has also demonstrated her "concern that the provisions of Article 31 of the Act [of Quebec] which requires physicians who refuse a request for medical aid in dying to participate, despite their objection, in the process of finding another physician willing and consenting to perform the act".

'Medical aid in Dying' in Québec is Euthanasia

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

In his decision on December 1, Justice Michel Pinsonnault of the Québec Superior Court stopped the Québec euthanasia law from coming into effect on December 10. The case was launched by the Coalition of Physicians for Social Justice which sought to obtain an injunction and to declare that the Québec law is unconstitutional.

The Euthanasia Prevention Coalition (EPC) intervened in the case.

According to the National Post:

The judge noted that last February’s Supreme Court of Canada decision striking down a federal ban on assisted suicide gave Ottawa and the provinces a year to prepare new legislation before the Criminal Code provisions in question become invalid. 

Pinsonnault ruled that as long as those provisions are on the books — and it is expected Ottawa will request an extension to the Feb. 6 deadline — a Quebec physician administering euthanasia under the provincial law would be committing a crime. He ordered the suspension of the articles of the Quebec law concerning euthanasia until the Criminal Code is changed.

Dr Paul Saba

Paul Saba, the leader of Coalition of Physicians for Social Justice, and Lisa D’Amico, a woman with a disability, brought the suit. But the federal attorney general “intervened on their side, arguing that application of the Quebec law should be suspended until the Criminal Code is amended,” the National Post reported.

The Québec government reacted to the judgement by declaring that they will appeal the decision. The government suggested that the judge made an error when finding that ‘medical aid in dying’ constitutes euthanasia. CTV news reported:

The senior Couillard government ministers reminded reporters in Québec City the law addressed end-of-life care for those with serious illness and should not be associated with a form of euthanasia, a parallel made in the injunction ruling.

According to the CTV news Québec Justice Minister Stephanie Vallee said:

“There is a clear difference between euthanasia and medical aid in dying.”

The comments by the Québec government defy logic.

It is one thing to devise political “talking points” to hide the fact that ‘medical aid in dying,’ which includes death by lethal injection, is euthanasia. It is another thing to appeal a court decision based on a talking point.

In his decision Justice Pinsonnault saw through the rhetoric.

The National Post’s Graeme Hamilton noted

What is more devastating for Quebec’s euthanasia advocates is that Pinsonnault’s ruling picks apart the foundation of the Quebec law. Quebec has argued that it was within its rights to legislate because “medical aid in dying” is simply an element of health care, which is a provincial jurisdiction. 

Pinsonnault writes that Quebec cannot resort to a euphemism to skirt criminal law. “It must be concluded at this stage that ‘medical aid in dying,’ in the present context, corresponds prima facie to the euthanasia of a human being at his express request,” he writes, “or in other words, assistance with suicide necessarily through the intervention of another person.” Whatever the act is called, it is not currently permitted under the Criminal Code. “Adding the word ‘medical’ to the expression ‘aid in dying’ is alone not enough to protect provincial legislation that is incompatible with federal criminal legislation.”

Justice Minister
Stephanie Vallee

Hamilton then quotes Québec Justice Minister Stephanie Vallee, who disagreed:

“In the judgment, a much too narrow parallel is made with euthanasia. Medical aid in dying is health care; it is part of a continuum of care.”

EPC will intervene at the Court of Appeal in this case. We will urge the Court to employ the same clear thinking as Justice Pinsonnault did in his Superior Court decision.

• Québec Superior Court decision prevents December 10 launch of Québec euthanasia law.

Québec euthanasia regulations are clear as mud.

By Amy Hasbrouck:

Amy Hasbrouck

When Québec passed its euthanasia law in 2014, we pointed out many problems, hoping that these would be remedied before the law came into effect.

Québec assisted dying law in conflict with the Criminal Code.

Eighteen months later we are on the verge of entering the euthanasia era in Québec, with many issues still unsettled. Thus far, Québec has:

• Issued a set of regulations governing a narrow slice of the euthanasia process;
• Offered a “five year plan” for palliative care which proposes “equitable” but not “universal” access to palliative care;
• Through the college of physicians, issued guides to performing euthanasia and continuous palliative sedation, and offering care “at the end of life.”

The government of Québec has also threatened hospices which refuse to perform euthanasia with loss of funding, in direct violation of § 72 of the law. The government is also requiring doctors who refuse to kill their patients to provide a referral for euthanasia.

Despite these actions, many standards and procedures remain unclear:

• The application process still lacks any provision for accessibility to people who have communication disabilities. Nor are there guarantees that people with mobility impairments will receive medical care in a timely manner on equipment which is accessible to them.
• There are still no protections against family members with financial interests who witness or fill out the forms on the person’s behalf.
• There are no procedural barriers to serial applications in case of refusal, or “doctor shopping.”
• Neither a psycho-social evaluation, nor a home visit is required to verify capacity to make decisions, that the decision is free and informed, or to ensure the person is not being abused or coerced.
• The competency determination does not appear to involve the judicial process already used for determining capacity in Québec.
• There is no requirement that the person receive palliative care or other support services to enable him or her to live well until natural death occurs. The “choice” to die remains an illusion where the person does not have a choice in where or how to live.
• The definition of “end of life” is entirely subjective, and can range from two months to eight years. 
• The eligibility decision is made only by the treating physician, who could be a generalist or a specialist, even in an unrelated area. The government doesn’t take into account that 25% of Québécois do not have a primary care doctor.
• The treating physician must consult a specialist in the person’s disease or condition, but does not have to follow the advice of the second doctor.
• The treating physician has the right to bring in an interdisciplinary team to provide advice, but the person doesn’t have the same right to the advice of an interdisciplinary team.
• There are no objective measures that need to be met to determine eligibility. The doctor must simply “assure” him or herself that the person meets the criteria, without explicit procedures for how to do so.
• Doctors are supposed to “develop proficiency” in the techniques of euthanasia, with no indication of how much training they must take to achieve and maintain this proficiency.
• The length of the cooling off period is not stated.
• Though individual doctors are supposed to have “conscience rights” to refuse to perform euthanasia, they must nonetheless determine eligibility, but are barred from providing a second opinion. Multiple passages discourage doctors from following their conscience and refusing to kill.
• Nurses and pharmacists must participate in the preparation for euthanasia, including preparing the dosage and setting up the IV, though they may opt out of performing the lethal injection.
• It appears the person’s medical record will not be part of the application for euthanasia, only the request form and results of a physical exam will be included.
• The oversight Commission has not yet been appointed.
• The data collected will be insufficient to track doctor shopping and the reasons applicants are refused. Data will only be kept for five years, making long-term analysis impossible.
• The Commission’s oversight is after-the-death, which doesn’t help the person who died because of a slipshod eligibility determination.
• The commission has no responsibility to police the practice of euthanasia beyond the reports that are submitted.
• Plans are already in the works to extend eligibility to children and other groups.

Amy is a lawyer and the founder of disability rights group Toujours Vivant - Not Dead Yet.  Amy is also the VP of the Euthanasia Prevention Coalition.

Québec Superior Court decision prevents December 10 launch of Québec euthanasia law.

For Immediate Release - December 1, 2015

Justice Michel Pinsonnault of the Québec Superior Court made the right decision, today,  by preventing the Québec euthanasia law from coming into effect on December 10, 2015.
The Euthanasia Prevention Coalition (EPC) intervened in the court case by the Coalition of Physicians for Social Justice.

EPC is a national non-profit corporation that exists to build a broad based network of groups and individuals that support measures that will create an effective social barrier to euthanasia and assisted suicide.

EPC argued that euthanasia does not constitute health care. EPC Executive Director, Alex Schadenberg, stated:

Euthanasia is done by lethal injection which does not constitute a form of health care.

EPC is also convinced that Québec does not have jurisdiction to legalize euthanasia. EPC legal counsel, Hugh Scher, stated that the Supreme Court of Canada recognized the role of the federal government to legislate on the issues of euthanasia and assisted suicide.

The federal government either has sole jurisdiction or shared jurisdiction concerning these issues. The decision was necessary based on the federal right to legislate on these issues.

Amy Hasbrouck, the Director of Toujours Vivant – Not Dead Yet said:

Inconsistency between federal and provincial regulation for death could foster confusion and dangerous errors. We must handle these policies with extreme care.

For more information contact:

Hugh Scher, EPC legal counsel (Toronto): (416) 816-6115 or hugh@sdlaw.ca
Amy Hasbrouck, Toujours Vivant – Not Dead Yet (Montréal): (450) 921-3057 or tigrlily61@gmail.com
Alex Schadenberg, EPC Executive Director (London): (519) 851-1434 or info@epcc.ca