Advanced Request For Euthanasia?

This article was written by Dr Catherine Ferrier and published on June 10, 2016 by impact ethics in Canadian Bioethics, Death & Assisted Dying, Law & Policy, Mental Health

Catherine Ferrier a physician in the Division of Geriatric Medicine of the McGill University Health Centre, and is the president of the Physicians’ Alliance against Euthanasia.

The June 6 deadline for legislation in response to the Carter judgment has come and gone, and our government has yet to adopt a law regulating medical assistance in dying. Too few of us have any idea what we are rushing into.

In the Carter decision the Supreme Court judges stated that the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards. In contrast, the pressure is on to offer death as a solution for all forms of suffering, available to virtually everyone, including those who fear future suffering or disability.

The Standing Senate Committee on Legal and Constitutional Affairs wants Bill C-14 amended to include the recommendation of the Special Joint Committee on Physician-Assisted Dying, “That the permission to use advance requests for medical assistance in dying be allowed any time after one is diagnosed with a condition that is reasonably likely to cause loss of competence or after a diagnosis of a grievous or irremediable condition but before the suffering becomes intolerable….”

The Old Age, The Seven Ages of Man
by Robert Smirke (1798- 1801)

I have spent the last 30 years diagnosing, treating, and caring for people with Alzheimer’s disease and other dementias. It takes no special insight to realize that they are the principal intended “beneficiaries” of this recommendation.

Dutch academic Boris Brummans wrote in his 2007 article Death by Document of his father’s euthanasia death through an advance directive. His father had cancer, not dementia, but the issue is the same.

I used to be in favor of euthanasia… Although the euthanasia was meant to liberate my dad from the conventional constraints of suicide, its textual, declarative form turned him into a prisoner of himself (and us into his cellmates). By signing the euthanasia declaration… my father created a persona of, and for, himself… based on the person he thought he would be. On what were these thoughts based? Hollow images of a self not yet lived; meager ideas about a life not yet fleshed out.

The mantra behind advanced directives is “choice,” whereby one chooses to die rather than live with the “indignity” of dementia, of dependence, of becoming a burden. Brummans questions whether one can truly choose for one’s future self. He describes how he and his family members projected themselves into the future “in ways that deprived us, especially my dad, from the very liberty we thought to have signed for”.

A diagnosis of dementia is a major life crisis. Those of us who have been through even lesser crises know that our judgment is not at its best when flooded with overwhelming emotions, fears, and questions. Most of us would be sensible enough to defer life-changing decisions until we are calm enough to think clearly. But for the person diagnosed with dementia the clock is ticking and the advance directive must be signed before decision-making capacity is lost.

Troubling? I think so.

Wesley Smith: Canada Senate Votes for More Euthanasia.

This article was published by Wesley Smith on June 10, 2016.

Wesley Smith

By Wesley Smith

Assisted suicide advocates in this country pretend it is about terminal illness as a political expedience. It’s baloney, but a lot of people fall for it. Ya gotta want to believe! 

The need for euthanasia advocates’ deploying this tactic was obliterated in Canada when the Supreme Court conjured a right to be lethally injected if one has a medically diagnosed illness causing irremediable suffering–as defined by the patient. That goes waaay beyond a terminal illness, perhaps to the mentally ill (as allowed in Belgium and the Netherlands) 

Now, euthanasia advocates, freed from having to persuade the public, are have revealed their true goals, pushing for the most radical and broad license to be killed in the world. 

The House of Commons passed enabling legislation that mildly reined-in the agenda, requiring death to be “reasonably foreseeable.” That’s a mere pretense of limitation–more a gesture than a policy–which isn’t the diagnosis of an actual terminal condition, just one that could become terminal…someday. 

Too restrictive! The Canadian Senate just removed the “foreseeable” requirement. From the National Post story: 

The Senate voted Wednesday to allow suffering Canadians who are not near death to seek medical help to end their lives, knocking out the central pillar underpinning the federal government’s proposed new law on medically assisted dying. 

Senators voted 41-30 to amend Bill C-14, deleting the requirement that a person’s natural death must be “reasonably foreseeable.” 

The amendment replaces the eligibility criteria in the bill with the much more permissive criteria set out in last year’s landmark Supreme Court ruling, which struck down the ban on assisted dying. 

The Senate is indeed more in line with the Supreme Court’s ruling. 

But the Canadian Charter could have allowed the Parliament to temporarily void the ruling or make it nonbinding through a process know as the “notwithstanding clause.” (Would that the US had such an ability.) It didn’t even try. 

It it is beyond disturbing how enthusiastically–indeed, like being swamped by a dam bursting–Canada has being swept up into the culture of death. 

As our closest neighbor, both in proximity and culture, we will not be unaffected.

Belgian Psychiatric euthanasia request based on sexual attraction.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Sébastien

BBC News has reported that a Belgium man, known as Sébastien, is seeking euthanasia based on psychological suffering in order to end his struggle with his sexual attractions.

The BBC article by Jonathon Blake explains that in Belgium, euthanasia for psychological suffering requires three doctors to approve the act (one of the doctors should be a psychiatrist), The law says that they must be suffering incurable, constant and unbearable physical or psychological suffering. The article states:

Sébastien has undergone 17 years of therapy, counselling and medication and believes he has no other option. 

He claims to be attracted to young men and adolescent boys and is scarred from a difficult childhood; his mother was ill and there was a strict Catholic ethos. 

"My whole life has led me to this, really," 

"I have always thought about death. Looking back on my earliest memories, it's always been in my thoughts. It's a permanent suffering, like being a prisoner in my own body," 

"A constant sense of shame, feeling tired, being attracted to people you shouldn't be attracted to - as though everything were the opposite of what I would have wanted."

The article examines differing views on psychiatric euthanasia. Psychiatrist Caroline Depuydt, who works at a psychiatric hospital in Brussels, encourages her patients to try further treatment.

We always have something that could work. Time, medication, psychotherapy - something that we must try and keep going with that. And the psychiatrist must give hope to the patient that it's never finished,

Gilles Genicot, a lecturer in medical law at the University of Liege, and a member of the euthanasia review committee says that you can never rule out the option of euthanasia.

Sébastien's case does not fulfil the legal criteria for euthanasia. 

It's more likely he has psychological problems relating to his sexuality. I cannot find a trace of actual psychic illness here. 

But what you cannot do is purely rule out the option of euthanasia for such patients.
They can fall within the scope of the law once every reasonable treatment has been tried unsuccessfully and three doctors come to the conclusion that no other option remains. 

Sébastien's request for euthanasia has been accepted initially, he now faces further assessments to determine whether his case fits within the law.

When asked whether he would change his mind, Sébastien states:

"If someone could give me some kind of miracle cure, why not? But for now, I really don't believe it any more. And I'm too exhausted also, whatever may be out there." 

Although he is calm - almost matter of fact - about wanting to end his life deliberately, he acknowledges the effect this will have on the people around him. 

"The hardest thing now is telling my family. If I get a yes, that's what's going to be most delicate."

Belgian Psychiatrist, Lieve Thienpont, published a study, last year, on the first 100 requests she received for euthanasia for psychiatric reasons. The data states:

• 77 euthanasia requests were made by woman, 23 were men,
• of the 48 approved requests, 35 died by euthanasia, 
• 1 died by palliative sedation (sedation with withdrawal of water),
• the average age was 47,
• 58 were depressed, 50 had a personality disorder,
• 12 were autistic, 13 had post traumatic stress disorder, 11 had anxiety disorder, 10 had an eating disorder, etc.

Last year, there were 2021 reported euthanasia deaths in Belgium. Recent studies indicate that more than 40% of the euthanasia deaths are not reported.

Australian Assisted Dying Report - A sugar coated poison pill.

“vulnerable people—the elderly, lonely, sick or distressed—would feel pressure, whether real or imagined, to request early death” House of Lords.

B

Paul Russell

y Paul Russell

The Legal and Social Issues Committee of the Victorian Parliament handed down its Report into End-of-Life choices in Victoria today.

The extensive report makes some valuable comments and recommendations in respect to improvement in palliative care.

It acknowledges that access to palliative care is patchy, is overburdened and needs improvement. In a country rated recently as second in an international table for end-of-life care, it still remains that the availability of such care is more closely related to postcode than it is to need.

The committee heard from many individuals whose family members had passed away in circumstances that were clearly far from what all Victorians would want and certainly far from best practice. The committee seems to take it as read that such cases are compelling proof that Victoria needs a regimen of ‘assisted dying’ – euthanasia or assisted suicide. Few, I contend, are that clear.

While family members submitting their stories to the committee often (but note: not always) called for legislative change, the submissions and stories may well have been evidence of poor care, lack of care options or, indeed, refusal of good care options; we simply do not know. For the committee to seem so easily to have accepted that poor deaths require the State of Victoria to help people to suicide is a travesty as much as it is the potential abandonment of people in great need.

Certainly, the admission that palliative care is still not able to meet the needs of Victorians is an important one and we welcome all policy and planning decisions that bridge the gap between need and availability. Sadly, however, the committee seems intent that, for those who cannot access such care, being made dead is an option. This is a failure of the committee’s stated aims to improve choice; suicide in such circumstances is no choice at all.

Of course, when the committee talks about ‘assisted dying’ they really mean euthanasia or assisted suicide, or both. That they seem so reluctant to call a spade a spade is rather telling. The reality is that they are recommending suicide:

At the end of life (final weeks or months of life). Suffering from a serious and incurable condition which is causing enduring and unbearable suffering that cannot be relieved in a manner the patient deems tolerable.

It remains for the government to respond to this report within six months, so any legislative framework may not necessarily follow the suggested framework. Still, there will be many who made submissions calling for law reform who will be disappointed; who, indeed, would not qualify.

How any doctor can accurately predict that the person is in the ‘final weeks or months of life’ is not stated. Nor is it easy to predict. While the intent seems to be to provide a minimalist approach, perhaps in an attempt to appear moderate and thoughtful, the reality is otherwise.

In the described framework the person does not need to be actually dying from a condition. In April this year a Quebec man who had been partially paralysed for a number of years but who was not dying, starved himself to the point where he was actually dying from starvation so that he could fulfil the criteria for assisted suicide. He was living with a disability. Death for disability may well be an accepted reason for suicide under the proposal, just as it was an acceptable reason to want to die according to the Supreme Court of Canada.

No more potent example of disability discrimination exists currently than the new Hollywood movie, Me Before You that sees a quadriplegic young man commit suicide in a Swiss clinic. Disability advocates across the globe are outraged by the depiction of disability as being ‘worse than death’ going so far as to call the movie ‘disability snuff porn’ and asking people to boycott the film. That the makers of this film simply don’t get the problem speaks to the reality that many in the disability community talk about; being made to feel that death is better than disability. The Victorian Parliament has, perhaps unwittingly, only reaffirmed those concerns.

The committee seems to be claiming a mandate for action when no mandate exists. Approximately 78% of substantive submissions (submissions of detail and from health providers, institutes, lobby groups etc.) were either against euthanasia and assisted suicide or were neutral and preferring to focus on end of life care more generally. Overall, the total submissions were about 56% in favour with the remainder either being opposed (approx. 35%) or neutral (approx. 7.3%).

The clear mandate is for better care.

There is much more to be said about this report, not all of which is unacceptable.

Failing to gain any publicity are the two dissenting reports by members of the committee. They are appended in the table of contents under one line, yet they comprise a far more robust analysis of available evidence than the entire Majority Report.

The Hon Inga Peulich MLC summarizes the concerns about human destruction via assisted suicide well:

"Any accidental loss of life – even the loss of one life, means such a regime cannot be justified, just as the loss of life, due to capital punishment, deliberate or due to a possible miscarriage of justice, cannot be justified and was the reason for its abolition."

Daniel Mulino MLC’s analysis should be read first, before the Majority Report. It forms not only a sound academic and rigorous approach but also, by implication, is damning of the narrow, outcome focus of the Majority Report:

“Moreover, the rapid growth in documented cases of euthanasia and assisted suicide probably materially understates the actual prevalence of the practice. There is a widespread failure of safeguards and procedures across jurisdictions, including low rates of reporting. 

“While legalisation was supposed to bring what was occurring in the shadows into the light, legalisation has simply pushed the boundary of what is legal out further and may have increased the amount of activity that occurs beyond the sight of regulators.”

Even tempered and thorough, Mulino concludes:

"The Majority Report asserts that the evidence is “clear” that safeguards work in jurisdictions with legalised euthanasia and assisted suicide. A balanced reading of the evidence would lead one to conclude that such an unequivocal statement is not true."

The Majority Report in its conclusions and recommendations on assisted suicide, have presented the Parliament and the people of Victoria with a sugar-coated poison pill. We hope that the government of the day will see through this charade and act at all times to protect vulnerable people while prioritizing palliative care.

Not Dead Yet Activists protest Me Before You in Philadelphia.

The Philadelphia Metro news published an excellent report on the Not Dead Yet protest of the movie Me Before You. The Metro wrote (this article was edited for length):

A new Hollywood film depicting a romance between a quadriplegic and his caretaker that ends in the man choosing suicide over life in a wheelchair is being denounced by the disabled community. 

Two dozen activists with disabilities and their supporters protested outside a South Philadelphia movie theater Monday against the film "Me Before You," calling it "poisonous" and saying it could encourage suicide among people with disabilities. 

“As of Saturday, June 4, I have lived with a spinal cord injury for 15 years,” said activist German Parodi, 32, who uses a wheelchair and became disabled after he was shot in the throat during a carjacking. “There’s no reason for us to kill ourselves.” 

The activists in Philly sang and chanted for more than an hour outside the UA Riverview 17, one of two theaters in the city that is showing the film. They were affiliated with Not Dead Yet, a disability rights group that is organizing protests nationwide and protested the film’s red-carpet premiere in Hollywood. 

For those participating in the protest, the story of the film is a painful parallel to their own experiences. 

“I’ve struggled with depression and suicidal thoughts,” said Anomie Fatale, 28, a musician and performer who became disabled at 20 due to Ehlers-Danlos syndrome. “Putting that out there in the mainstream is dangerous. … It could kill someone.” 

Fatale said she has quadriparesis, severe muscle weakness affecting all four limbs. 

“You are suggesting, romanticizing, glorifying, encouraging suicide. That is a thing I can’t be okay with,” Fatale said. “I’m worried about young, impressionable teenagers. I want to put the right message out there.” 

Director Thea Sharrock recently defended the film against the criticisms of ableism, telling The Hollywood Reporter, “I didn’t quite anticipate this” and that the criticisms arose from “a fundamental misunderstanding of what the message is.”

Activists said the film barely portrays any characters who disagree with the protagonist’s decision to end his life in Switzerland at ..., a real assisted suicide organization. 

“There is product placement for an assisted suicide organization in this film,” said Clark Matthews, 34, a filmmaker who uses a wheelchair. “Can you name the last romantic film with a disabled protagonist? The first one in decades, and of course he kills himself.” 

There is also no depiction in the film of the community of people with disabilities, which activists credited with helping them live their own lives. 

“In the past five years, I started meeting other people with disabilities. I stopped feeling ashamed. These people made me feel like I’m not a burden,” said Liam Dougherty, 26, who uses a wheelchair due to Friedreich's ataxia, a progressive neural disorder. 

“It’s a road I could have gone down,” Dougherty said of the story depicted in the film. “I’m so glad I have a supportive organization that made me realize I shouldn’t have gone down that path.”

Congratulations to the NDY activists in Philadelphia who effectively got their message out.

Bill C-14 must be amended or defeated.

Alex Schadenberg

Alex Schadenberg

Executive Director - Euthanasia Prevention Coalition

The House of Commons passed Bill C-14, the government bill to regulate euthanasia and assisted suicide in Canada, with a 186 to 137 vote. Canada's Senate will begin to debate Bill C-14. The Senate has the power to amend and/or defeat the bill.

For those who are concerned that Bill C-14 will not be passed by June 6, the date imposed by the Supreme Court of Canada, stop worrying, it will definitely not become law by June 6. Therefore the approach needs to be to amend Bill C-14 in the Senate and if it is not adequately amended, to defeat the bill.

I appreciate the amendments to Bill C-14, An act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying made by the House of Commons

I recognize that conscience protection language has improved and some of the language of the bill was improved, but the most grievous sections of Bill C-14 were not amended. 

If this bill passes, in its current form, the language of Bill C-14 will lead to significant growth of euthanasia. There will be many stories that people will refer to as a "slippery slope." Let me tell you now, these stories will not be the result of a "slippery slope" but rather they will be based on the fact that the language of Bill C-14 allowed these acts to occur.

When I stated that the most grievous sections of the bill have not been amended, here is what I meant:

1. Bill C-14 continues to allow anyone to cause death by euthanasia or assisted suicide.

• Bill C-14 - Section 227(2) states: No person is a party to culpable homicide if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2. 

• Bill C-14 - Section 241(3) states: No person is a party to an offence under paragraph (1)(b) if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2. 

• Bill C-14 - Section 241(5) states: No person commits an offence under paragraph (1)‍(b) if they do anything, at another person’s explicit request, for the purpose of aiding that other person to self-administer a substance that has been prescribed for that other person as part of the provision of medical assistance in dying in accordance with section 241.‍2.

No jurisdiction in the world offers legal immunity to anyone who does anything for the purposes of assisted dying. These sections must be struck from the bill.

2. Bill C-14 continues to provide medical practitioners or nurse practitioners total immunity for decisions or acts that contravene Bill C-14.

• Section 241.3 states: Before a medical practitioner or nurse practitioner provides a person with medical assistance in dying, the medical or nurse practitioner must: (a) be of the opinion that the person meets all of the criteria set out in subsection (1); 

• Section 227(3) states: For greater certainty, the exemption set out in subsection (1) or (2) applies even if the person invoking it has a reasonable but mistaken belief about any fact that is an element of the exemption.

Sections 241.3(a) and 227(3) make it impossible to penalize medical or nurse practitioners for approving or doing an assisted death that contravenes the law, since the bill only requires them to: “be of the opinion” that the person meets all of the criteria of the law. This is the lowest possible standard. Further to that, Bill C-14 provides no effective oversight of the law.

If the person who died was incompetent, the medical or nurse practitioner would only need to state that he/she was “of the opinion” that the person was competent.

The Supreme Court of Canada in Carter approved assisted death based on: “a competent adult person who clearly consents to the termination of life.” 

Section 241.3(a), does not assure that the person is competent or clearly consents to the termination of life.  Therefore Bill C-14 does not respect the language of Carter. Unless Section 241.3(a) is amended to ensure that the person meets all of the criteria set out in subsection (1), Bill C-14 will be struck down by a future court decision. 

Bill C-14, in its current form, must be defeated.

People with disabilities comment on Me Before You.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Me Before You has become one of the controversial films of the decade, with protests, boycotts and many articles about the film. Not Dead Yet organized protests outside movie theaters, EPC asked its supporters to boycott the film in order to not give the makers of this movie our hard earned cash, nonetheless, the clearest voices have been disability leaders.

John Kelly

John Kelly, the New England Regional Director for Not Dead Yet, who has read the book, was reported by the New Boston Post as saying:

“After a new injury, people are very vulnerable, because suddenly you become part of a marginalized group,” And in terms of the film, “Only a disabled character could have their suicide presented as noble. Imagine if another character in the movie had killed themselves based on their own internalized depression.” 

“People happily cry over people like me killing ourselves,” 

“Where are the films where he changes his mind and they live happily ever after?”

Dominick Evans

Dominick Evans, was interviewed by Montgomery Jones for Film Obsession. Evans is a movie director and critic. Evans stated:

The disability community is really worried about what this is going to say to a newly disabled person. No one is disputing how vulnerable it can be to go from being able to move physically and suddenly being disabled. It is a huge transition, and that is why a lot of rehabilitation centers look for anxiety and depression, because those things need to be treated. If a person is non-disabled and they are suicidal, we do everything in our power to give them a reason to want to live. Why are we not seeing the same level of care and concern for disabled people? Why is it just accepted without question that disabled people should be allowed to kill themselves, and why is there this default belief that disability = suffering? We deserve just as much right to suicide prevention as any other person. 

When I was 19 years old because of years of systemic abuse and oppression which I endured from my family, my school, and my community as a disabled person, and as an LGBT person, I tried to kill myself. I am so grateful today that I did not make it through the process. I hear this over and over from my disabled friends who have tried to kill themselves. Many of us become depressed because of how we are treated by society, especially when it is our families, and other loved ones. That depression needs to be treated, and disabled people are not receiving that kind of care.

The comments by Ella Frech, really hit home. Frech, who will soon be 12-years-old and is a wheel chair athlete, wrote an article for Aleteia.org:

Well, what’s wrong with a life that looks like mine? 

My mom says this isn’t the first movie where a handicapped person had to die for being paralyzed. There was one called Million Dollar Baby where a woman is a quad and bravely chooses death instead of an imperfect life. 

So I’m asking you again, what’s wrong with my life? Why do you think I should want to die? 

You sit there with your able bodies, and look at people in chairs and think you feel pity for our sad little lives, but the truth is you’re afraid. You don’t want to imagine that you might be one of us one day. You think you can be perfect, and think you’d rather die than have parts that don’t work right. I think that’s sad.

Crippled Scholar has published a list of commentaries by the disability community concerning Me Before You.

Legalizing euthanasia and assisted suicide creates a cultural paradigm - whereby some people are deemed worthy of life and others are deemed unworthy.

Kevin Yuill: Me Before You is fiction, but so are most arguments for assisted suicide.

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Kevin Yuill

Kevin Yuill, a history professor at Sunderland University, wrote an excellent article that was published in the Telegraph today. Yuill's argues that Me Before You is simply one of many fictional stories about assisted suicide, but then he also states that arguments supporting assisted suicide are also fictionally based. Yuill writes:

There is an outbreak of fictional assisted suicides, of which the film released this week, Me Before You, is simply the most recent example. Before, we had Million Dollar Baby, The Sea Inside, One True Thing, and episodes of Lena Dunham’s Girls, Coronation Street, and Hollyoaks. Such a plot-device is neither new nor "taboo-busting" – that taboo has been well and truly busted. 

It is interesting that the case for assisted suicide exists more in the fevered imagination of authors and screenwriters than in reality. Only a handful of Britons kill themselves in Swiss assisted suicide clinics every year; the rate of fictional representations to people actually killing themselves in Switzerland must be nearly 1:1. But Me Before You has sparked protests, mostly from disabled groups, because it implicitly asks the question: If you were quadriplegic (or severely disabled), would/should you kill yourself? 

Of course, the film is fiction and not particularly imaginative fiction at that, but there is a real context to the unease of groups of disabled activists like Not Dead Yet who have protested outside cinemas.

Yuill outlines some of the information from his book: Assisted Suicide: The Liberal, Humanist Case Against Legalization (2015) 

The whole case for assisted suicide is fictional. Rather than empathy, it is based on anxiety in the worried well. “I’d rather die than suffer like you do”, some actually say out loud to disabled people, who, in my experience are a feisty lot who enjoy (and all too often must fight for) their lives. There are real disabled lives – and there is the narcissistic projection of gloomy imaginings onto the disabled. 

Physicians Alliance Against Euthanasia - Sign the Declaration

Physicians: Sign the Declaration (English) (French)

Citizens: Support the Declaration (English) (French)

WE AFFIRM THAT:

1. Patients at the end of life should receive diligent and competent care to relieve their pain and suffering. The physician has the obligation to use all the means available to achieve this end.

2. If a patient refuses treatment or requests its withdrawal, his or her wishes must be respected.

3. Modern palliative care skills, drugs and technology permit adequate symptom control for all terminally ill patients. These methods should be universally accessible.

4. A physician who is caring for a dying patient, and who cannot adequately control the person’s symptoms, should have access to the necessary expertise and support to be able to do so.

5. When suffering remains uncontrolled by state-of-the-art palliative care, individually adjusted sedation to a point of comfort may be used. In this, as in all palliative care, the goal remains optimal quality of life.

6. To provoke death voluntarily, by lethal injection or any other method, cannot be considered under any circumstance as “medical care”, and is contrary to medical ethics. It is never necessary to kill a patient in order to end his or her suffering. The 2400-year-old Hippocratic tradition was a major advance in civilization. It forbids euthanasia and mandates the protection of the weak and the maintenance of trust between the physician and the patient. It calls on physicians and other health professionals to use their knowledge and skills to heal the sick, creating a climate of mutual solidarity. It is ironic that the accepted standards of this ancient code of conduct, written at a time when the means of countering end of life suffering were very limited, might be considered inadequate in this age of refined capacity to control symptoms.

7. We must learn from the negative experiences of countries that have legalized euthanasia. Decriminalization often causes more problems than it is claimed to solve; those documented in the medical and legal literature include:

• High rates of euthanasia without consent;
• The impossibility of ensuring adequate reporting and respect for safeguards;
• A loss of trust in the physician-patient relationship;
• Conflicts within medical teams and within patients’ families

8. Medical licensing bodies must continue to fulfil their role as protectors of the public and of life, and support physicians in their efforts to improve the quality and accessibility of care of the dying, thus allowing all patients to receive excellent symptom relief throughout their illness and at the time of death.

Will Johnston: The case against physician-assisted dying

This article was published by the CanadianHealthcareNetwork.ca on June 1, 2016

Discussed: The 'wedge' cases, the language of the debate, the moral culpability of the doctor, and the question of pure autonomy

Dr Will Johnston

By Tristan Bronca.

The Euthanasia Prevention Coalition was officially founded in 1998 in response to rising public support for physician-assisted dying. It’s made up of about 2,000 donors—both members and organizations—who began to come together in about 1993 during the Sue Rodriguez case. One of those members is Dr. Will Johnston.

Now the chair of the B.C. chapter of the coalition, the family physician took a strong stance against euthanasia about 22 years ago, when he began writing about it and speaking to high school students and church groups. He also testified opposite euthanasia advocates in the Carter case, which led to the legalization of medically assisted death in Canada. Dr. Johnston spoke with the Medical Post about his concerns with the legislation recently passed through the house of commons, the laws around the world, and why he feels Canada is about to make a dangerous mistake.

Q: Explain the impetus for a coalition of bodies who are opposed to physician-assisted dying.

The bodies that are involved in the Euthanasia Prevention Coalition might not agree on any other issue but they share in common a sense of the huge societal mistake that is being made in euthanasia and assisted suicide. We realize that there is some strength in numbers. Obviously not enough strength to stop the freight train that ended with the Supreme Court being unanimous in its decision—which I think is a troubling sign of the shallowness of the Supreme Court’s reasoning—but nonetheless more power than we would have as individual activists.

Q: Which elements of the proposed federal legislation do you personally find most troubling?

The legislation doesn’t yet allow the euthanasia of children, psychiatric patients, or mentally incapable patients long after they consent, but the preamble to the legislation promises to explore those areas further, which is deeply troubling.

The activists who won in the Supreme Court won in part because they assured Canadians that they weren’t talking about those three groups. They were only talking about competent adults at the end of their lives who were able to give consent at the time they were killed.

Q: So you see the expansion of the legislation to include these other groups as problematic?

Absolutely. It seems clear that this no longer has anything to do with dying. This legislation has left open the door for assistance for people who want to commit suicide but don’t want to do it themselves, while it was originally marketed as helping terminally ill people in terrible pain to die sooner than they would have otherwise died. The latter was used as the cloak to wrap the agenda inside.

When the real agenda is to allow anyone who is dissatisfied with their life to be killed with the endorsement and assistance of the national medical system, it makes sense to hide those intentions behind the story of a person about to die who was having difficulty controlling physical symptoms.

Q: My understanding is that the reason why this legislation may be extended to psychiatric patients and to mature minors is because the legal experts didn’t feel that exempting those two groups would stand up to a charter challenge. It would be discriminatory to bar them from access to the service that is now being talked about as a universal human right.

You’re absolutely right and, in fact, I was making that point exactly as you have just made it back in the days when we were in court with Gloria Taylor and the Carters. You could never contain it to just these terminally ill patients but in court that’s all they claimed they were asking for: Terminally ill, capable adults who were suffering intolerably at the end of their lives and who consented and were capable of consent to be killed. That was the story on which the Carter case was won. . . .

These judicial activists were happy to pass the Carter case through on the narrow grounds knowing that it would be expanded later. They were happy to make an incremental change that they knew could not withstand a further charter challenge because of section 15 equality rights and so-forth.

Covenant Health in Alberta will not participate in euthanasia.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Last February, Archbishop Richard Smith of Edmonton stated clearly that Covenant Health will not participate in acts of euthanasia or assisted suicide.

A few days ago, CBC news reported that Alberta's Associate health minister stated that:

physicians and other health-care workers will not be forced to take part in this procedure if it goes against their beliefs. She said procedures are being set up to move patients, if necessary.

"We're working to set out a framework of protocols and processes to ensure that if a patient in a facility where medical assistance in dying is not available, that there will be a process in place for transfer of care likely through Alberta Health Services,"

Payne stated that this framework for transferring patients will be in place by June 6.

Covenant Health has proven that protecting Conscience rights requires a clear and united position by health care professionals and institutions. Thank you Covenant Health.

Press Release: Rally and Demonstration on Parliament Hill.

June 1 2016

The Euthanasia Prevention Coalition, Vivre dans la Dignité, Toujours Vivant - Not Dead Yet and the Physicians Alliance Against Euthanasia have organized a rally and demonstration on Parliament Hill on June 1 from 12:15 to 1:30 pm.

The rally will begin at 12:15 at the steps of Parliament Hill, with speeches by politicians and the organizing groups.

At 1 pm there will be a visual demonstration.

For more information contact:
Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition @ 519-851-1434
Amy Hasbrouck, Director, Toujours Vivant - Not Dead Yet @ 450-921-3057
Aubert Martin, Director, Vivre dans la Dignité @ 438-931-1233

Stephanie Gray: You Before Me is Better than Me Before You.

The Euthanasia Prevention Coalition has urged its supporters to boycott Me Before You.

The disability rights group, Not Dead Yet has urged people to protest Me Before You.

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Stephanie Gray

tephanie Gray wrote an excellent blog article on the book that the movie - Me Before You is based upon. She begins her article by stating that a friend texted her urging her to read the book Me Before You. Her friend said it will make you raaaaage. This what Stephanie wrote:

So on the weekend, as it poured rain, I curled up and got caught up in the world of the main characters Louisa Clark and Will Traynor. So would I recommend it? Absolutely not. It’s dangerous—very dangerous. Setting aside the obvious problems of blasphemous language and sexual references, the storyline supports assisted suicide—but it does so in a sneaky way, making it all the more dangerous.

Initially Louisa, hired to be a companion and helper to wheelchair-bound Will, was my hero. She was from a family that, while it had its own dysfunctions, overall lived a self-less philosophy:

· Louisa worked so as to help provide for her poverty-stricken family. You before me. 

· Her parents welcomed her sister home when faced with an unplanned pregnancy, and helped care for their grandson. You before me. 

· Her mom quit work to care for the family’s ailing grandfather. You before me.

But the world of you before me was about to collide with another world—the ugly world of me before you. The Traynor family had it all—by the world’s standards: unlimited wealth and the ability to go wherever and do whatever. But they were all miserable because they lacked love:

· Mr. Traynor was having an affair (not his first). Me before you. 

· When Will’s sister Georgina visits and learns of his plan to have assisted suicide in 6 months she gets angry that he would do it, but instead of using the 6 months to give him the gift of time, attention, and love, to try to convince him he’s valuable and should stay alive, she returns to Australia saying, “…this was just a visit…It’s a really good job…the one I’ve been working toward for the past two years…I can’t put my whole life on hold just because of Will’s mental state.” Me before you. 

· Will himself, pre-accident, lead a life of self-indulgence. Me before you.

So why was Louisa my hero initially? When she learns that the parents have agreed to assist Will in his suicide in 6 months’ time, she quits because she doesn’t want to be part of killing. Louisa, you’re my hero. Then she decides to return to work, realizing she can spend the next few months trying to make Will’s life as incredible as possible so he doesn’t choose suicide. Louisa, you’re my hero. Then she takes Will on a life-creating and spirit-building vacation and tells him she wants to devote her life to loving and serving him, but he refuses saying he still plans to commit suicide, so she cuts him off in a decision to remove herself from the killing. Louisa, you’re my hero.

But then it all goes downhill. And I understood why my friend said “It’s going to make you raaaaaaaage.” Almost every single character caves. Mr. and Mrs. Traynor, Georgina, Mr. Clark, Louisa’s sister. And Louisa herself. They all cave. They all encourage, facilitate or are actually present at Will’s suicide the way he wants it.

And a morally un-formed reader will think, “Maybe it’s not so bad after all. Maybe, by being present, that was the loving thing to do.” No, no it’s not. Would they have been present if Will was killing a child? Then why would they be present when Will killed himself? His life is just as unrepeatable, and just as irreplaceable, as a child’s. Life, whether our own or someone else’s, is not ours to take. Moreover, Will couldn’t have gotten to the suicide clinic without their help. So his act of suicide actually turned into their act of homicide. Had they refused to “help” him, especially when, as a result of Louisa’s involvement in his life, he admitted those were the best 6 months of his entire life, Will may have gone on to thrive in a world of human connection and a world of you before me. But we will never know. Because he’s dead. And they helped kill him.

Will was obsessed with control, and argued he needed to end his life because it was the one thing he could control. But he could control more than death—he could control his perspective. Holocaust survivor Dr. Viktor Frankl wrote in his book, “Man’s Search for Meaning,” that “everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances…”

When someone is despairing so much that they can’t see they can choose their attitude, it’s the job of people who care to help them see this, not to feed into despair. As one palliative care website says for why they don’t allow or encourage assisted suicide, “In our experience, the issue of physician-assisted suicide often arises as a response to a complex set of problems which we help people sort through and address.” If only Louisa et al had helped Will sort through and address his problems.

So when the movie is released this Friday, and unsuspecting movie-goers who’ve seen the trailer may have no clue it’s actually about assisted suicide, please boycott the film and encourage others to do the same. And when someone asks why, you could begin by explaining, “You before me is better than me before you…”

Euthanasia for Psychiatric reasons is complicated.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Doctor K Suno Gaind, who ishe President of the Canadian Psychiatric Association and an associate professor at the University of Toronto wrote an article that was published in the Globe and Mail on Friday May 27, 2016; where he states that there are no known standards for approving euthanasia for psychiatric reasons.

Dr K Suno Gaind

Dr Gaind questions how euthansia fits with  - Do No Harm - ethic:

Do no harm. How do we square this guiding tenet with medically assisted death? Which is the greater harm – helping a person to end his life, or allowing continued suffering when he seeks death? 

When it comes to mental illness, it is even more complicated. The 2015 Supreme Court decision emphasized the need to protect the vulnerable from seeking suicide at a time of weakness. Less clear is how we actually do that. 

Mental illness can affect how a person thinks. Depression fuels negative self-thoughts, self-blame, hopelessness and struggling with one’s place in the world. Negative events are dwelt upon and positive ones discounted, with emotional resilience lowered until mundane stresses seem overwhelming. 

This is not to deny the real pain and suffering of mental illness, nor to imply that it invariably compromises clarity of thought. However, in severe cases, teasing apart how illness-based cognitive distortions can influence decision making is a formidable challenge. Heart disease might produce suffering but not necessarily alter thought processes; with depression, people often say they no longer feel or think like themselves. 

This predicament could be moot if suffering continued indefinitely. The value of suicide prevention is not to stay alive with intolerable suffering, but to avoid ending life during a vulnerable period. Unfortunately, cognitive distortions can lead some to decline treatment and seek death, despite the prospect of a healthy future. 

Dr Gaind explains how difficult it is to assess irrmediable suffering of psychiatric patients. 

Assessing irremediability in mental illness is very difficult. In neurodegenerative diseases with continued decline, irremediability can confidently be predicted. Not so with mental illness; in most cases, we can’t say when there is no chance of improvement.
  
Remediability goes beyond biomedical symptoms. Social isolation, underemployment, poverty or lack of housing all have an impact on the suffering from mental illness. It may be more a societal question, but the question is, at what point are these irremediable? These concerns aren’t academic: In the Netherlands, most of the people receiving a medically assisted death for psychiatric conditions cited depression and unresolved loneliness. 

The Canadian Psychiatric Association has cautioned that there is no established standard of care in Canada for defining when typical psychiatric conditions are irremediable. We are not alone in struggling with this. I have spoken with leaders of psychiatric associations from Australia, New Zealand, the United Kingdom and the United States, and none is any further ahead at defining this. 

Dr Scott Kim

This lack of standards is troubling for medically assisted dying assessments based on irremediability. As University of Michigan researcher Scott Kim recently warned the Senate committee looking into Bill C-14, lack of standards leads to clinicians basing decisions on personal beliefs rather than on sound medical science.

Dr Gaind then assesses problems associated with Bill C-14:

Bill C-14, the legislation to govern medically assisted dying, advises needing further study when mental illness is the sole criterion, leading some to charge discrimination. Such arguments are specious. The fight against stigma and discrimination includes appreciating that “equity” does not mean everything is “the same.” Equity involves impartial and fair evaluation of situations. It is not discrimination for illnesses such as epilepsy to have reporting requirements about driving, for example; nor is it discriminatory to have dedicated parking spaces for people with disabilities. 

Opening the door to assisted suicide for people with mental illness, involving inconsistent application of non-existent standards, would itself be discriminatory against this vulnerable population.

Dr Gaind then comments on the recent decision of the Alberta Court of Appeal to approve euthanasia for a woman with a psychiatric condition:

Consider the recent case in which the Alberta Court of Appeal ruled that a woman suffering from a psychiatric condition known as conversion disorder (which leads to unexplained physical symptoms) has a constitutional right to medically assisted death. The ruling emphasized that her suffering was from physical symptoms, noted that she was “not suffering from depression,” and acknowledged the case’s uniqueness, stating that each authorization for medically assisted death “is specific to that person and their unique circumstances” and “the antithesis of precedential.” The court also noted that a psychiatrist who opined in the case had reviewed the woman’s medical file “although he did not examine her,” which again emphasizes the need for established standards. 

In making the shift from a death-denying society to one that views death as another treatment option for illness, we must appreciate the nuanced differences leading to the common endpoint of death. Complex decisions without standards become value judgments or best guesses, and we should not be gambling with the vulnerable lives. 

While modern realities may preclude absolute adherence to the “do no harm” principle, surely we should aim to do the least.

Euthanasia for psychiatric reasons simply cannot be controlled because it is based on one's personal feelings, that cannot be known by another person, even for a professional.