Analysis of Canada's 2019 MAiD Annual Report

This article was published by Toujours Vivant - Not Dead Yet on Sept 8, 2020.

By Amy Hasbrouck, Director Toujours Vivant - Not Dead Yet.

Does the MAiD Program shown in the first annual report meet the Supreme Court’s requirements?

In July of 2020, Health Canada issued the first annual report on Medical Assistance in Dying (MAiD) using data drawn from the monitoring system that went into effect in November of 2018. The report covers MAiD provided throughout Canada during the 2019 calendar year.

Before we talk about the substance of the report, it’s important to remember that, in the 2015 Carter decision, the Supreme Court of Canada said that protecting vulnerable people required “a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced.” Yet as Alex Schadenberg of the Euthanasia Prevention Coalition has pointed out, the law has no method for families to appeal a determination of eligibility they believe is wrong.

• Canada's MAiD report: 26% increase in 2019 euthanasia deaths. The hidden story of abuse (Link).
  

Further, Health Canada has denied any responsibility to ensure compliance with the MAiD law’s safeguards. In the final regulation, Health Canada says: “[Monitoring] is fundamentally distinct from a process that seeks to assess individual medical or nurse practitioners’ compliance with the Criminal Code exemptions. Investigating instances of non-compliance with the eligibility criteria and procedural safeguards set out in the Criminal Code falls outside of the scope of the federal monitoring regime, and is under the purview of local law enforcement.” If Health Canada offloads compliance onto local law enforcement, how does Health Canada propose to ensure that the law is “scrupulously monitored and enforced”?

On page 17 of the report, Health Canada says that “all cases of MAiD are captured.” But that’s not the same thing as saying that all euthanasia deaths were reported. The report doesn’t include deaths by Continuous Palliative Sedation (CPS), euthanasia that doctors didn’t declare, or other life-ending acts without explicit request. There are no eligibility criteria, approval process or safeguards to be met for continuous palliative sedation. Studies in jurisdictions where euthanasia is legal which traced the cause of all deaths during a certain period of time have found that many euthanasia deaths were not reported, even when the doctors knew they were performing euthanasia. As well, Québec’s monitoring system, which has a two-track verification design, has consistently shown that doctors are not reporting all euthanasia procedures they perform. Nor does Health Canada discuss how many reports contained incomplete or inaccurate information, or how these were corrected. Thus, Health Canada may have reported all the MAiD declarations they received, but they didn’t count all euthanasia deaths.

At the same time, Health Canada admits there remain “data gaps.” They point out that, because an oral request can start the eligibility determination process, “many assessments for MAID are taking place with the written request only being completed once a finding of eligibility has been determined or a date for MAID has been established.” Thus the number of written requests reported in 2019 (7,336) is probably substantially lower than the real number of people who asked for euthanasia, because those who are determined ineligible upon making an oral request are not counted by the monitoring system. As well, not all requests that pass through MAiD case coordination or referral systems are captured because some employees of such services are not required to file MAiD reports. Nor does Health Canada document the role of euthanasia advocacy groups in facilitating MAiD approvals and procedures.

The report uses two different figures for the number of MAiD deaths being reported, which creates some confusion. In footnote 1, Health Canada says: “When all data sources are considered, there were a total of 5,631 MAID deaths in Canada in 2019. This includes 242 MAID deaths that were reported voluntarily by the provinces and territories. The detailed analysis on requests for MAID (7,336 written requests), and cases of MAID (5,389 provisions), are available only for the reports collected through the federal monitoring system (for requests received on or after November 1, 2018).” A clarification is provided on page 16. “[A]ggregate data for MAID deaths in 2019 is based on two data elements: MAID provisions in 2019 resulting from a written request prior to November 1, 2018, and data collected under the Regulations for the period January 1, 2019 to December 31, 2019.” So if a person asked to die before November 1, 2018, and was euthanized after January 1, 2019, their death was counted in 2019, but was not subject to the new monitoring system’s reporting requirements. This was the case for 242 people.

Of the 7,336 written requests for MAiD in 2019, 1,947 (26.5%) did not result in euthanasia.

• 1,113 (15.2%) died before approval or euthanasia 
• 571 (7.8%) were deemed ineligible due to:
  
  • lack of capacity – 184* (32.2%),  
  • natural death was not reasonably foreseeable – 159 (27.8%),  
  • not in an advanced state of irreversible decline – 134 (23.5%)
    

• 263 (3.6%) requests were withdrawn.

There were 5,631 MAiD deaths in 2019 (including 242 requested before November 1, 2018)

• Accounted for 2% of all deaths in Canada (ranging from .3% of deaths in NL to 3.3% in BC) 
• All but a handful (< 7) were by euthanasia.  
• Total since 2016 = 13,946
  

*These numbers are estimates based on the percentage of 571 people found ineligible. The report did not provide the exact figures.

The annual report reflects corrections and adjustments to the statistics given in the interim reports. The number of MAiD deaths has increased each year.

• 1,015 in 2016 
• 2,833 in 2017
• 4,467 in 2018 = 58% increase over previous year,
• 5,631 in 2019 = 26% increase over previous year.
  

On page 19, Health Canada explains the small number of assisted suicides by saying “providers are less comfortable with self-administration due to concerns around the ability of the patient to effectively self-administer the series of medications.” They do not talk about the individual’s choice, nor the apparent conflict between the idea of MAiD as a form of self-determination, and the small number who choose the more autonomous option of assisted suicide. This is important because, according to Statistics Canada, intentional self harm (suicide) was the 9th leading cause of death in Canada in 2018,** accounting for 3,811 deaths, whereas MAiD accounted for 4,467 deaths in 2018. But because MAiD isn’t counted either as suicide or as a separate “cause of death” it doesn’t take its place as the 9th leading cause of death in the country. In 2019, MAiD accounted for 2% of all Canadian deaths.

**The 2019 statistics are not available.

The monitoring system did not collect crucial demographic information that would show the impact of discrimination, economic and social pressures on requests to die. Health Canada is not tracking information about the person’s race, ethnic background, income, indigenous status, sexual orientation, disability status, first language, or other grounds of discrimination. Indigenous and racialized Canadians have been calling for accurate data collection to document racism in the health care system for decades, and we raised the issue in our comments on the draft monitoring regulations. As well, though the monitoring system collects data on where euthanasia was performed, it doesn’t ask about the person’s living situation when the request is made.

There are three “catch-all” categories in the section on underlying medical conditions (4.1) that total 19.8% (or 1,067) of all cases; “Multiple Comorbidities,” “Other Condition” and “Other Organ Failure.” An explanatory note says that: “other conditions” includes “a range of conditions, with frailty commonly cited.” When “miscellaneous” medical conditions make up 20% of cases, and include non-terminal conditions such as frailty, something smells fishy.

As we observed in our comments on the draft regulations, the monitoring system does not collect data on whether suicide prevention services were provided in response to requests for MAiD. The data in Section 4.3 regarding palliative care and disability support services gives no indication what services were provided, or whether the services met the person’s needs. Health Canada reports that 82% of people received palliative care, and 89% of those who needed them received disability support services. The authors conclude these findings: “seem to suggest that requests for MAiD are not necessarily being driven by a lack of access to palliative care services,” (p. 24) though they admit that “the data … [do] not speak to the adequacy of the services offered.”

Without suicide prevention intervention, or effective palliative care and disability support services, a person’s consent to euthanasia cannot be voluntary, capable, and free of external pressure.

A few items worth noting about who provided MAiD, and where it occurred:

• The monitoring system doesn’t record the medical specialty of the practitioner who provides the written second opinion. 
• While 20.6% of euthanasia were performed in “palliative care facilities” (p. 27) only 9% of MAiD practitioners were palliative care specialists. 
• As Richard Egan pointed out in his analysis of the Canada report, “Despite two thirds of cases with cancer as the underlying condition, only 1.7% of clinicians administering euthanasia gave their specialty as oncology.” 
• Mr. Egan also notes that even though euthanasia is not allowed for psychiatric conditions, 1.2% of euthanasia were administered by psychiatrists.
  

In its introduction to data on the kind of suffering reported by people asking to die (Section 6.1), Health Canada claims: “It is not the practitioner’s interpretation of the intolerability of an individual’s suffering; only the individual requesting MAID can determine whether their suffering is unbearable.” Yet there is ample evidence that medical professionals’ negative views of disability do affect how people value their disabled lives. This is why peer support is so essential to adapting to aging, chronic and degenerative illness and disability.

“Nature of suffering”

• Loss of ability to engage in meaningful life activities – 82% 
• Loss of ability to perform activities of daily living – 78% 
• Inadequate control of symptoms other than pain (or concern about it) – 56%  
• Inadequate control of pain (or concern about it) – 54%  
• Loss of dignity – 53%  
• Perceived burden on family, friends or caregivers – 34%  
• Loss of control of bodily functions – 32%  
• Isolation or loneliness – 14%  
• Emotional distress/anxiety/fear/existential suffering – 5% 
• Loss of control/autonomy/independence – 4% 
• No/poor/loss of quality of life – 3%
  

The medical practitioner is responsible for ensuring compliance with the law’s safeguards; the only “proof” that safeguards were met is the clinician’s opinion and assurance to that effect. Of course, nearly all clinicians said they asked the person what they wanted, but did that conversation take place privately, away from the influence of family or others who might sway the decision? One telling statistic is that only 14% of practitioners based their determination of the voluntariness of the person’s request on prior knowledge of the person. This suggests that few providers had the deeper knowledge that comes of long-standing relationships with the people they were assessing for eligibility to die.

The questions and concerns raised by this first annual report lead us to believe that Canada has not met the Supreme Court’s mandate to create “a carefully-designed system imposing stringent limits that are scrupulously monitored and enforced.” 

Amy Hasbrouck is the President of the Euthanasia Prevention Coalition

Book launch - Made To Live with Dr Paul Saba on September 15.

Dr Paul Saba is launching his book - Made To Live on September 15, 2020.

Alex Schadenberg is hosting the Zoom event featuring Dr Saba, who will speak about his new book.

Date: September 15, 2020

Time: 7:30 PM (Eastern Time).

Now that the event has happened. Here is a link to the video of the event (Link).

After registering, you will receive a confirmation email containing information about joining the meeting.

"Dr. Paul Saba’s personal journey to save life demonstrates his caring heart not only for his family but all those around him in the world whom he considers part of his extended family. He recognizes assisted suicide and euthanasia are neither caring nor compassionate. "

—Nancy Elliott
Euthanasia Prevention Coalition USA

"I consider Dr. Paul Saba to truly be a canary in the coal mine, alerting the world about the fatal flaws associated with euthanasia and assisted suicide.... This book is an incredible addition to the arsenal of data and stories upholding the value of human life and enunciating why killing people is not only bad public policy but simply wrong."

—Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

"In Made to Live, Dr. Paul Saba has provided a timely reminder of the underlying principles of medicine, which are to heal, promote health, and alleviate suffering, and to resist the temptation of killing the patient. Outlining his personal, family, and professional struggles to resist pressure coming from within the medical profession to take human life rather than preserve and cherish it, he provides valuable insight into the dangers posed to true medicine by the corrupting influence of the spread of euthanasia and assisted suicide. With reference to the history of the euthanasia movement, he shows that it is fundamentally opposed to the principles of medicine."

— Dr. Gordon Macdonald
CEO, Care Not Killing, London, UK

A euthanasia (MAiD) story. Who decides?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Why has assisted death become common so quickly in Canada?

I was visiting a friend, this weekend, who told me the story of how his neighbour died by (MAiD) euthanasia earlier this year.

He told me that he and his wife were helping their neighbour, who had cancer, by bringing him to the hospital for treatments and the doctors for appointments.

The man was considering a new round of treatment, but his family doctor urged him to "ask" for MAiD (euthanasia). The cancer had spread quickly and he was losing hope so he agreed to die by lethal injection. In case your wondering, finding a second doctor or nurse practitioner to agree is not difficult.

My friend then spoke about how the doctor, and his neighbour, kept the euthanasia decision a secret. His wife asked, how does my husband know that he is dying on that day? She became aware of the decision in the last minute. 

If there is nothing wrong with killing by euthanasia, then why keep it a secret?

She sat at his side holding his hand while he was injected and died. My friend looked at me and said, his wife was upset.

My friend did not question that his neighbour qualified for MAiD, he questioned the process that led to his neighbours death.

According to my friend, this man was not suffering, even though he probably feared possible future suffering.

This man was speaking to his doctor about another course of treatment, not euthanasia. I understand that the doctor thought that further treatment was futile, but why did killing become the answer? Was it compassionate?

Why didn't the doctor assure the man that he could be kept comfortable? Why was euthanasia brought up rather than caring options?

This appears to be a case of a doctor who has normalized killing within his medical practice. He has done it before and doing it again only rationalizes, for him that his other acts of euthanasia were good.

Killing justifies killing and normalizes the act.

Caring normalizes caring.

Killing is not caring. Killing is not dignified.

Legalising assisted dying can actually increase suicides

The Conservative Woman published an article on September 13 by Theo Boer analysing the suicide statistics in the Netherlands. Boer was a member of a Regional Euthanasia Review Committee in the Netherlands for 10 years and has done significant analysis of the experience with euthanasia in the Netherlands.

Here is what Professor Boer wrote:

Last week I addressed a group of Parliamentarians about assisted suicide and euthanasia. My talk, which coincided with World Suicide Prevention day, sought to address the unintended consequences of legalising assisted suicide and euthanasia in the Netherlands.

One of the arguments we hear is that assisted dying will bring down the numbers of violent suicides. It will provide a more peaceful death to patients in unbearable suffering who would otherwise have violently killed themselves. For other patients, the mere option of assisted dying (even if it will never be effectuated) is said to be a reassuring thought that will keep them from killing themselves.

I admit that these arguments may hold in individual cases. However, on the whole, the argument is mistaken. In the Netherlands, assisted dying gradually became available for patients commonly considered to be at risk of committing suicide: psychiatric patients, people with chronic illnesses, dementia patients, and elderly people without a terminal disease. But instead, the suicide numbers went up: from 1,353 in 2007, they went up to 1,811 in 2019, a rise of 33.8 per cent. In surrounding countries, most of which have no assisted dying practice, the suicide numbers went down. Germany, with a population much like the Dutch in terms of age, economy, and religion, saw its suicide numbers decrease by 10 per cent in the same period.

One hypothesis I increasingly accept as an academic and as someone who worked for almost ten years in monitoring and reviewing assisted dying cases for the Dutch authorities is the normalising effect that legalising assisted dying has had on the general population. We already know from the literature that when one person takes their own life, it can be a catalyst for others. Indeed, there are over 50 peer-reviewed studies reaching the same conclusion in what has been dubbed suicide contagion, copycat suicides or the Werther Effect. Not without reason, and based on advice from the World Health Organisation, the media go to great lengths to censor details that could trigger further suicides. Unfortunately, the same can’t be said about their carefulness when reporting assisted suicide stories, the great majority of which express an ill-informed and naïve sympathy for assisted dying.

The Netherlands should act as a cautionary tale to those in power in the UK. Like many of the current supporters of assisted dying, I used to believe that it was possible to regulate and restrict killing to terminally ill mentally competent adults with less than six months to live. I also thought that regulating suicide and death in this way would curtail those tragic cases where someone ends their own life. I was wrong. If there is one thing I learned in my country, it is that legalising assisted dying will not constrain the numbers. Deep down, many campaigners consider the legalisation of assisted dying for terminal patients merely as a stepping stone towards further liberalisation. Take Canada as an example. Soon after euthanasia was legalised in 2016, right-to-die lobbyists contested the limitation to the terminally ill. Not without success: in 2019, the Superior Court of Quebec ruled that such a limitation is ‘unconstitutional’ and that euthanasia should become available to any patient, whatever their life expectancy. As for the Netherlands, a Private Member’s Bill is making its way through The Hague that would extend killing to any person of 75 years and older.

Again, it may be reassuring to some that they will have access to an assisted death. But legalisation also conveys a cynical political signal: some people may be right if they no longer want to exist. In the Netherlands, I have witnessed a growing portrayal of death as the most effective and dignified remedy to unbearable suffering. Not only has this led to more assisted deaths, but it may well be one of the causes of the increased suicide numbers. This matters to the UK, because your number of suicides is roughly 3.5 times the Dutch level. According to your ONS, in 2018 there were just over 6,500 suicides. Even a modest percentage increase could add dozens if not hundreds to these figures, and this seems a risk too far.

Many of those campaigning for a change in the law have a genuine compassion for suffering people. However, be careful what you wish for. The legalisation of assisted dying will not only lead to tens of thousands of cases of assisted dying – the Netherlands, with 17 million inhabitants, has between 6,000 and 7,000 cases of assisted dying yearly – but may well contribute to more people, not fewer, taking their own lives.

More articles on this topic:

• Does legalizing assisted suicide lead to more suicides in general? (Link). 
• In Oregon, suicides have increased with the legalization of assisted suicide (Link).

 

Utah man claims his wife's death was not murder but assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
 

Dennis & Jean Chamberlain

Dennis Chamberlain was convicted for attempted murder in the death of his wife, Jean, in 2014. Dennis is asking for parole by claiming it was an assisted suicide and not murder.
 
Marcos Ortiz, for ABC news - The Justice Files, reported:

In 2014, he was arrested for the murder of his wife, Jean. He eventually accepted a plea bargain and the charge was reduced to attempted murder. He was sentenced to a minimum of three years and up to life in prison.

Chamberlain claimed, during the parole hearing, that it was an assisted suicide, not murder.

Before the hearing officer, Chamberlain continued to maintain it was an assisted suicide, not murder. But an assisted suicide is still against the law in Utah.

“We decided the two of us together to help her pass on to the next life,” he said. “And so what I did is I put a plastic bag on her head … and she didn’t survive very long after that. ”

The act of asphyxiating a person with a plastic bag is murder not assisted suicide. Chamberlain claims that he received advice from the Hemlock Society:

During the 2015 defense of his actions, Chamberlain claimed the two of them were followers of the Hemlock Society. The organization believes it is one’s right to choose when they died. He said he met with members of the group who told him that helping his wife die was an option.

“It wasn’t just my decision,” he said. ” It was mine and my wife Jean’s decision and we went along with the people that were part of that organization.”

Chamberlain's daughter, Sonya Balling, and Jean's sister, Janis Farran don't believe him and don't want him released. Ortiz reported Farran as stating:

“He was not a grieving widower but a calculated killer who planned the execution of our beloved sister and then covered it up,”

“In the face of the evidence of his actions Dennis still denies that he killed her. He has shown no remorse whatsoever.”

“He’d tape her to a chair and leave her,”

“And (he’d) be upset and punish her if she soiled herself.”

Balling also commented on her father's crime:

“In my father’s mind he hasn’t done anything wrong so until he makes an effort to acknowledge his actions for what they truly were or try to change his mindset or make amends, I do not believe he should be released”

If assisted suicide were legal in Utah, Chamberlain could have argued that all he did was complete an act that is legal for doctors to do.

The fact is that putting a plastic bag over someone's head and asphyxiating them to death is murder. He did the act, therefore he should serve his time.

• Nitschke possibly connected to a murder in America (Link).

Nova Scotia court case about the husband who was approved for euthanasia, but is not terminal and may be delusional, continues.

Alex Schadenberg
Euthanasia Prevention Coalition

The Nova Scotia court case concerning a woman who is trying to prevent her husband of 48-years from dying by euthanasia will continue on September 24.

Katherine's husband was approved for (MAiD) euthanasia even after receiving conflicting assessments for MAiD (euthanasia). Katherine says he is not dying and is delusional about his medical condition. Justice Elizabeth Van den Eynden recently lifted a temporary injunction to allow the man to die by euthanasia, even though the judge set the court date for September 24.

The Euthanasia Prevention Coalition found the decision by Justice Van den Eynden to be untenable.

To schedule a hearing on the merits of the injunction for September 24 and then lift the temporary injunction on September 4, allowing him to die by lethal injection, makes a mockery of justice. 

If the case continues, and if it is decided that the husband lacked effective capacity to decide or did not qualify under the law, but at the same time he had already died by euthanasia is farcical.

Katherine lawyers were denied a formal review of the decision even though her husband can die by euthanasia before September 24. The case questions whether her husband qualifies for MAiD and how to respond to conflicting or false MAiD assessments.

In response to media inquiries Katherine stated:

I have learned so much about the potential for abuse of vulnerable people in Canada through MAID. The MAID programs don’t even follow their own procedures. Doctor shopping is rampant and there is no oversight by court or Tribunal. This must change for the safety of all vulnerable Canadians.

Her Lawyer Hugh Scher noted:

There must be a significant overhaul to MAID in Canada. The limited safeguards put in place by parliament have proven ineffective to prevent against doctor shopping and arbitrary application of the law. If MAID is health care as many argue then it must be subject to the same oversight requirements as other end of life treatments in terms of resolving disputes about capacity, consent and reasonable foreseeability of death.

Absent that we have unleashed a dangerous program of euthanasia on demand that puts the lives of vulnerable people at risk.

Hugh Scher

In an interview by CTV News Avis Favario, Scher suggested that this case may be appealed to the Supreme Court of Canada.

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

The decision as to whether Katherine will seek to appeal this case to the Supreme Court of Canada cannot be determined at this time.

The question that the Euthanasia Prevention Coalition seeks to clarify that when there are conflicting or a false MAiD assessment, is there an avenue to challenge the assessment, especially since this is a life and death decision.

The Euthanasia Prevention Coalition needs your help.

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

Donate to the Euthanasia Prevention Coalition (Link) by:

Paypal (Link),
Donate by credit card by calling the EPC office at: 1-877-439-3348, or
Send cheques to the Euthanasia Prevention Coalition, Box 25033, London ON., N6C 6A8.

More information on this case.

• Nova Scotia court decides that a man who is not dying and may be delusional can die by euthanasia (Link). 
• Woman goes to court to prevent her husband's assisted death (Link). 
• Nova Scotia woman seeks to prevent her husband's death by euthanasia (Link).

Euthanasia advocate in France has resumed eating and drinking.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alain Cocq, who was blocked by facebook earlier this week from live streaming his death, has changed his mind and has started eating and drinking. On Wednesday he said that he did not have the "capacity for the fight any more".

Mr. Cocq has been lobbying French legislators to legalize euthanasia. BBC news reported:

In July, he wrote to French President Emmanuel Macron, describing his "extremely violent suffering" and asking for permission to die "with dignity". 

Mr Macron said he was "moved" by the letter, but could not grant the request for euthanasia as he was "not situated above the law". 

"Your wish is to request active assistance in dying which is not currently permitted in our country," he said.

Last Saturday Mr Cocq announced that he ate his last meal and would livestream his death on facebook. The BBC news report stated:

"I know the days ahead are going to be difficult but I have made my decision and I am calm," he said. 

But Facebook on the same day blocked his plan to livestream himself slowly dying, stating that it did not allow portrayals of suicide.

On Monday, Mr Cocq was admitted to hospital because he was suffering from starvation and dehydration. On Wednesday he started eating again. BBC reported:

After eating again, Mr Cocq told AFP on Wednesday he would be allowed to return home in the next 10 days, where a medical team would be installed.

Mr Cocq health condition is difficult. We hope that he finds caring people to help him find the will to live.

Nova Scotia court decides that a man who may not be dying and may be delusional can die by MAiD (euthanasia).

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Update: Katherine's lawyer requested a judicial review to prevent her husband's death until after the Sept 24 court case. On Sept 10 we learned that the review was dismissed. It is crazy that the court is willing to hear the case on Sept 24 but Katherine's husband could die by lethal injection before the case, even the the court may decide that he doesn't qualify.

Taryn Grant reporting for CBC News Nova Scotia that a man who has received conflicting assessments for MAiD (euthanasia) and whose wife of 48 years says is delusional about his medical condition, can go ahead and die by euthanasia. Grant reported:

A Nova Scotia Court of Appeal judge has upheld a lower court decision that effectively allows a man to go ahead with a medically assisted death, in spite of his wife's efforts to stop him.

The 83-year-old man from Bridgewater, N.S., was assessed by physicians and approved for medical assistance in dying (MAID) earlier this year, but his wife, Katherine, 82, filed for an injunction with the Supreme Court of Nova Scotia, forcing him to cancel his plans.

CBC News is identifying the couple only by the woman's first name to protect their privacy and his ability to access health care. His wife has threatened to sue health-care providers who help her husband access a medically assisted death.

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

The couple have known each other for more than 60 years and have been married for 48.

Hugh Scher

Hugh Scher, the lawyer for Katherine sent out the following comment:

The decision calls into serious question the arbitrary application of the criminal law in a way that puts vulnerable people at risk.

In this case there are multiple medical opinions questioning the husband's capacity while others say he has capacity. Similarly multiple reports state that his death is not reasonably foreseeable. Others say his death is reasonably foreseeable.

The notion that a court should be precluded from resolving such a fundamental conflict about capacity and that the legal requirements of the criminal code are met is a glaring violation of the rule of law in Canada that puts vulnerable people at risk of death.

The notion that individuals should be free to see 10 doctors who find they lack capacity, but then find 2 more that say they don’t to justify an assisted death is troubling and renders the safeguards and protections of the criminal law completely meaningless.

Katherine calls on Parliament, the Nova Scotia Legislature and the courts to fix an arbitrary and broken legal process that permits the intentional killing by euthanasia of those who lack capacity and who don’t meet the most basic requirements of the law.

The Supreme Court of Canada made clear that legalization of euthanasia in Canada depended completely on parliament’s ability to implement reasonable safeguards to protect the most vulnerable of Canadians.

Today’s decision by a single judge of a court of appeal on a procedural matter demonstrates how woefully inadequate the present regime and procedures are to protect vulnerable people lacking capacity from being put to death in Canada.

Katherine

Grant reported that the case might continue:

The case could still go to a formal appeal hearing and is scheduled to do so on Sept. 24.

Katherine's lawyers noted last week that should her husband go ahead with the MAID procedure before then, it would render the appeal moot. This was one of their arguments for an extension of the interim injunction.

The Euthanasia Prevention Coalition finds this decision to be untenable.

To schedule a hearing on the merits of the injunction for September 24 and then lift the temporary injunction on September 4, allowing him to die by lethal injection, makes a mockery of justice. 

If the case continues, and if it is decided that the husband lacked effective capacity to decide or did not qualify under the law, but at the same time he had already died by euthanasia is farcical.

Katherine lawyers may ask for a formal review of the decision, but her husband might be dead before the review can be considered.

This is a clear example of justice being denied. 

Katherine could not have carried out the legal proceedings and or file an appeal without the support of the Euthanasia Prevention Coalition. She loves her husband and she launched the legal action to prevent the wrongful death of her husband, but she could not do so without help.

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

Donate to the Euthanasia Prevention Coalition (Link) by:

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

We will provide more information, but based on privacy, we are providing as much information, at this time, as possible.

Thank you for considering EPC in this precedent setting case.

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

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

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

Gordon Friesen

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

 -- What is really at stake here ?

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

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

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

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

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

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

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

But such is simply not the case.

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

The instructive cases of Belgium and the Netherlands

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

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

Nothing but the facts...

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

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

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

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

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

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

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

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

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

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

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

A return to the Canadian experience

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

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

Canada by the numbers

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

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

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

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

A sad portrait of quantitative over-reach

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

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

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

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

Woman dying of cancer urges New Zealand to vote NO to euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Vicki Walsh

As New Zealand debates a euthanasia referendum a woman dying of cancer is urging New Zealanders to Vote NO to euthanasia saying people could be coerced into an early death. The New Zealand Herald reported:

Vicki Walsh, who is now 53, was diagnosed with Glioblastoma Multiforme in June 2011.

The aggressive brain cancer is nicknamed "The Terminator" and those who have it typically die within 14 months of diagnosis.

But nine years later, Vicki is still around, living near Palmerston North with her husband and two adult children.

She has been taking the drug Avastin - which has cost her $24,000 - and the mass in her brain has halved.

"I was always told there was nothing more that could be done," she said. "So in eight years, nine years, things have changed, so I got another surgery, I got radiation and now we're having this drug that we're paying for."

There was a time when Vicki wanted to end her life.

She said she watched people, who were battling the same illness overseas, choose euthanasia and felt she should take her own life. 

"I actually felt kind of gutless, I was looking at my husband and we were trying to keep life normal and I had a bit of a stroke and it ended up really, really big and I just felt that this is it for me," she said

"It had been several weeks, it wasn't just an overnight thing, and I just thought, if this is how it's going to be, I don't want to live like this anymore."

But Vicki changed her mind in the last moment.

Had she gone through with it, she said she would have missed out on watching her grandchildren grow up.

"If you'd asked me if I want to live like I am now, I would have viewed my life 15 years ago as not having much of a quality of life now," she said. "I love my life, you know, I love my life."

Vicki is concerned that legalizing euthanasia will lead to coercion

But Vicki's greatest fear is that people will feel pressured to end their lives earlier than they need to.

"The coercion thing is one of biggest concerns for me about this bill. People say it wouldn't happen - well we already have an elderly abuse problem in this country," she said.

"So I already know what I feel like, like my family don't make me feel like a burden, but I also feel like a burden sometimes and I'm not getting that pressure."

More articles on the New Zealand euthanasia referendum.

• New Zealand End of Life Choices Act would lead to many, not a few assisted deaths (Link).
• New Zealand End of Life Choices Act is not what it claims to be (Link).
• Claire Freeman was encouraged by the suicide outreach clinic to consider assisted suicide (Link).