Monday, February 20, 2023

Wesley Smith and Alex Schadenberg discuss Canada's euthanasia epidemic and assisted suicide in America.

Wesley Smith, who is a regular contributor to the National Review and other publications recently interviewed Alex Schadenberg for his Human Exceptionalism podcast about Canada's euthanasia epidemic and assisted suicide in America.

In the hour long podcast, Wesley and Alex discuss the events that led to Canada legalizing euthanasia, they talked about how the law came to be, how it is administered, as well as the current stories and developments with relation to euthanasia in Canada.

In the interview they compare the Canadian euthanasia experience with other jurisdictions including the US assisted suicide regimes.

They also talked about the cultural factors that led to the legalization of euthanasia in Canada and assisted suicide in America and the best responses to the culture to prevent the spread of euthanasia and assisted suicide.

Wesley wrote:

No modern society has embraced lethal injection euthanasia with the enthusiasm of Canada, where not only the terminally ill can be killed by doctors but also people with chronic conditions and disabilities. Soon, people with mental illnesses will qualify for a doctor-hastened death. In 2021, more than 10,000 Canadians were euthanized by doctors or nurse practitioners.

Why has Canada, of all countries, embraced doctor-administered death? Wesley’s guest on this episode of Humanize has the answers. Alex Schadenberg is one of the world’s premier opponents of euthanasia and assisted suicide. He is the co-founder and executive director of the Euthanasia Prevention Coalition, founded in 1998 and based in the Canadian Province of Ontario. He produced The Euthanasia Deception documentary that explores 15 years of euthanasia legalization in Belgium. Schadenberg has traveled the world speaking about the issue, authored countless opinion columns, and moderates the world’s most widely-read blog devoted to the issue, the link to which can be found in the program notes. He is also the author of Exposing Vulnerable People to Euthanasia and Assisted Suicide.

 

Québec has the highest euthanasia rate (7%) in the world.

More than 7% of deaths result from medical assistance in dying in Quebec. More than 5,000 people could use it this year, compared to less than 1,000 five years ago.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A CBC radio program (French) by Davide Gentile & Daniel Boily reported on February 16 that more than 7% of deaths result from medical assistance in dying in Quebec with more than 5,000 people use it this year, compared to less than 1,000 five years ago.

The report stated that (google translated):
Quebec now ranks well ahead of the Netherlands and Belgium in terms of the use of medical assistance in dying. To understand this rapid progression, the Commission on End-of-Life Care launched a consultation with hundreds of doctors.
According to Québec's annual euthanasia report that was released on December 9, 2022 there were 3663 reported euthanasia deaths from (April 1, 2021 to March 31, 2022) representing 5.1% of all deaths. The last report indicated that the number of euthanasia deaths was up by 51% in the past year and had more than doubled in two years.

The Québec report also indicated that there was a discrepancy of 289 deaths that may be explained by under-reporting

Since the release of that report the Commission on End-of-Life Care has launched a consultation since new data indicates that there will be at least 5000 reported euthanasia deaths representing 7% of all deaths in the next report.

Dr Michel Bureau, the President of the Commission on End-of-Life Care stated:

"in Quebec, there are more of them than in Ontario, more than in Europe, and it is our duty to see if there are causes obvious to that".  

"where there is a risk is that it is so embellished in the population that many suffering people will say to the doctor: 'I want medical assistance in dying' even if they don't are ineligible".

Bureau believes that euthanasia is mean't to be care of the "last resort" and he wants there to be more access to palliative care. 

But not all doctors agree. Dr Pierre Viens (right), who has been a physician since 1963 and who regularly does euthanasia, is not concerned with the number of euthanasia deaths. He stated:

“It does not indicate that there are more cases of cancer, ALS, etc. It simply indicates that more people with serious illnesses, with suffering, at the end of life, are aware that there is a way to die with dignity, humanely, through MAID."
At the same time the Québec government introduced a bill to expand the law to approve euthanasia for incompetent people who requested death by lethal injection in their advanced directive.

Friday, February 17, 2023

Canadian Children may be euthanized with or without parental consent.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Sign the EPC petition: Oppose Child euthanasia in Canada (petition link).

A report by the Special Joint Committee on Medical Assistance in Dying (AMAD) was tabled in the House of Commons on February 15 calling for a drastic expansion of euthanasia (MAiD) in Canada. Among other recommendations, the report recommends that euthanasia be expanded to include children "mature minors."

Recommendation 19 in the report states:

That the Government of Canada establish a requirement that, where appropriate, the parents or guardians of a mature minor be consulted in the course of the assessment process for MAID, but that the will of a minor who is found to have the requisite decision-making capacity ultimately take priority.

This means that parents or guardians may or may not be consulted, in the euthanasia death of a child that is deemed capable of decision-making.

To understand Recommendation 19 better we to go back to the policy developed by the Hospital for Sick Children in Toronto on euthanasia for "mature minors" that was published as a report in the Journal of Medical Ethics in September 2018.

According to an article by Sharon Kirkey published by Sun Media, on October 9, 2018; the ethicists at the Children's Hospital believe that there is no difference between killing someone and letting them die. Kirkey reported:

The working group said it wasn’t convinced that there is a meaningful difference for the patient “between being consensually assisted in dying (in the case of MAID) and being consensually allowed to die (in the case of refusing life-sustaining interventions).” 

Sick Children's hospital draft policy applies the same "ethics" for mature minors making medical decisions as making death decisions. Most Canadian provinces allow mature minors to make decisions about their own care, including withdrawing or withholding life support. In Ontario a minor can provide consent for treatment or withdrawal of treatment if they understand the “reasonably foreseeable consequences” of their decision. The Sick Kids' hospital stated that they encourage minors to involve their families in medical decisions.

Kirkey explained that the Hospitals for Sick Children draft policy would permit children to decide to be killed by euthanasia without the consent of the parents:

The draft policy argues the same rules should apply to MAID since there is no meaningful ethical or practical distinction from the patient’s perspective between assisted dying and other procedures that result in the end of a life, such as palliative sedation (where people sleep until they die) or withdrawing or withholding life-sustaining treatments. 

The draft policy by Toronto's Hospital for Sick Children set out what can be expected if Canada permits euthanasia for children (mature minors).

Children who are deemed, by their physician, as competent to make medical decisions will be also deemed competent to decide, with or without the consent of their parents, to die by lethal injection.

Now that the Canadian government is considering child euthanasia and euthanasia of incompetent persons who requested death in an advanced directive, the requirement to consent to die has become only an option.

Every time a door is opened to new reasons for killing it always leads to another door. Opening the door to child euthanasia also opens the door to euthanasia without consent.

Canada's Senate only has one week in parliament to pass Bill C-39 and delay euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Toronto Sun reporter Catherine Lévesque stated that on February 15, the House of Commons unanimously passed Bill C-39, the bill that would delay the implementation of euthanasia for mental illness until March 17, 2024. But Canada's Senate only has one week to also pass C-39.

Lévesque explained:
Time is of the essence, as both houses will not be sitting for the next two weeks and will come back on the week of March 6 before another break week. That means the Senate will only have one sitting week to study and vote on C-39 before the deadline of March 17 2023.
Lévesque reported that Justice Minister David Lametti is confident that the Senate will vote on the bill quickly but it was the Senate that originally amended Bill C-7 to include euthanasia for mental illness.

Lévesque reported that Marc Gold, the government's representative in the Senate stated:
“We are confident that the Senate will complete a final vote on Bill C-39 before March 17.”
Lévesque reported that during the parliamentary debate on Bill C-39:
Lametti said the main objective of C-39 is to give more time to nurses and practitioners to get more training on the issue and to give the government more time to consider a new report from the parliamentary committee looking at extending eligibility of assisted dying.

NDP MP Alistair MacGregor told Lametti at a committee meeting this week that elected officials studying the issue “always felt under the gun” because of the sunset clause expiring and welcomed the one-year extension provided by the new bill.

Conservatives, on the other hand, are clear that they oppose the extension of MAID to people suffering from mental disorders and have another year to try to make this clause disappear.

Speaking in the Commons on Wednesday evening, things got emotional as Liberal MP John McKay spoke about the hurdles of navigating through the health system for 25 years ever since his stepson was diagnosed with schizophrenia.

The Euthanasia Prevention Coalition welcomed Bill C-39 but it is not a victory since it only delays and stops the implementation of euthanasia for mental illness. For the sake of John McKay's stepson, euthanasia for mental illness should not even be considered.

I do not trust this government. I still fear that Bill C-39 may be held up in the Senate and not meet the March 17 deadline.

Previous article:

Canadian Parliamentary Committee Recommends Euthanasia for Minors without Parental Consent

This article was published by National Review online on February 16, 2023.

Wesley Smith
By Wesley J. Smith

Euthanasia advocates tend to advance their cause by requesting that panels of  “experts” or lawmakers conduct oh, so careful studies to recommend policies that, invariably, would legalize assisted suicide or expand it where already allowed. These are stacked decks; activities choreographed to reach a particular conclusion.

Such a bit of theater was just performed in Canada, where a report was just published by the Canadian Parliament’s Special Joint Committee on Medical Assistance in Dying (AMAD). Surprise! It calls for even further expansion of the already permissive law that allows terminally ill and chronically ill adults, people with disabilities, and the frail elderly to opt to be killed by doctors or nurse practitioners. The mentally ill are scheduled to be included in this dismal list next month under existing law, but that may be put off for a year because of domestic and international agitation around the issue. But, mark my words, they too will eventually become eligible for the lethal jab.

The committee has now recommended that “mature minors” whose deaths are “reasonably foreseeable” be allowed to access death — perhaps even without parental consent. From, the AMAD report’s recommendations:

Recommendation 14: That the Government of Canada undertake consultations with minors on the topic of MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, within five years of the tabling of this report.

Recommendation 15: That the Government of Canada provide funding through Health Canada and other relevant departments for research into the views and experiences of minors with respect to MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, to be completed within five years of the tabling of this report.

These two provisions loosen the foreseeable-death requirement listed below, as it already has been for adults:

Recommendation 16: That the Government of Canada amend the eligibility criteria for MAID set out in the Criminal Code to include minors deemed to have the requisite decision-making capacity upon assessment.

Recommendation 17: That the Government of Canada restrict MAID for mature minors to those whose natural death is reasonably foreseeable. . .

Recommendation 19: That the Government of Canada establish a requirement that, where appropriate, the parents or guardians of a mature minor be consulted in the course of the assessment process for MAID, but that the will of a minor who is found to have the requisite decision-making capacity ultimately take priority.

In other words, children would be able to choose to die even over the objections of their parents. (It’s worth noting that a similar recommendation was previously made in a medical-journal article by Canadian pediatricians, which I wrote about here.)

The committee also wants people who have been diagnosed with dementia to be allowed to order themselves killed in an advance directive:

Recommendation 21: That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition disease, or disorder leading to incapacity.

Recommendation 22: That the Government of Canada work with provinces and territories, regulatory authorities, provincial and territorial law societies and stakeholders to adopt the necessary safeguards for advance requests.

My editorial comment: What a joke.

Recommendation 23: That the Government of Canada work with the provinces and territories and regulatory authorities to develop a framework for interprovincial recognition of advance requests.

This practice is already allowed in the Netherlands and Belgium — and yes, there have been abuses of these laws that haven’t matter a whit.

Will these recommendations be followed in Canada? Almost surely, in part or in full. That’s why the committee was asked to file a report in the first place. Why should we, in the U.S., care? Canada, being our closest (and, according to many progressives, a far more enlightened) cultural cousin, exerts a substantial influence on our own country’s social policies.

Thursday, February 16, 2023

Government report recommends euthanasia for children and euthanasia by advanced directive.

By James Schadenberg

A report by the Special Joint Committee on Medical Assistance in Dying (AMAD) was tabled in the House of Commons on February 15 calling for a drastic expansion of euthanasia  (MAiD) in Canada. The report recommends that children "mature minors" and patients with mental illnesses should be eligible for euthanasia and that patients with illnesses such as dementia should be permitted to make advanced requests by advanced directives for euthanasia. The report, Medical Assistance in Dying in Canada: Choices for Canadians, can be viewed here: (Link).
Sign our petition: No to child euthanasia in Canada (Link)

The report was supported by Liberal, NDP and Bloc-Quebecois members of the committee. The report gave 23 recommendations for actions by the government regarding euthanasia. 

Recommendation 13 involved euthanasia for mental illness alone. The report suggests that prior to the legalization of MAiD for mental illness, AMAD should re-convene to ensure its "safe and adequate application":

Recommendation 13 

That, five months prior to the coming into force of eligibility for MAID where a mental disorder is the sole underlying medical condition, a Special Joint Committee on Medical Assistance in Dying be re-established by the House of Commons and the Senate in order to verify the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC situations). Following this assessment, the Special Joint Committee will make its final recommendation to the House of Commons and the Senate.

Recommendations 14 - 20 all involve the exapansion of euthanasia in Canada to children (or as referred to in the report as "mature minors"):

Recommendation 14

That the Government of Canada undertake consultations with minors on the topic of MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, within five years of the tabling of this report.

Recommendation 15

That the Government of Canada provide funding through Health Canada and other relevant departments for research into the views and experiences of minors with respect to MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, to be completed within five years of the tabling of this report.

Recommendation 16

That the Government of Canada amend the eligibility criteria for MAID set out in the Criminal Code to include minors deemed to have the requisite decision-making capacity upon assessment.

Recommendation 17

That the Government of Canada restrict MAID for mature minors to those whose natural death is reasonably foreseeable.

Recommendation 18

That the Government of Canada work with provinces, territories and First Nations, Inuit and Métis communities and organizations to establish standards for assessing the capacity of mature minors seeking MAID.

Recommendation 19

That the Government of Canada establish a requirement that, where appropriate, the parents or guardians of a mature minor be consulted in the course of the assessment process for MAID, but that the will of a minor who is found to have the requisite decision-making capacity ultimately take priority.

Recommendation 20

That the Government of Canada appoint an independent expert panel to evaluate the Criminal Code provisions relating to MAID for mature minors within five years of the day on which those provisions receive Royal Assent, and that the panel report their findings to Parliament.

Recommendations 21 - 23 all call for permitting advance requests for euthanasia for those with dementia and other incurable illnesses. This would mean that patients can be killed through euthanasia after they've lost the capacity to consent to it:

Recommendation 21

That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition disease, or disorder leading to incapacity.

Recommendation 22

That the Government of Canada work with provinces and territories, regulatory authorities, provincial and territorial law societies and stakeholders to adopt the necessary safeguards for advance requests.

Recommendation 23

That the Government of Canada work with the provinces and territories and regulatory authorities to develop a framework for interprovincial recognition of advance requests.

The report also included a dissenting opinion by members of the committee from the Conservative Party. In it, the Conservative members of the committee express their disapproval for the hasty and reckless way that the government has moved to expand Canada's MAiD regime, though they are divided on whether to allow advanced requests. They claim the government refused to put "evidence ahead of ideology" when they moved to expand MAiD for situations where mental illness is the sole underlying medical condition without first determining whether it could be implemented safely. 

The Conservative members dissenting report did not approve child euthanasia, claiming "it would be irresponsible for the Liberal government to move ahead with any expansion of MAID for mature minors" and that "Conservatives do not support MAID for mature minors at this time".

The dissenting report concluded with the following statement:

The Liberals’ rushed and reckless approach to Canada’s MAID regime has put the lives of vulnerable Canadians at risk. We caution the Liberal government against repeating the mistakes they made concerning MAID MD-SUMC. MAID policy must be grounded in evidence, consultation with impacted groups, and with serious consideration given to protecting the vulnerable.

The recommendations being put forth by AMAD would give Canada the most permissive euthanasia law in the world. Given the current state of Canada, where vulnerable people continue to be pressured to euthanasia on a frequent basis, it is inappropriate for the government to consider these radical expansions to the euthanasia law. There should instead be a greater focus on how governments in Canada can help people who may be feeling that their life is not worth living.

The Euthanasia Prevention Coalition submitted a brief to AMAD in early 2022, which expressed the dangers of Canada's current MAiD regime, and the dangers of expanding it to allow for advance directives and child euthanasia. This brief can be viewed here: (Link).

Further reading:

Euthanasia doctor regrets killing a patient with a treatable condition.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Macleans Magazine has published an insightful interview by Liza Agrba with Dr Madeline Li, a Canadian euthanasia doctor. The article: I am a MAiD provider. It's the most meaningful - and maddening work that I do. Here's why explains the concerns that Li has with Canada's euthanasia Li from the perspective of a doctor who does it.

Li specializes in cancer psychology with the University Health Network (UHN) in Toronto and is the head of the UHN's MAiD program. Li states:
I oversaw hundreds of cases. I also personally provided MAID numerous times. I can’t tell you how many, because I don’t keep track. They’re not trophies—this is usual care. I see a lot of death: 60 per cent of my patient population in routine clinical care die. I don’t keep track of how I help them die, whether by MAID or my regular psychosocial care.
Li is interesting because she is an active euthanasia doctor while thinking Canada has gone too far. Li continues:
Being a MAID provider requires what I call exquisite professionalism: my personal values shouldn’t matter when it comes to how I assess a patient for MAID. Having said that, my opinion is that we shouldn’t be providing MAID for mental disorders—and more broadly than that, for chronic illness. I don’t think death should be society’s solution for all forms of suffering. Society needs to agree on what types of suffering are appropriate to respond to with MAID. If someone is suffering primarily because they can’t afford housing rather than directly from a qualifying medical condition, do we think that death is the appropriate solution for that? If your suffering is because you can’t afford your medication, or other structural vulnerabilities only indirectly related to a medical condition, is that a good reason for MAID? I personally think this is the medicalization of suffering, but I’m a servant of my country, and I will do what the public mandate demands. I’m just not sure we have that mandate.

My concern with Li's comments is that she views her values as not mattering when assessing someone for death and she views her role as being a servant to her country. Killing becomes dangerous when a person disconnects it from their personal values and they agree to do it in service to their country. Remember, others in history have stated: "I was only following orders."
Li then explains some of her concerns:
I also find it maddening that the law itself is missing crucial safeguards for patients. The original MAID law stipulated, among other requirements, that a patient’s natural death has to be “reasonably foreseeable.” In 2021, this condition was successfully challenged in a court case, which created a second MAID track for people with serious and chronic (but not life-threatening) illness. This year, the law was set to expand to include patients whose sole reason for seeking MAID is mental illness. The government just announced that it would seek a one-year delay in the expansion to allow more time to prepare the health-care system. The delay was the right move.
The problem with Li's arguement is that she is suggesting that what is needed is more guidelines and training for euthanasia practitioners.

Li then comments on the reality of euthanasia and loneliness.
The stakes are higher when you give MAID to someone who wouldn’t otherwise die. I was on call recently and was consulted to see a patient admitted to the hospital for chronic pain. This patient has a complex medical and psychiatric history, significant trauma and a lot of psychosocial vulnerability. They are lonely. The patient was told there is nothing further that could be done for their pain, and so they asked to apply for MAID.

I was not their MAID assessor, but I was asked to consult as a psychiatrist for depression and suicidality. The patient told me that if they didn’t feel quite as lonely, if they felt that anyone cared about them at all, they probably could tolerate their pain better. I expressed to this patient that I thought it would be a great loss to society if they died because they had contributed and still had a lot to offer. In other words, I expressed caring, which seemed to mean everything to this person.
The lonely person was offered treatment that the person couldn't afford.
I did my best to advocate for getting this person into a study for psychedelic-assisted psychotherapy, which I thought could be very helpful, but I wasn’t successful. There was no way they could afford it privately, since it costs thousands of dollars. This was so morally distressing to me. This person was willing to have the treatment, but couldn’t access it. I think it would be a tragedy if this lovely person went ahead with MAID. As far as I know, this person is now applying for MAID. I have no doubt in my mind that when they apply, they could be found eligible and receive it.
That case gives me so much distress.
The person may have benefited from psychedelic-assisted psychotherapy, but this person really needed a caring friend. Li states that she has to fight with herself not to follow the patient and counsel them, but considering the fact that this person needs a friend, saving the life of this person. Li continues:
The law desperately needs a greater role for clinical perspective. Right now, MAID assessment is a checklist of legal requirements: you have to be considered capable of making your own decisions, be above 18 years of age and have a “grievous and irremediable” condition, among other stipulations. It’s about checking boxes. More than that, MAID assessors typically parachute into a patient’s life: they don’t typically have a long-term relationship with them.
Li explains a case of a person who had treatable cancer but died by euthanasia.
Early on, I had a young patient who had cancer with a 65 per cent chance of cure. This person refused any treatment, and two other MAID assessors agreed they met all the eligibility criteria, in that they had a grievous and irremediable condition—it was irremediable because they didn’t want the treatments available. That’s what the law currently states: as long as the patient doesn’t want the treatment, their condition is considered irremediable—even if there are effective treatments.

But not treating a cancer with such a high chance of cure goes against medical practice standards. The doctors involved had a lot of moral distress about this person’s request for MAID. This person signed consent for me to share their story, but I feel differently about it than they did. They saw it as an expression of their autonomy; I saw it as dystopian.
It is concerning that Li killed this person, even though she disagreed. Li continues:
This person organized a goodbye party. They invited all their friends to the hospital atrium and ordered pizza, calling it a reverse birthday party. It was a large gathering of friends. They had about eight people in the room where I was going to administer MAID. They got into a hospital bed, and everyone in the room laid a hand on them. There was so much crying in the room, including from their parents.

The IV was set up and prepared. “This is the very last time I’ll ask you this,” I said. “Are you sure?” They looked at me and said yes. And then the syringes went in, one after the other. The whole thing usually takes about five minutes, although it took longer than usual in this case because the patient was otherwise young and healthy. Eventually their heart stopped, I left the room and did my usual post-MAID routine: called the coroner, reported the death and filled out the paperwork. We always have social workers and spiritual care available for the family and friends, but this time no one asked for additional support. After the coroner cleared everything, they started drifting off one by one.

I didn’t regret it at first. But when I started thinking deeply about how to better safeguard this process, I regretted ending this young person’s life.
Li then comments about her concerns with euthanasia for mental disorders.
Gaps in the law become a bigger problem with mental disorders. It’s not at all clear, even for a practising psychiatrist like me, what to do for a patient with a mental illness who asks to die. I recently had a patient with chronic depression who was planning to apply for MAID until we finally found an effective treatment. They asked me how requests in patients with depression would eventually be assessed. I said we’d have to distinguish a rational desire to die from one driven by depression, and they replied, “But why would I want to die if it wasn’t because of the depression?” That gave me pause. At the very least, I think we need to prompt clinicians to exercise clinical judgment—both the clinician and the patient should feel that there have been reasonable attempts at treatment. And rather than just checking boxes, we should have to sit down and have a meaningful conversation about the desire for death.
Li then comments on the lack of definition concerning "reasonably foreseeable death".
Finally, there needs to be a clear temporal timeframe in the law assigned to the phrase “reasonably foreseeable natural death.” This was part of the original law, which was very Canadian—it was purposefully vague so as not to upset anybody. But in practice, providers have interpreted this to mean anything from a few months for terminal illness to several years for chronic illness. The MAID track for people who don’t have a reasonably foreseeable natural death is more safeguarded, including a 90-day waiting period and required expertise on the condition underlying the request. It’s not safe clinical practice for people who potentially have years to live to bypass these safeguards.
Li concludes by stating:
Helping someone die, especially when they wouldn’t otherwise, shouldn’t be a matter of checking things off a list.
Li is correct in her concerns about the lack of oversight and the language of Canada's euthanasia law but she is wrong in her ideology. She admits that she has killed people, even when she disagreed, because the death had been approved and she views her role as being morally neutral and acting as a servant of the country. When your service to the country includes killing people, then you need to re-evaluate your purpose.

Wednesday, February 15, 2023

Schrader: Disabled people must continue our unequivocal opposition to assisted suicide

By Meagan Schrader

Meagan is an instructor at E4 Texas at the University of Texas at Austin and a member of the EPC-USA board.

I started advocating against assisted suicide in 2015. I never had a terminal illness, but I had studied the issue because of my exposure to the field of bioethics, and to its generally negative, prejudiced conceptions of disability. Anyone who has read Peter Singer’s books, or studied the field of bioethics in general, will understand what I mean.

For me, that prejudice evokes my own experiences as a Special Education student, during which I observed people abusing loopholes in the Americans with Disabilities Act to get me to do things and make choices that I would never choose for myself. I was an honors student, but the pressure to make those choices-such as not taking college preparatory math courses, not taking the SAT or even dropping out of high school-was intense. Moreover, the systems put in place to prevent that kind of discrimination, such as the ADA, failed to stop this behavior. My experience as a Special Ed student and disability studies scholar taught me that ableism is baked into society and maintained by powerful forces that benefit from that ableism. 

Assisted suicide will always operate within that realm of systemic inequality. Disabled people’s experience of autonomy will always be constrained by systemic ableism because human beings have selfish inclinations. People will and have been pushed toward assisted suicide by systemic factors just like I was pushed towards dropping out of high school as a Special Education student. It’s inevitable. And forcing someone to justify their existence in a similar way that I was asked to justify my presence in the mainstream school system is disgusting. “Engage us in a debate about why you shouldn’t kill yourselves,” is a very cruel burden for pro-assisted suicide forces to put on disabled people. Standing with a despairing person as they move through the storms of life is an act of love. Helping people kill themselves is an act of hate. And, whether they know it or not, that’s what assisted suicide proponents are enabling: violence and hate against a disenfranchised minority group.

The assisted suicide laws in the US don’t currently apply to me personally, but the United States media has already published several treatises advocating for assisted suicide for mental disorders, and there my experience becomes relevant. If I lived in Canada, I would qualify for euthanasia. The psychotic depression that I experienced in 2016 was a quintessential example of what some assisted suicide advocates mean when they say that psychiatric disorders caused just as much suffering as terminal illnesses and that assisted suicide is a response to intractable mental health problems. 

By the summer of 2016 I had been in an episode of treatment-resistant depression for a year and a half. I had exhausted pretty much every treatment option available to people with treatment resistant depression-I had seen multiple psychiatrists at the top of their field, and no one had a solution for me. I had been hospitalized multiple times, and had tried multiple classes of psychiatric medication. I had Transcranial Magnetic Stimulation, a new treatment for depression that uses magnets to reorganize brain function. After my TMS treatments, I heard voices condemning me to Hell. I perceived things that weren’t there and lost pretty much all cognitive function. I was besieged by bizarre, repetitive muscle movements. I couldn’t remember who was president, or what day it was. I screamed incoherently for months & wandered around my house in a catatonic stupor. The stress of seeing me in that state was so severe that my mother vomited, which I had to watch. The experience was the psychiatric equivalent of shoving someone’s hand into a pan of boiling water, so I eventually found myself in a state where I was screaming, “Why was I born? Please God, just let me die!” I did eventually recover, but it took about two years.

Starting in 2024, some mentally ill people in Canada will never have the chance to recover, because a doctor killed them. The euthanasia laws there are already having a pernicious impact on disabled Canadians’ mental health;. For several months I’ve been corresponding with disabled friends in Canada who have been offered euthanasia as a “treatment” for their disabilities, and the offer itself was experienced as an act of abuse-because it is. I’ve heard a lot of people use the term “fear” to describe disability rights activists’ perspectives on assisted suicide, and I personally think a more appropriate term to describe my own feelings is anger. I’m angry on my friends’ behalf, and on my own behalf. It’s tough enough to get through the day with a mental illness or disability without society telling you that your darkest, most destructive inclinations are healthy, reasonable responses to your situation and that your suicide should be turned into a medical procedure.

In the United States, assisted suicide laws are a clear violation of the Americans with Disabilities Act, because suicide prevention is a public health service. When assisted suicide advocates offer suicide to disabled people, they deny us equal access to a healthcare service that able-bodied people take for granted. They are trying to add yet add an even deeper level of depravity to the systemic ableism that we experience on an everyday basis. Indeed, pro-assisted suicide violations of the ADA are already impacting equal standards of suicide prevention for disabled social media users. Twitter, for instance, has a clear anti-suicide policy. Users are not allowed to tell other users to kill themselves. Yet, Twitter allows Dying With Dignity Canada to have an account and blatantly sell suicide to people with disabilities. As such, Twitter is in violation of its own policies regarding bullying and hate speech, and it is violating the ADA by subjecting disabled users to a different standard for suicide prevention. Twitter blocks able-bodied, neurotypical users from seeing pro-suicide messages and helps send them to disabled people. This is the kind of thing that the Americans with Disabilities Act was meant to stop and that the disability justice movement was created to oppose.

Hence, I feel the need to remind readers that opposition to assisted suicide should be a non-negotiable component of disability justice work. Every state that legalizes assisted suicide brings our country one step closer to a Canada-like political landscape. I have observed some leaders in the assisted suicide movement trying to build bridges with the disabled community through token twitter posts lauding the Americans with Disabilities Act or appeals to shared values of “autonomy” and “dignity,” even as they encourage legislatures to lower disabled people to the status of animals. Based on my observations of their social media posts, it strikes me that the leaders of the assisted suicide movement are observing our arguments against assisted suicide and are attempting to punch holes in them with tokenism. I think that it’s important that we all shut those efforts down. 

Do not seek “common ground” with the assisted suicide movement. Although there may be some misguided individuals who honestly believe that suicide can coexist with disability justice, the dedicated leaders of the assisted suicide movement care about the disability rights movement in the same way that a driver of a car cares about a tree that has fallen across a road. Their aim in trying to connect with us to neutralize an impediment to their agenda.

In the case of assisted suicide, the proponents have twisted autonomy into an implement of violence. Assisted suicide isn’t just wrong because of the systemic circumstances that might push someone toward that choice, presenting the choice itself is an act of violence. Generally, the act of ending one’s life is considered “violence to yourself.” That’s the standard that is operative for able-bodied people in our culture. Assisted suicide proponents try to create a legally validated template for disabled people to engage in sanitized self-harm. They’re saying that in our case, suicide is acceptable, as long as a doctor approves it, and no one is traumatized by the sight of our violently killed bodies. The collective trauma that assisted suicide laws and messages do to the disabled community is completely ignored in order to satisfy assisted suicide proponents’ desire for control over every aspect of their lives.

There’s even evidence that for some assisted suicide proponents, advocacy and activities produces sexual pleasure. For instance, assisted suicide proponent Phillip Nitskche has admitted that assisting people's suicides in the 1990s caused him to become sexually aroused. Lonny Shavelson, one of the plaintiffs in a lawsuit seeking to bastardize the Americans with Disabilities Act and expand assisted suicide in California, has asserted that assisted suicide is one of the most “intimate” experiences that can be shared with another person. That’s depraved. Disabled people need to stand up and collectively say that we are not pornography videos. We are not condoms. And that’s the level of respect that the mainstream bioethics and assisted suicide movements have shown to disabled people-the quantity of respect that you’d show to a used condom.

As many assisted suicide opponents have pointed out, suicide advocacy typically stems from the more privileged contingent of society, the cohort of people who have actually endured the least amount of suffering possible and are unwilling to experience the suffering that is inherent to the human condition-nothing matters but them not suffering. Bioethics, a field that is preoccupied with autonomy and often promotes assisted suicide, is a big offender in this regard-the idea of not being in charge of one’s body is anathema to the field, which is dominated by white, upper class, educated individuals. These people are used to having what they want, and they are not concerned with the negative effects to others.

It is true that some assisted suicide proponents don’t mean harm to the disabled community; they are unaware of the historical connection between eugenics and euthanasia and they honestly believe that assisted suicide will function as a legitimate failsafe, without causing harm to disenfranchised people. It’s appropriate to sympathize with such people, or try to educate someone who is on the fence about the issue. However, some pro-assisted suicide academics and activists know that they’re harming the disabled community, and they don’t care. Autonomy is their “religion.” They love their god of autonomy like Christians love Jesus and Muslims love the Koran. Disability rights activists need to collectively communicate that assisted suicide leaders are welcome to practice their religion in private, but they are not entitled to conscript disabled people into the role of human sacrifices to their god.

For me personally, this understanding of autonomy seems like a mystical unicorn that exists only in the minds of the proponents. It’s a totally alien concept. My brain was injured at birth, which means that my body frequently does things that I didn’t give it permission to do. I may not always be happy about that, but it is what it is. I can’t drive a car, for instance, because my perception of spatial relationships is too weak. Driving a car would put my own life and the lives of others at risk, so even though I’d like to drive myself to the grocery store or to the mall, I can’t. During my last two episodes of psychotic depression, I wasn’t able to have autonomy at all, because I needed constant care and was too sick to make decisions for myself. This is the situation that assisted suicide proponents are trying to avoid. But their desires cannot reign supreme. That’s not fair to the disabled community.

My experience, and I think the experiences of most disabled people, teaches us that sometimes autonomy is the most just principal for a person to uphold in a given situation, and sometimes it is not. Autonomy is a great thing, and the disability rights movement values autonomy highly. However, the disability rights movement’s understanding of autonomy is different from the experience of autonomy reflected by pro-assisted suicide academics and activists. The latter idea of autonomy reflects the influence of white, upper-middle class ideals-it’s a privileged conception of autonomy based on the experiences of people with the resources and power to have control over most aspects of their lives. This is the conception of autonomy that predominates in white Anglo Saxon culture. Western culture is an individualistic one that emphasizes self-gratification and control. Disabled people, in contrast, cannot always control our bodies and we can’t always make any choice that we want. We are more vulnerable to being pressured into making a choice, and we are used to accepting limitations on our choices. So, our conception of autonomy is closer to that found in the Latino culture. That culture places more emphasis on family and community-the individual is regarded as being part of a cohesive whole, and the impact of individual choice on that whole matters. I think disability studies scholar Paul Longmore puts the difference between the disability rights movement’s conception of autonomy and assisted suicide supporters’ conceptions of autonomy best when he asserts:

“Some people with physical disabilities have been affirming the validity of values drawn from their own experience. These values are markedly different from, and even opposed to, nondisabled majority values. They declare that they prize not self-sufficiency but self-determination, not independence but interdependence, not functional separateness but personal connection, not physical autonomy but human community.”
And, that’s what the motto of the disability rights movement is: “Nothing about us without us.” “We” and “us” are the operative concepts. The assisted suicide movement’s motto is, “My life, my death, my choice.” To impute that conception of autonomy to the disability rights movement is an act of ideological colonialism. No matter how many times assisted suicide proponents may close their eyes and wish, the conception of autonomy that underpins disability justice and that underpinning assisted suicide are simply not compatible with one another.

There are times when what one individual may want is not as important as what’s just for the collective, and assisted suicide is one of those situations. Disabled people should not have to accept dramatic injustices, such as lack of access to suicide prevention, so that assisted suicide proponents can die at the exact moment and in the exact way that they want. That’s not progressive, and it’s not ethical. Disabled people must continue our unequivocable opposition to assisted suicide as a matter of self-respect. In the case of assisted suicide, autonomy needs to take a backseat to the values of love, justice and equality.

Tuesday, February 14, 2023

Yale professor calls for mass suicide for Japanese seniors and mandatory euthanasia

By James Schadenberg

Yusuke Narita
On February 12, 2023, the New York Times published an article by reporters Mokoyoko Rich and Hikari Hida about controvesial statements made by an assistant professor of economics at Yale named Dr. Yusuke Narita regarding the burdens caused by Japan's rapidly-aging society.

Dr. Narita believes that the only solution to relieving the financial strains caused by Japan's aging demographics is the mass suicide of the elderly. He also believes it is possible that euthanasia will become mandatory. As the New York Times reports:

"I feel the only solution is pretty clear," [Narita] said during one online news program in late 2021. “In the end, isn’t it mass suicide and mass ‘seppuku’ of the elderly?” Seppuku is an act of ritual disembowelment that was a code among dishonored samurai in the 19th century.

Last year, when asked by a school-age boy to elaborate on his mass seppuku theories, Dr. Narita graphically described to a group of assembled students a scene from “Midsommar,” a 2019 horror film in which a Swedish cult sends one of its oldest members to commit suicide by jumping off a cliff.

“Whether that’s a good thing or not, that’s a more difficult question to answer,” Dr. Narita told the questioner as he assiduously scribbled notes. “So if you think that’s good, then maybe you can work hard toward creating a society like that.”

At other times he has broached the topic of euthanasia. "The possibility of making it mandatory in the future," he said in one interview, will "come up in discussion".
The article claims that Dr. Narita has developed a large following in Japan, partially due to his provocative statements. He has hundreds of thousands of followers on social media and frequently appears on Japanese online shows. The New York Times reports:

A growing group of critics warn that Dr. Narita’s popularity could unduly sway public policy and social norms. Given Japan’s low birthrate and the highest public debt in the developed world, policymakers increasingly worry about how to fund Japan’s expanding pension obligations. The country is also grappling with growing numbers of older people who suffer from dementia or die alone.
The comments made by Dr. Narita calling for the mass suicide of the elderly are disturbing and reflective of a mind that's been distorted to see vulnerable groups as being a mere problem that must be dealt with, as opposed to groups of persons who worthy of being treated with dignity and respect. 

Dr. Narita's predictions of mandatory euthanasia are shocking but not without historic precedence. Societies have never been immune from reducing vulnerable groups to "undesireables". As seen in the eugenics and euthanasia programs of the 20th century, human rights are sometimes ignored to "deal with" the financial strains attributed to these groups. Dr. Narita is not the first person to suggest euthanasia as a method to reduce healthcare spending, nor will he be the last.

 Further reading:

Monday, February 13, 2023

Seven states are debating the legalization of assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Anita Cameron (center)
James Reinl, social affairs columnist for the Daily Mail, wrote an article that was published on February 11, 2023 concerning the assisted suicide debate in 7 US states. The article interviews several people with personal stories related to assisted suicide.

The story begins by interviewing Anita Cameron, who is a leader of the disability rights group, Not Dead Yet. Her mother Anita Bozeman was told, in 2009, that she had terminal lung cancer and her doctor hinted that assisted suicide would be an option. Bozeman, who said that she was 'too ornery to die' lived another 12 years and died at home in February 2021. Cameron told Reinl:

I'm just so thankful. We wouldn't have had 11 years and 10 months more of my mom, to see her grandkids get married and have kids,'
Cameron says that she is frightened as the 10 US states that have legalized assisted suicide are loosening their rules and may soon become like Canada. Reinl reported:
Meanwhile, some of the 10 states that already allow medical aid-in-dying (MAiD) are loosening their rules, by cutting wait times, letting nurses join doctors in prescribing lethal drugs, and by letting out-of-staters visit to end their lives.
Reinl reports that not only are the states that have legalized assisted suicide loosening their rules but some people who are dying by assisted suicide that don't technically qualify. Reinl writes:
Some Americans who receive fatal doses do not appear to meet the requirements.

Last year, Dr Jennifer Gaudiani, who treats eating disorders, stoked controversy by prescribing lethal doses to three patients with anorexia nervosa — a mental health and body image condition that often sees sufferers starve themselves.

One 36-year-old woman died after ingesting the drugs. Dr Gaudiani, who still practices, argued that anorexia, while not as severe as cancer, is brutally lethal for sufferers.

Still, even pro-MAiD groups criticized her for doling out drugs to folks with psychiatric illnesses.

Cases of diabetics also qualifying for assisted deaths have raised similar concerns. 

The concept of "dying with dignity" was also challenged by Reinl who wrote about how the assisted suicide drugs have a failure rate.

in Oregon in 2021, five MAiD patients vomited after ingesting pills, and one person passed out but later regained consciousness. 

Most people died within 30 minutes, but others took more than 100 hours to perish.

A report last year in the British Medical Bulletin found that it was not always a 'Hollywood-style peaceful and painless death,' citing the example of a Colorado cancer sufferer who took nine hours to die after much 'choking and coughing.'

Reidl reports that assisted suicide legalization bills are currently being debated in 7 states:

Sympathetic lawmakers have introduced MAiD bills this session in Arizona, Connecticut, Indiana, Massachusetts, New York, Rhode Island, and Virginia. Others may come to Delaware, Maryland, Minnesota and Nevada.

Further to that assisted suicide expansion bills are being debated in Hawaii, Washington state, Oregon and Vermont. Reidl explains that Oregon and Vermont have bills to remove their state assisted suicide residency requirement permitting assisted suicide nationally. Already one resident of Texas has died by assisted suicide in Oregon.

Reidl reports that Montana is debating a bill to once again prohibit assisted suicide and Virginia has already debated and defeated an assisted suicide legalization bill.

Reidl finishes his article by telling the stories of Brianna Hammon who lives with cerebral palsy, Christopher, whose dad died by assisted suicide, John Kelly who lives with quadriplegia after an accident in 1984, and Anita Cameron, whose mother rejected assisted suicide and lived another 12 years.

The majority of Canadians oppose euthanasia for mental health.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Angus Reid Institute conducted a poll that was published on February 13, 2023 concerning Canada's current (MAiD) euthanasia law. The poll indicates that support and opposition to euthanasia has increased. 

Recently the federal government announced that they are delaying the implementation of euthanasia for mental illness until March 17, 2024. Based on the current political direction, it is important that the majority of Canadians do not support euthanasia for mental health as a sole condition.

The poll indicated that 51% were opposed, 31% supported and 18% were unsure of euthanasia being approved for mental health as a sole condition.

Opposition to euthanasia for mental health as a sole condition was strongest in Saskatchewan with 68% opposition and 21% support and lowest in Québec with 43% opposition and 36% support. It is interesting that British Columbia, that has the highest rate of euthanasia deaths, had stronger opposition than the rest of Canada with 55% opposing euthanasia for mental health and 25% supporting it.

On the issue of whether Canadians should first attempt effective medical treatments before being approved for euthanasia, The Angus Reid Instute found that:
Two-thirds (65%) say that potential MAID patients should have to exhaust all treatment options to access the procedure. One-quarter (24%) disagree.
Canada's euthanasia law does not require a person to attempt effective medical treatment before being approved for euthanasia. The majority from every political party support the need to exhaust all treatment options before being approved for euthanasia and supporters of the Québec BQ party had the strongest support for this position at 73%.

The recent news of people with disabilities being approved for euthanasia, who requesting it based on poverty, homelessness, or an inability to receive effective medical care, is of concern to Canadians. Angus Reid Institute reported that:
More than half of Canadians (55%) say they worry about MAID taking the place of improvements in social service. One-in-three are not concerned (36%)
When examining different scenario's for approving euthanasia, the only category with a majority of Canadians supporting euthanasia is for people suffering from debilitating chronic pain. The Angus Reid Institute reported:
The only scenario that receives majority support (64%) is MAID for a person who is suffering from debilitating chronic pain. Two-in-five (40%) would support someone who has several serious health problems requesting MAID. Lower levels of support are found for mental disorders like serious depression (22%) or severe anxiety (16%).
Canada permits euthanasia, based on the interpretation of the assessor, for many of these conditions. Canadians seeking euthanasia based on "affordable housing" is only supported by 9% of Canadians, euthanasia based on having severe anxiety was supported by 16%, euthanasia based on depression was supported by 22% and euthanasia for an armed forces member with PTSD was supported by 23%.

The poll indicated that Québec residents are the strongest supporters of euthanasia. The poll found that 78% of Québec poll participants support the current euthanasia law, which was up from 62% in 2016. The Maritimes have the second highest support at 62% while it was interesting to not that the lowest support was in British Columbia with 51% support, even though BC has the highest percentage of deaths by euthanasia in Canada.

There were many factors that were included in the Angus Reid Instutite poll that you can examine (Link to the poll). Every poll question offered people the choices of supporting, opposing or not sure. When the poll stated that 65% supported and 24% opposed people being required to exhaust all effective medical treatments before being approved for euthanasia, that mean't that 11% were not sure.

Canadians do not support euthanasia for mental health as a sole condition and they do not support that our current law does not require people to exhaust effective medical treatments before they can be approved for euthanasia.

A study by Dr Sara Moore, a University of Ottawa medical oncologist examined 45 euthanasia deaths of people with lung cancer concluded that people with lung cancer who died by euthanasia were less likely to consult with a radiation or medical oncologist and less likely to undergo effective treatments. The study indicated that 13 of the 45 people with lung cancer who died by euthanasia did not even have a biopsy to confirm the diagnosis. 

Dr Moore proved that some Canadians are dying by euthanasia who may have recovered with treatment and without confirming their diagnosis.

The Angus Reid Institute poll indicates that the majority of Canadians oppose euthanasia for mental health as a sole condition. A recent letter from more than 30 Canadian legal professors stated that there is no legal obligation for Canada's government to extend euthanasia to people with mental illness. It is clear that the federal government needs to reverse its position and not permit euthanasia for mental health as a sole condition.

Further reading: