Isle of Man (UK) doctors overwhelmingly reject assisted suicide

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ashlea Tracey reported for BBC News on October 18, 2023 that doctors from the Isle of Man have rejected assisted suicide. The Isle of Man is debating a bill that would legalize euthanasia and assisted suicide. It is expected that MHK Alex Allinson’s Assisted Dying Bill 2023 will have its second reading on October 31.

The survey of Isle of Man Medical Society members found that 74% of the respondents were against legalizing euthanasia and assisted suicide. 

Tracey reported: 

About 74% of those who responded to the poll asking members for opinions on the Assisted Dying Bill 2023 said they were against the proposed changes.

The poll also found 34% of respondents would consider leaving the island if the new legislation was introduced.

It is due to have its second reading in the House of Keys on 31 October.

Tracey stated that 61% of Isle of Man Medical Society members responded to the poll. The survey indicates that 74% were against the proposal to legalize euthanasia and assisted suicide while 19% indicated that they were willing to participate if legalized.

Since 34% of the respondents stated that they would consider leaving the island if euthanasia or assisted suicide were legal, legalizing euthanasia may create recruitment and retention concerns for medical professionals.

The Isle of Man needs to examine Canada's experience with euthanasia and reject it. Alex Schadenberg will be speaking in the Isle of Man in early November.

Slovenian legislature debates palliative care rather than euthanasia

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Slovenian News reported on October 17, 2023 that:

The opposition Democrats (SDS) have tabled a palliative and hospice care bill which would establish a palliative and hospice care network in Slovenia and provide financing. Palliative care with medical and nursing services, and psychosocial support would be covered by mandatory health insurance, said SDS MP Alenka Jeraj.

On June 19 I reported that Slovenia was debating euthanasia and assisted suicide. A Slovenian group called Silver Thread collected signatures and were demanding the legalization of assisted dying. The bill proposed by Silver Thread was to be introduced in the Slovenian legislature. 

A Slovenian News article indicated that an assisted dying bill was introduced in the Slovenian legislature on July 17.

On July 25 Representatives of doctors and medical organisations held a press conference to express opposition to the proposed bill to legalise assisted dying, arguing that it is inconsistent with medical ethics and the constitution.

Slovenia needs to provide proper end-of-life care not kill its citizens by euthanasia. 

The Majority of Canadians say that religiously affiliated hospitals should not be forced to provide euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

St Paul's hospital Vancouver

A euthanasia lobby group has been lobbying the British Columbia (BC) government to force Catholic hospitals to provide euthanasia. 

Samantha O'Neill (34), died by euthanasia (MAiD) on April 4, 2023 after being transferred from St Paul's hospital in Vancouver to St. John’s Hospice. 

O'Neill's family argue that Samantha should have been able to die by euthanasia at St Paul's hospital rather than be transferred to St. John's Hospice to die.

Katie DeRosa reported for The Vancouver Sun on June 23 that Dying With Dignity and O'Neill's family initiated a campaign to pressure the BC government to force Catholic hospitals to kill their patients by euthanasia.

On October 17, 2023; an Angus Reid Institute poll indicated that 58% of Canadians believe that religiously affiliated healthcare should not be forced to provide (MAiD) euthanasia but should transfer the person to a facility that will provide euthanasia, while 18% of Canadians were unsure and only 24% of Canadians demanded that religiously affiliated healthcare facilities must provide euthanasia.

The poll results varied by province with Manitoba (65%) and Saskatchewan (64%) offering the strongest support for religiously affiliated healthcare while Québec (47%) responded with the lowest support. Only 35% of the Québec poll participants stated that religiously affilitiated institutions must provide euthanasia.

The other key question in the Angus Reid Institute poll concerned conscience rights for medical professionals who oppose euthanasia. The poll found that 70% of Canadians thought that a medical professional who opposes euthanasia should refer someone who requests euthanasia to a medical professional who will provide it while 30% believed that medical professionals should not be forced to refer for euthanasia.

The Angus Reid Institute did not differentiate between a doctor being required to refer a patient for euthanasia or a doctor who opposes euthanasia being required to make an "effective referral" for euthanasia. Most medical professionals are willing to refer a patient, but not make an effective referral since an effective referral means sending the patient to a medical professional who will do the act.

Medical professionals who oppose euthanasia, usually oppose killing their patients. If they believe that its morallly wrong to kill a patient then they will also believe that its morally wrong to send their patient to someone who will kill their patient.

Nonetheless, Canadians clearly support the right of religiously affiliated healthcare institutions to not provide euthanasia.

An Angus Reid Institute poll that was published on September 28 found that only 28% of Canadians support euthanasia for mental illness alone. This is important because Canada is adding mental illness as a reason for euthanasia starting in March 2024.

People with mental healthcare needs are valuable. Vote Yes on Bill C-314.

The Euthanasia Prevention Coalition supports Bill C-314 and we urge our supporters to contact their Members of Parliament to support Bill C-314. This is important as several Liberal and NDP MP's have indicated that they plan or want to support Bill C-314. Contact your Member of Parliament (MP Contact Link) 

Open Letter to MPs: Vote Yes for Bill C314: Stop MAID for Canadians with only Mental Health Challenges

Dr Paul Saba

Bill C-7 came into effect on March 17, 2021 and will allow people with only a mental disorder to be euthanized as of March 17, 2024. This, despite the overwhelming evidence that people with mental disorders can be treated, and that most psychiatrists cannot determine which patient has an irremediable (irreversible and treatable) condition. (Link to the study).

According to Montreal lawyer, Natalia Manole, from a legal standpoint, those with mental disorders requesting medical assistance in dying (MAID), do not meet the condition of free and informed consent. “So how can we legalize medical aid in dying for people with mental illness, knowing that the desire to die is in most cases a symptom of mental illness? In other words, consent would be vitiated in most cases." (Commission spéciale sur l'évolution de la Loi concernant les soins de fin de vie, August 19, 2021).” (Link to the Commission report).

Bill C-314 which will be voted on October 18 in Ottawa, will prevent euthanasia (MAID) for people with mental health disorders as the sole criterion.

Some mental health disorders include: generalized anxiety, depression, personality disorders, bipolar disorder, attention deficit disorder, autism, and schizophrenia.

• In most cases, the desire to die is a symptom of mental illness. (Link to the study).
• 90% of people who end their lives were affected by a mental disorder at the time of their suicide.
• Most people who have attempted or completed suicide don’t want to die; rather, they want to escape their emotional distress (Link to the information). 
• According to a Harvard School of Public Health study, 9 out of 10 people who attempted suicide but were unsuccessful in their attempt, did not commit suicide following treatment. With the right treatment, suicide disappeared. (Link to the Harvard study).
• Most people with mental disorders need the evaluation and support of psychiatrists, psychologists, and social workers. Many live in precarious financial and social situations. They need financial support, including affordable, housing, and food security.
• The Canadian social and healthcare system is deficient for people with mental health problems.
• In Quebec, the average waiting time between referral to a psychiatrist and treatment is 5 months.
• Psychologists are in short supply and rarely accessible in the public system.

It is time for Members of Parliament to stand in solidarity and support people with mental health disorders. They need care, treatment and support. They must not be euthanized (MAID). Parliamentarians must stop MAID for those with mental disorders.

Vote yes on Bill C-314.

People with mental healthcare challenges are valuable.

For more information:
Dr. Paul Saba
514-886-3447
pauljsaba@gmail.com

MPs should vote on Bill C-314 (euthanasia for mental illness) with their eyes wide open

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Bill C-314, the bill to prevent euthanasia for mental illness (alone) in Canada will go to a vote in the House of Commons on October 18.

The Euthanasia Prevention Coalition supports Bill C-314 and we urge our supporter to contact their Member of Parliament to support Bill C-314. This is important as several Liberal and NDP MP's have indicated that they plan or want to support Bill C-314. Contact your Member of Parliament (MP Contact Link)

Dr Sonu Gaind

On Sunday October 15 the Hamilton Spectator published an excellent article by K. Sonu Gaind who is a professor at the University of Toronto and a former president of the Canadian Psychiatric Association.

In his article - MPs should be voting on MAiD with their eyes wide open, Gaind explains that Bill C-314 would reverse the clause in Bill C-7 that was passed in March 2021, that approves euthanasia for mental illness alone, a provision of the law that will be implemented in March 2024.

In his article, Gaind first answers the question of who would be approved for euthanasia for mental illness.

At heart of the issue is whether death by MAID for mental illness would be provided for the reasons it is claimed to be for. Regardless of one’s ideology, the inescapable answer is that it would not be. Instead we would be providing death under false pretences to many struggling with mental illness — from which they could recover — fuelled by social inequities like poverty and housing insecurity.

Canadians have been falsely reassured MAID would only be provided if the person’s mental illness would not improve, and that traditionally suicidal people who benefit from suicide prevention would not get MAID. Evidence shows both these claims are false, and in fact cannot be met. Despite some MAID assessors believing they can make these distinctions, evidence shows they are wrong. MAID provided for sole mental illness is different than MAID for near end-of-life conditions, and we can neither predict when the mental illness will not improve, nor can we separate suicidality from psychiatric MAID requests.

Gaind then deals with the question - is it discrimination to deny euthanasia for mental illness.

Expansion activists have claimed it would be discrimination to not provide MAID for mental illness. This appropriates the word “discrimination” while ignoring the meaning of it. The real discrimination is providing death under false pretences to suicidal individuals who could improve, based on unscientific assessments of zealous MAID assessors wrongly predicting that person will not get better. This poses discriminately high risk to marginalized individuals receiving avoidable deaths fuelled by social distress and inequities, which sadly afflict those with mental illness disproportionately.

No wonder so many MAID assessors have indicated unwillingness to participate in MAID for sole mental illness assessments. In some regions, all existing MAID assessors have flagged their refusal to participate in MAID for mental illness provision. Who does that leave? The true believers: those who believe, ignoring science, that they can predict an individual’s mental illness will not improve, and who believe, ignoring evidence, that they would not be providing MAID to marginalized suicidal individuals.

Gaind challenges those that he refers to as euthanasia expansion activists.

The government’s policy agenda has been driven by an echo chamber of such expansion advocates. The same experts charged with designing MAID for mental illness guidelines have refused to provide any actual standards on what type of treatments need to have been tried before providing MAID for mental illness; have openly stated that suicide and MAID for mental illness may be the same thing, but claimed that society has made an ethical decision to provide MAID anyway; and have whittled away any actual safeguards to empty reassurances without meaning.

Some of these expansion advocates have said they would approve a person for MAID if they were on a long enough wait list, even if there was care that could help. Others have openly argued that providing MAID for poverty, social suffering and inequities to non-dying individuals is acceptable, and a form of “harm reduction.”

Gaind concludes his article by supporting the Society of Canadian Psychiatry statement and calling for MAID for mental illness expansion to be paused indefinitely.

In other words, Gaind is asking MP's to support Bill C-314.

Society of Canadian Psychiatry: Brief on MAiD and Mental Illness Expansion

Link to the Society of Canadian Psychiatry Brief on MAiD and Mental Illness Expansion (full brief) (Link).

Society of Canadian Psychiatry: Brief on MAID and Mental Illness Expansion

October 13, 2023

This Brief reviews key areas related to Canada’s planned 2024 expansion to provide medical assistance in dying (MAID) for sole mental illness conditions. The Board of Directors of the Society of Canadian Psychiatry (SocPsych) does not have an a priori opinion on whether or not MAID for sole mental illness should be provided. The intent of this document is to review the evidence and processes to date regarding Canada’s plans to expand* eligibility for MAID to sole mental illnesses in 2024, and make recommendations based on that review.

Based on its review of evidence outlined further in the Brief, the Board of Directors of the Society of Canadian Psychiatry concludes the following (note: abbreviated conclusions and recommendations are presented in the Executive Summary, refer to the full Brief for complete text)

 

CONCLUSION 1: At this time, it is impossible to predict in any legitimate way that mental illness in individual cases is irremediable. A significant number of individuals receiving MAID for sole mental illness would have improved and recovered. 

CONCLUSION 2: Evidence shows that individuals with suicidal ideation symptomatic of mental illness cannot be differentiated or identified as distinct from those seeking MAID for sole mental illness. Suicidal individuals who could benefit from suicide prevention will receive psychiatric MAID instead.

 

CONCLUSION 3: Non-dying disabled marginalized Canadians suffering from poverty and other social distress are at higher risk of premature death by MAID, with their disability allowing them to qualify for MAID while their social suffering fuels their MAID request. 

CONCLUSION 4: Key consultations from the Canadian Psychiatric Association and Association des médecins psychiatres du Québec informing the sunset clause failed to provide essential relevant evidence and due diligence that would normally be expected of expert professional bodies informing public policy discussions.

CONCLUSION 5: Most psychiatrists oppose expanding MAID for mental illness, despite not being conscientious objectors to MAID. 

CONCLUSION 6: The political process leading to the planned expansion of MAID for mental illness has not followed a robust and fulsome process, has not reflected the range of opinions and evidence-based concerns on the issue, and has been selectively guided by expansion activists. 

CONCLUSION 7: Reassurances of safety have been provided but safeguards have not been implemented to substantiate those reassurances. The lack of safeguards in planned MAID for mental illness expansion allows suicidal Canadians afflicted by mental illness, who could get better, to receive MAID for social suffering.

SUMMARY RECOMMENDATION: Based on review of evidence, the Board of Directors of the Society of Canadian Psychiatry believes the process leading to the planned 2024 MAID for mental illness expansion was flawed, insufficiently responsive to evidence-based cautions, and resulted in a lack of safeguards. The Board of the Society of Canadian Psychiatry recommends that the planned 2024 MAID for mental illness expansion be paused indefinitely, without qualification and presupposition that such implementation can safely be introduced at any arbitrary pre-determined date; and that any future potential consideration of MAID for sole mental illness policy be informed by evidence, guided by experts reflecting the range of views rather than being driven exclusively by ideological advocates, and only be potentially considered following fulsome and unbiased review of the issues and process flaws identified in this Briefing.

Link to the Society of Canadian Psychiatry Brief on MAiD and Mental Illness Expansion (full brief) (Link).

Assisted suicide by telehealth may continue until 2025.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Euthanasia Prevention Coalition opposes the dangerous practice of assisted suicide by telehealth.

An October 10, a CNN news report by Kristen Rogers stated that:

The DEA and the Substance Abuse and Mental Health Services Administration announced May 9 that the temporary rules would be extended through November 11, while the DEA and HHS considered the public comments and any revisions to the proposals — buying more time for telehealth patients who might have otherwise experienced a disruption in care.

Now, after holding two days of public listening sessions on the rules in September, the DEA and HHS have further extended the flexibilities through December 31, 2024.

This means that the dangerous practise of approving assisted suicide by telehealth will continue in states that permit assisted suicide until December 31, 2024.

The CNN article stated that the American Medical Association was pleased with the decision to extend the practise of prescribing Schedule II medications or narcotics by telehealth. The reality is that this decision enables assisted suicide to be prescribed by telehealth and ignores the concerns around the opioid crisis.

The Drug Enforcement Administration (DEA) began their consultation on the proposed rules for prescribing controlled substances via telehealth in February 2023.

The assisted suicide lobby has been promoting the approval of assisted suicide by telehealth. The assisted suicide lobby also wants to have the lethal assisted suicide drug cocktail delivered by courier.

On April 17, 2023, Kristen Senz reported for The Journalists Resource that the DEA had approved the guidelines and stated that they would go into effect on May 1, 2023.

The proposed DEA guidelines stated that prescribing Schedule II controlled substances would require an in-person visit. Patients being treated for opioid use disorder could be prescribed via telemedicine but they would be required to have an in-person visit within 30 days of receiving a prescription for buprenorphine (Suboxone, Zubsolv, and Sublocade) via telemedicine and to obtain refills.

But the story didn't end there. 

Based on a massive response by the assisted suicide lobby the DEA placed their guidelines on hold until November 11, 2023.

The Euthanasia Prevention Coalition opposes the dangerous practice of assisted suicide by telehealth and supported the DEA proposed guidelines that were approved in April, 2023.

The DEA guidelines were based on reducing the opioid crisis by making it more difficult for people to obtain Schedule II controlled substances for resale. 

Previous articles:

• The US Drug Administration tightens regulations on Schedule II Controlled Substances (Link). 
• Help EPC stop assisted suicide by Telehealth (Link).

Psychiatrist: Anorexia does not justify Aid in Dying

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Psychiatrists Dr Patricia Westmoreland, Dr Cynthia Geppert, Dr Mark Komrad, Dr Annette Hanson, Dr Ronald Pies and Dr Philip Mehler wrote a response to the story of Lisa Pauli, a Canadian who lives with Anorexia Nervosa (AN) who wants to die by euthanasia (MAiD) that was published in the Psychiatric Times on October 11, 2023. (Link to the article).

The article that is based on clinical research counters the concept that AN is a condition that can lead to approval for euthanasia or assisted suicide. The authors write:

In a recent article published by Reuters, a 47-year-old Canadian woman with anorexia nervosa (AN) tells a reporter that when an expansion of the criteria for medically assisted death comes into effect in March 2024, she plans to apply for medical aid in dying (MAID). Lisa Pauli, who has suffered from AN for many decades, stated that she goes days without eating solid food. She characterized every day as “hell,” and noted, “I’m so tired. I’m done. I’ve tried everything. I feel like I’ve lived my life.” However, it is worth noting that 3 issues received scant attention in the article: the types of treatment she had tried, the extent to which any comorbid psychiatric conditions (such as depression) had been treated, and whether she even has mental capacity to make this decision.

Proponents of MAID, otherwise known as physician-assisted suicide (PAS)—the term preferred by the American College of Physicians and used in the American Medical Association Code of Ethics—cite “terminal anorexia” as a new, valid construct justifying MAID for individuals with severe, longstanding AN. Terminal anorexia has been recently applied to individuals who:

(a) have a diagnosis of AN and are age 30 or older;

(b) have had prior, persistent engagement in high quality, multidisciplinary eating disorder treatment;

(c) express a clear, consistent wish to stop trying to prolong their lives;

(d) possess adequate decision-making capacity;

(e) understand that further treatment of AN will be futile; and

(f) accept that death will be the natural outcome of discontinuing treatment.

But is terminal anorexia a valid construct? Several eating disorder experts, with decades of experience in the field, have opined that this term cannot adequately be defined and should therefore not be used.

Regarding criterion (a)—that, to be considered terminal, an individual must be 30-years-old or older—Mack et al noted that it is a commonly held myth that older individuals cannot recover from AN. Both Mack et al and Guarda et al cited the longitudinal study by Eddy et al, indicating that, while individuals with AN may not recover in the first 5 to 10 years of their illness, two-thirds of individuals with AN had recovered after 22 years.

Interestingly, the mean age of participants in the Eddy et al study was 47—the same age as Lisa Pauli. It is thus concerning that Ms Pauli’s recovery would be deemed impossible. While the term terminal is certainly well-established in certain medical spheres of health care, those conditions entail clear, objective parameters establishing that an end-stage illness is untreatable and that death is naturally imminent, even in the face of continued treatment for the underlying illness. Examples include certain cancers; end-stage cirrhosis; heart failure; or multiple organ failure (MOF) from sepsis. Such objective parameters have no parallel in AN.

The second criterion (b) is “prior persistent engagement in high quality multidisciplinary eating disorder treatment.” Individuals in the case report in which Gaudiani used the term, terminal anorexia do not appear to have had such treatment; eg, 2 brief inpatient stays before leaving against medical advice; failure to complete residential treatment; and lack of full weight restoration. This may also be the case with Pauli, who apparently was hospitalized on only 2 occasions for her longstanding eating disorder. There are 2 additional factors which make the inclusion of the “prior persistent treatment” criterion concerning. First, individuals with eating disorders are frequently ambivalent regarding treatment, and often completely opposed to it, given the necessary but distressing emphasis on weight restoration. Second, there is commonly a lack of access to high quality multidisciplinary treatment. Sharpe et al pointed out that Gaudiani et al presupposed that high quality treatment exists and is accessible to all individuals with AN. This, according to Sharpe et al, is “discordant with our experiences as patients, clinicians and peer advocates within systems of ED treatment.”

Both fiscal and societal pressures may also not favor costly treatment for a chronic mental health condition. In Canada, it may take 4 months to enroll in any mental health treatment and as much as 417 days to receive specialized eating disorder treatment. The more expeditious option of MAID (90 days for patients whose death is not imminent, and immediate approval for those whose death is termed imminent) may appeal to those who have become hopeless. Even more concerning is the potential appeal of MAID to contain cost and deal with waitlists for mental health care. A glaring example of this was a patient who presented to an emergency department in Vancouver with suicidal ideation. Her goal that day was simply to keep herself safe and be admitted to the hospital. However, given the long wait time to see a psychiatrist, the evaluating clinician asked if she had considered MAID for her psychiatric illness. She was told of another patient who had reportedly found “relief in death.” The hospital subsequently apologized to the patient.

Similarly, in response to the proposed definition of terminal anorexia, Elwyn—an individual with lived experience of severe and enduring AN—reflected on how receiving a terminal diagnosis would substantially increase an individual’s sense of burdensomeness; decrease their sense of meaningfulness; and (along with decreasing any hope of recovery) decrease attempts at seeking help. All of these factors, in addition to commonly co-occurring depression and anxiety, may actually increase risk for suicide, whether medically assisted or via other methods.

Regarding criteria (c) through (f)—ie, the person expresses a clear, consistent wish to stop trying to prolong their life; has adequate decision-making capacity; understands that further treatment will be futile; and accepts that death will be the natural outcome of discontinuing treatment—several caveats are in order. First, individuals with severe eating disorders frequently lack decisional capacity. To be sure: there is a difference between a decision that seems illogical versus one arising from lack of capacity. But while AN is not synonymous with decisional incapacity, it is nonetheless troubling that a decision with an irreversible outcome is being made by an individual with questionable decision-making capacity, particularly in cases of severe AN.

The delusional level of cognitive distortions regarding food and body image is the irrational lens through which the decision to refuse treatment and to seek MAID is filtered. Accordingly, the clinician who assumes that the patient has the capacity to consent to assisted suicide (rather than seeking further treatment) is not relieving the patient’s suffering, but is actually furthering and colluding with the disease itself. This is especially true when individuals with AN are highly ambivalent about recovery.

Furthermore, that MAID appears to be not just offered but encouraged exploits the ambivalence that is intrinsic to AN. As noted by Geppert, given that decisional capacity is almost always regained with weight restoration, are we not then obligated to treat an individual so that they are able to regain capacity? In severe AN, involuntary treatment provided by a behavioral inpatient specialty program can be lifesaving—and when effective, is often met with gratitude by patients.

Back to Lisa Pauli. Although we have not personally examined Ms Pauli, the fact that she reports minimal prior treatment for her eating disorder; that recovery is not impossible at age; that there is no mention of strategies to treat comorbid mental illness; and that, being undernourished, she may well lack capacity, all argue against her illness being terminal and MAID being her only option.

Instead, efforts should be directed toward improving access to care in the United States and Canada for individuals with eating disorders, rather than providing “a form of state-assisted suicide,” as a Canadian psychiatrist described it. Even if a curative approach were not possible in Ms Pauli’s case, both harm reduction and palliative care are options for managing AN and its comorbidities. These interventions could lead to enhanced quality of life, even if that life proved to be shorter than anticipated; and would also give individuals like Ms Pauli the option of exploring a curative approach in the future.

The notion of providing MAID for an individual in whom a so-called terminal illness cannot be accurately defined, is both troubling and unjustifiable. As psychiatrists in the United States, we owe it to our patients to join with legislators who fight for equitable access to mental health care. Psychiatrists must strive to provide high-quality, evidence-based care, and to hold out hope for our patients until they can do so themselves. When further treatment after judicious deliberation and consultation appears unproductive or unwarranted, let us provide comfort and support—not take steps to provide the suicide some patients seek.

Article references are contained within the original article. (Link to the article)

More articles on this topic:

• Canadian woman with anorexia wants to die by euthanasia (Link). 
• Assisted suicide for anorexia: Anorexia is not a death sentence. I am living proof of this (Link).
• Assisted suicide for Anorexia Nervosa (Link).
• Assisted suicide for Anorexia Nervosa is Abandonment (Link). 
• Assisted suicide for Anorexia Nervosa expands assisted suicide from terminal to chronic conditions (Link).
• Assisted suicide lobby admits that assisted suicide for Anorexia Nervosa violates the law (Link).

American Medical Association (AMA) is debating assisted suicide and euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The American Medical Association Policy 5.7 on assisted suicide currently states:

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.

Physicians:

• Should not abandon a patient once it is determined that cure is impossible.
• Must respe∘ct patient autonomy.
• Must provide good communication and emotional support.
• Must provide appropriate comfort care and adequate pain control.

At the Interim meeting of the AMA House of Delegates on November 10 - 14, 2023 in Maryland, 50 draft resolutions will be debated. Two of the draft resolutions will concern assisted suicide and euthanasia.

• Resolution 4 is to change the position of the AMA on Medical Aid in Dying (Resolution Link).
• Resolution 5 is for the AMA to adopt a neutral stance on Medical Aid in Dying (Resolution Link).

It is important to note that Resolution 4 would remove the AMA statement on not performing euthanasia or participating in assisted suicide:

Physicians must not perform euthanasia or participate in assisted suicide. A more careful examination of the issue is necessary. Support, comfort, respect for patient autonomy, good communication, and adequate pain control may decrease dramatically the public demand for euthanasia and assisted suicide. In certain carefully defined circumstances, it would be humane to recognize that death is certain and suffering is great. However, the societal risks of involving physicians in medical interventions to cause patients' deaths is too great in this culture to condone euthanasia or physician- assisted suicide at this time.

Both resolutions use the term Medical Aid in Dying (MAiD) rather than Physician Assisted Suicide. The term Medical Aid in Dying is not limited to assisted suicide, it also includes euthanasia. The assisted suicide lobby wants to legalize euthanasia (medical homicide) in America.

Both resolutions need to be vigorously opposed. The assisted suicide lobby likely introduced both resolutions to create the impression that Resolution 5 (adopting a neutral stance on Medical Aid in Dying) is a compromise resolution, whereas, both resolutions will effectively lead to the same outcome.

Hon. Ed Fast (CPC) - Parliamentary speech in support of Bill C-314

The following is the speech by Hon. Ed Fast presented during the second hour of debate on Bill C-314 on October 5, 2023 at 6:30 pm. The final vote on Bill C-314 will happen on Wednesday October 18, 2023.

Hon. Ed Fast

Link to the video of this speech in parliament. (video link).

Link to his first speech in Parliament on Bill C-314 (Link).

Please tell your Member of Parliament that you support Bill C-314 (Member of Parliament link)

Hon. Ed Fast (Abbotsford, CPC)

Mr. Speaker, medical assistance in dying will soon be expanded to include those with mental illness, including depression. My bill, Bill C-314, would reverse this terrible decision. My bill is very narrow and would not repeal the other provisions of Canada's medical assistance in dying laws.

There is no national consensus on expanding MAID to include mental disorders, none. The most recent Angus Reid poll found that a very small number of Canadians actually favour expanding assisted suicide to the mentally ill, somewhere around 28%.

The mental health community has raised significant concerns. A recent letter to government from the heads of seven Canadian psychiatry schools implored decision-makers to hold off on expanding assisted suicide to the mentally ill. Similarly, the Canadian Psychiatric Association does not support the expansion of MAID due to the many ethical and clinical concerns that have not been resolved. They argue that mental illness is often highly treatable and that patients should be provided with the treatment they need to manage their symptoms and lead fulfilling lives.

Stakeholders have deplored the lack of social and economic supports for persons with mental illness and how this can lead people to consider MAID. They have pointed to the fact that the federal government has not fulfilled its promise to deliver dedicated mental health and palliative care funding to the provinces, leaving Canadians without access to the support that would lead them to choose life rather than death.

Many others have joined the chorus. They note that the issues of suicidal ideation, irremediability and competency have not been resolved, ensuring that Canadians will needlessly die because we have rushed ahead with expanding MAID.

At greatest risk are those suffering from depression, veterans suffering from PTSD, the opioid addicted on our streets, our indigenous communities and those seeking to escape a life of poverty. The government has even signalled its openness to allowing children to access assisted suicide, presumably without their parents' consent.

Last year, in my home town of Abbotsford, Donna Duncan was swiftly approved for assisted suicide after failing to receive proper treatment for chronic mental health issues. Her assisted death happened so quickly and so totally blindsided her daughters, Alicia and Christie, that they referred the case to the RCMP. Is this the dystopian world we are leaving behind?

Has anyone consulted with our first nations? Meaghan Walker-Williams of the Cowichan Tribe recently wrote in the National Post:

As a Sixties Scoop survivor, my lifelong personal journey back to my community of Cowichan has also been marked by the painful consequences of policies that didn’t respect or understand Indigenous cultures. Another policy, blind to my culture, may soon join them: assisted suicide for mental illness.

She concludes by saying, 

“it's crucial that the narrative remains firmly rooted in upholding the sanctity of life—a cornerstone of Coast Salish teachings.”

I note that the government originally excluded the mentally ill from its MAID regime and went to great lengths to explain why that was necessary. It was only after the unelected Senate included the mentally ill in Bill C-7 that the government suddenly enthusiastically embraced the idea.

The question is this: Should Canadians be able to trust their government to act in a way that values the life of every Canadian, or do we give up on the most vulnerable among us? Someday, all of us will have to give an account.

A famous world leader by the name of Moses once challenged his own people with a choice and a promise: “I have set before you life and death, blessing and curse. Therefore choose life, that you and your offspring may live”. I want my descendants to live, to prosper, to thrive, and I want the same for our mentally ill, our Indigenous peoples and indeed all Canadians. It is time to end this experiment. With so much uncertainty, surely we should err on the side of life, not death.

I respectfully ask members to support Bill C-314.

Don Davies (NDP) - Parliamentary speech in support of Bill C-314

The following is the speech by Don Davies presented during the second hour of debate on Bill C-314 on October 5, 2023. This is an important speech because Mr. Davies is a NDP Member of Parliament in support of Bill C-314.

Don Davies

Please tell your Member of Parliament that you support Bill C-314 (Member of Parliament link)

Mr. Don Davies (Vancouver Kingsway, NDP)

Mr. Speaker, in March 2023, legislation to extend by one year the temporary exclusion of eligibility for MAID where a person's sole medical condition is a mental illness received royal assent and immediately came into force. This means that persons suffering solely from a mental illness will be eligible for MAID as of March 17, 2024. Bill C-314, the bill before the House today, would remove this eligibility at least until we have satisfactory answers and guardrails to ensure that we can extend this profoundly permanent step with confidence. In my view, we do not have that necessary confidence today, and I think the majority of Canadians and health professionals, and the data, concur.

Data released in September 2023 from the Angus Reid Institute found that a majority of Canadians, 52%, worry that treating mental health will not be a priority when MAID eligibility is expanded to include individuals whose sole condition is mental illness. A vast majority of Canadians, 80%, are concerned with the mental health care resources available in this country, namely that they are not sufficient. Overall, one in five Canadians says they have looked for treatment from a professional for a mental health issue in the last 12 months, and in that group, two in five say they faced barriers to receiving the treatment they wanted. These obstacles appear to be more of an issue for women, among whom 45% of those who sought treatment say it was difficult to receive, and young Canadian adults aged 18 to 34.

A majority of Canadians support the previous rules governing MAID, first passed in 2016 and then updated in 2021, but there was more hesitation when it comes to this next step. Three in 10 say they support allowing those whose sole condition is mental illness to seek MAID, while half are opposed.

I will turn to some of what the professionals are telling us, starting with the Centre for Addiction and Mental Health. A survey recently of CAMH physicians found a lack of agreement on whether or not mental illness could be considered “grievous and irremediable” for the purposes of MAID and what criteria could be used to determine whether a person is suffering from an irremediable mental illness. The survey also found significant disagreement among physicians on whether or not a request for MAID can be differentiated from suicidal intent. These physicians also highlighted the concerns they had about access to mental health care in the context of expanded eligibility for MAID.

Canada's mental health care system has experienced chronic underfunding, leading to a significant shortage of community- and hospital-based mental health care across the country. Between one-third and one-half of Canadians with mental illness were not getting their mental health needs met before the COVID–19 pandemic exacerbated the mental health crisis and increased the burden on our mental health system and therefore on Canadians. The results of that survey replicate the findings from the Canadian Psychiatric Association's member consultations in 2020 and the conclusion of the Council of Canadian Academies' expert panel working group report in 2018.

Let me turn to the Canadian Mental Health Association, Canada's premier organization dealing with mental health:

CMHA's position, first articulated in a national policy paper in August 2017, and later, in testimony to the Senate in November of 2020, is that until the health care system adequately responds to the mental health needs of Canadians, assisted dying should not be an option....

First, it is not possible to determine whether any particular case of mental illness represents “an advanced state of decline in capabilities that cannot be reversed.”

Second, we know that cases of severe and persistent mental illness that are initially resistant to treatment can, in fact, show significant recovery over time. Mental illness is very often episodic. Death, on the other hand, is not reversible. In Dutch and Belgian studies, a high proportion of people who were seeking MAID for psychiatric reasons, but did not get it, later changed their minds.

Third is the issue of whether this distinction for mental illness vis-à-vis all other types of illness is inherently discriminatory. Denying access to MAID for mental health reasons alone does not [necessarily] mean that those with mental illness suffer less than people afflicted with critical physical ailments.

That is true. The statement continues, saying, “What is different about mental illness specifically, is the likelihood [or not] that symptoms of the illness will resolve over time.”

We do not have the benefit of appropriate guidance from the Supreme Court of Canada on this issue, and that is something we need to take into account.

It is also noteworthy that with only 7.2% of Canada's health budget dedicated to mental health care, Canada spends the lowest proportion of funds on mental health among all G7 countries. For example, in the U.K., the National Health Service spends 13% of its budget on mental health care. According to the OECD's recent analysis of spending on mental health worldwide, it concluded that even that is too low, given that mental illness represents as much as 23% of the disease burden. The historical underfunding of mental health has been most pronounced in community-based mental health services and I think that ought to be taken into account.

According to the Canadian Psychiatric Association, perhaps Canada's foremost experts on mental health diagnosis and treatment, its members are profoundly split on this issue. The CPA's most recent member consultations in 2020 found that 41% of respondents agree that persons whose sole underlying medical condition is a mental disorder should be considered for eligibility for MAID, 39% disagree or strongly disagree, and 20% were undecided.

According to CPA president, Dr. Grainne Neilson:

Balancing the commitment of psychiatrists to provide treatment, care and hope for recovery with a person's lived experience of suffering and right to enact personal choice in health-care decisions, including MAiD, is a fundamental challenge, particularly where death is not naturally reasonably foreseeable.

Equitable access to clinical services for all patients is an essential safeguard to ensure that people do not request MAiD due to a lack of available treatments, supports or services. Poor access to care is particularly relevant for people of low-socioeconomic status, those in rural or remote areas, or members of racialized or marginalized communities.

The Canadian Psychological Association, another very important group in this matter, states the following:

Many mental disorders are managed, not cured. Medications for mental disorders are largely palliative. While it is possible that medications and psychotherapy may successfully treat an episode which then doesn’t recur, it is often the case that mental disorders require management across a lifetime.

In assessing whether a condition is incurable and irreversible, consideration must be given to equity of access to interventions. Wait lists for publicly funded services are long. Services, like psychotherapy offered in communities by psychologists, are not funded by Medicare. Needed services are not always available in rural or remote communities. To fully address whether a condition is resistant to intervention, that intervention must be accessible.

It is not.

The mental functions required to give consent to MAiD are the very ones sometimes impaired with a serious mental disorder, despite the grievous and irremediable suffering the disorder imposes. Consideration must be given to how to assess capacity despite the impairment in thinking that can accompany serious mental disorders.

I believe that we must act cautiously and prudently, and we must take a phased approach in this area. As has been noted by all parliamentarians, this is an intensely sensitive issue with grave moral and consequential concerns.

Adequate time, in my view, is needed to facilitate a comprehensive national conversation about acceptable safeguards and the availability of medically assisted dying for those suffering from psychological or mental health conditions alone, so that we minimize negative impacts on people living with mental health problems and illnesses when they are most vulnerable, and on their caregivers and health professionals.

I think holding that national conversation must involve people living with mental health problems and illnesses, and their experiences because they play a central role. We must get their input into what mechanisms must be there to minimize the risk of wrongful death.

It is going to be my position to support this bill and I think we must move very cautiously. I do not think that we can say that we can never move into this area, but I think we can say with confidence that now is not the prudent time.