Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
Cambridge University Press published an important research article on the realities of Canada's (MAiD) euthanasia law, on July 18, 2023. The research article, by Drs. Ramona Coehlo, John Maher, K Sonu Gaind, and Trudo Lemmens, provides clear research and explanations as to why other countries and jurisdications must reject the legalization of euthanasia and assisted suicide. Read the full article and acquire links to all references (Article Link).
Parliament legalized MAiD in June 2016 and expanded the legisation by passing Bill C-7 in March 2021. Bill C-7 expanded the law in the following way:
The legislation introduced a regime of 2 MAiD pathways. Several
safeguards from the initial regime were removed from what was now called
“Track 1,” a pathway for which an applicant still has to have an (Reasonably Foreseeable Natural Death) RFND.
Bill C-7 added “Track 2,” a new pathway for those with a serious
disease, illness, or disability and an irreversible decline of
capabilities, but who are not approaching their natural death. This
means de facto persons with disabilities. A delayed implementation
clause for Track 2 (“sunset clause”) stipulated that those with sole
mental disorders would become eligible for MAiD in March 2023.
The Truchon court decision, that led to Bill C-7, and the Supreme Court of Canada Carter decision, that led to the legalization of euthanasia in 2016, did not deal with the issue of euthanasia (MAiD) for mental illness. This is important because the Canadian government now claims that the Carter decision permitted euthanasia for mental illness.
The article discusses the increase in Canadian euthanasia deaths by comparing Canada to California. Canada and California have a similar population and both jurisdictions legalized assisted dying in June 2016. In 2021, Canada had 10,064 reported MAiD deaths and California had 486 reported assisted suicide deaths. Quebec now has the highest euthanasia rate in the world.
They then analyze Canada's experience with euthanasia by examining several categories.
They first analyze Canada's inadequate data collection:
The data are acquired from the MAiD providers via self-reporting. There
is no mechanism for objectively, prospectively, or retroactively
identifying or uncovering any errors or abuses of the process. Providing
assisted suicide and euthanasia outside the parameters of the law
remains prohibited. MAiD providers filling out the forms know that any
deviation of the key criteria may result in criminal prosecution, making
self-declarations of error or deviation unlikely.
Cases of non-compliance have been reported in Québec, Ontario, the Office of Correctional Investigator, and through several news articles. Yet, none of these stories or data appear in Health Canada's Annual reports.
Under the heading, Lack of Oversight, they examine several known cases.
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Donna Duncan's daughters.
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They first examine the death of Alan Nichols. Alan died by euthanasia in Chilliwack BC in August 2019. Alan (61) had lived with recurrent episodes of depression. When entering care he was diagnosed as suicidal, but soon he was deemed capable of requesting MAiD.The researchers then explain the case of Donna Duncan. Here is a link to the story of Donna Duncan's euthanasia death (Article Link).
Read the full article and acquire links to all references (Article Link).
The researchers state:
Rather than the government accepting responsibility for setting up
procedures for investigation, the Justice Minister stated that oversight
must be provided by family members complaining after the fact to
initiate disciplinary actions or police investigations.
Yet, the experiences of family members who have tried to pursue
concerns suggest that cases cannot be transparently reviewed, and health
authorities have invoked “best interest exceptions” to rebuff requests
for access to medical records.
They show how Canada is Prioritizing access to MAiD over patient safety and needs:
Sathya Dhara Kovac, 44, ended her life through the MAiD program. Kovac
lived with a degenerative disease and her condition was worsening, but
she wanted to live. However, she lacked the home care resources to do
so. “Ultimately it was not a genetic disease that took me out, it was a
system,” Kovac wrote in an obituary to loved ones.
The researchers point out that Canada's promotion of MAiD contravenes the Supreme Court of Canada Carter decision:
The Supreme Court’s decision that spurred the partial legalization of
MAiD did not create an explicit “right to die with dignity” and left it
to the legislature to design a “strict regulatory regime”.
Regardless, the decision is being interpreted by many as creating a
positive right of access to MAiD, even when other forms of medical care
are available and when psychosocial suffering can be ameliorated.
This is an important section of the article. Use this link to read the full article (Article Link).
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Christine Gauthier
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The researchers write about how MAid is proactively offered to patients as though it is one of many standard treatment options. The case of Christine Gauthier:A military veteran and former Paralympian who has been trying to get a
wheelchair ramp installed at her home for the past 5 years testified
that she was offered MAiD by her caseworker, and it has been confirmed
that at least 4 other veterans were also offered the option of MAID when
trying to access resources and care.
The researchers explain:
In Canada, the Canadian Association of MAiD Assessors and Providers
(CAMAP) recommends that all those who “might qualify should be offered
MAiD” as part of the informed consent process.
No other country in the world has normalized assisted suicide or
euthanasia in this way as a potential first line therapeutic option to
address suffering. Offering MAiD to a patient who has not raised it
could be interpreted as an indication that their suffering will likely
become intolerable, and that MAiD is the recommended way out, impacting
patient hope and resilience.
No other country in the world has normalized euthanasia or assisted suicide as a potential first line therapeutic option.
Read the full article and acquire links to all references (Article Link).
The problem of undefined terminology in the legislation:
The language in the Canadian MAiD legislation is imprecise and makes
clear determinations and consistent implementation of clinical practice
standards for MAiD difficult. Due to the imprecise term, “reasonably
foreseeable natural death” (RFND), physicians’ interpretations of
eligibility have been challenged in the courts.
They provide the following case as an example:
A man had a small stroke, affecting his balance and swallowing. The
prognosis was that this man would be able to eat normally and regain
most of his balance. The patient was depressed and isolated due to the
COVID-19 outbreak on his ward. He declined all therapy and requested
euthanasia. Neither of his MAiD assessors had expertise in stroke
recovery. In this acute phase, while struggling with his mood and
isolation, and with no therapy to gauge his final level of function, he
received MAiD. He had no terminal diagnoses, but due to the fact that he
was temporarily slightly undernourished, his MAiD assessors considered
him Track 1 eligible.
Track 1 eligible means he could have an immediate death.
Suffering is subjectively defined and can be rooted in psycho-social distress. The euthanasia lobby group Dying with Dignity states that people do not qualify for euthanasia on the basis of inadequate housing, disability supports, or home care. Whereas this statement is true it is also false.
The researchers refer to the story of Sophia:
A national CTV News story recounted how “Sophia” was unable to secure
affordable housing compatible with her chemical sensitivities. She chose
MAiD because she could not find a healthy and affordable place to live
given her meager disability support income, and prior to her death by
MAiD recorded a video where she stated “the government sees me as
expendable trash”
People are qualifying for euthanasia based on their medical condition, but they are requesting euthanasia based on their social condition. The researchers explain the problem of how assessments are done:
To qualify for MAiD, a patient must be in a situation of irreversible
decline of capability and experience intolerable psychological or
physical suffering. These terms are not further defined by the
legislation, and suffering is treated as purely subjective. If the
patient says their suffering is intolerable, there is no requirement for
further validation or requirement for clinicians to agree that there
are no other options to address the suffering.
No standard treatments have been tried first or even been available to qualify for euthanasia:
In Belgium and the Netherlands, 2 other jurisdictions that allow
euthanasia outside the end-of-life context, before euthanasia can be
provided the physicians must agree that there are no further medical or
social support options that can relieve a patient’s suffering. In
Canada, patients are required to be advised of treatment options that
may exist. For Track 2 cases, physicians have to verify that patients
considered all other options, but it is left unclear what “considered”
really means. There is no requirement that standard best-practice
treatments have been appropriately attempted, or even that they are
accessible.
Tragically, some people are choosing to die while on wait lists for
potentially effective treatment or because they are refused care.
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Jennyfer Hatch
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The researchers then write about the euthanasia death of Jennyfer Hatch:
A short film, titled “All is Beauty,” along with its advertising
trailers, was promoted by Simons (an upscale department store in
Canada). In the series, a young woman is encircled by people on a beach,
in a candle-lit forest, and in other settings that depict a romantic
and lovely tableau of her final days before MAiD. “Even now, as I seek
help to end my life, … there is still so much beauty,” says Jennyfer
Hatch. However, a national news agency has revealed that Jennyfer was
the same woman who spoke up earlier (under a pseudonym) about her
difficulties accessing treatment, prompting her to seek MAiD as a
last-ditch effort for access to palliative care. Hatch died by MAiD in
October 2022 at age 37. She was unsuccessful in her attempts to receive
other care.
The issue of Suicide contagion:
We have long known that publicized suicides can lead to more people choosing suicide. Well-known is how suicide rates went up when Robin Williams completed suicide.
This can also be seen in suicide clustering among Indigenous youth
where 1 suicide can set off a series of suicides in a community. As well, literature has shown that increased exposure to lethal means increases rates of suicide.
Canada's Justice Minister stated that legalizing euthanasia is a more humane way to die than suicide. The researchers respond:
In reality, the evidence from reviews does not support the hypothesis
that introducing MAiD reduces rates of (non-assisted) suicide.
Further, data on suicide rates would not factor in people who may have
been ambivalent and would never have attempted or completed suicide, but
who chose to receive MAiD following social normalization of assisted
suicide. In our view, the Justice Minister should be concerned about
suicide contagion rather than normalizing what he acknowledges MAiD to
be: “a species of suicide”.
MAiD in Canada is a Human rights outcry:
Three United Nations human rights experts, over a 100 Canadian disability and social justice organizations, Indigenous advocacy groups, and hundreds of medical
and legal experts have argued that Canada’s euthanasia and assisted
suicide laws put the lives of marginalized and vulnerable Canadians at
risk.
Criticism is growing as an increasing number of media
reports regarding worrisome MAiD stories are emerging in the Canadian
press. Yet, those who support the expansion of MAiD tend to reject the
claim that social service failures can create and sustain the
predicaments that can make death an attractive choice.
Dr. Stefanie Green, President of CAMAP admits, “Our
health system is woefully inadequate in serving our population with
these resources.” Even so, she adds, “I do not think we can hold these
patients hostage”. She seemingly condones the use of MAiD despite the lack of political will to provide necessary psychosocial supports. Bioethicists supporting MAiD expansion have argued that limiting MAiD
for reasons of psychosocial suffering “would translate into removing the
agency of decisionally capable patients without offering them a way out
of their predicament” and have remarkably claimed that providing MAiD
in response to social suffering caused by “unjust social circumstances”
is a form of “harm reduction”. This is particularly troubling considering that harm reduction
strategies precisely aim at saving lives. In addition to distorting the
concept of “harm reduction,” from an equity and diversity point of view,
the claim reflects a perspective based on privilege. This wrongly
suggests MAiD is supporting the autonomy of marginalized people who are
rather being driven to death by poverty and lack of care, despite
knowing how to address poverty and improve care. Dr. Ellen Wiebe, a
prolific MAiD provider (430 people as of May 2022) has said she will
provide MAiD while people are on waitlists for medical treatment.
They are concerned about the expansion of MAiD to those for the sole reason of mental illness. Euthanasia for the sole reason of mental illness was originally scheduled to be implemented by March 2023 but has been delayed until March 2024. They write:
Therefore, patients with mental illness, a population known for a high
prevalence of psychosocial suffering, will be wrongly informed, during
periods of despair and hopelessness, that their conditions are
“irremediable” and will not improve, despite this being impossible to
predict. In response to concerns that irremediability of any
individual’s mental illness could never be predicted (a legal
requirement to provide MAiD for mental illness in Canada), Dr. Justine
Dembo, a MAiD activist and psychiatrist who sat on the 2022 federal
panel on MAiD for mental illness, suggested she would simply advise the
patient of the uncertainty that they could recover so they could make
their own “informed decision” to receive MAiD, despite the fact that
legal reporting forms require indicating that the medical condition is
irremediable.
On top of offering MAiD under false pretenses for mental illness,
equally concerning is the fact that in the few European countries that
provide euthanasia for mental illness, the majority of those requesting
it are women and marginalized individuals disproportionately seeking
relief from suffering, not from their mental illnesses per se, but
because of marginalization, including unresolved social and economic
suffering and loneliness, all of which are remediable problems.
The researchers then ask the question, "What is next?"
A parliamentary committee released a report supporting euthanasia for "mature minors" and euthanasia by advanced directive. Quebec's Bill 11 expanded euthanasia by obliging all palliative care homes to provide MAiD and allows for MAiD by advance request for situations of dementia.
The researchers don't offer the reader signs of hope. They recognize the political pressure for further expansions of euthanasia.
Read the full article and acquire links to all references (Article Link).