Canada

Canada’s Assisted Suicide Law to Cover Mental illness, Dementia and Minors

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In a Canadian CBC News article titled “Mature minors, mentally ill should have right to doctor-assisted death, report advises”, a special committee of MPs (members of Parliament)  and senators issued a 70 page report “Medical Assistance in Dying: A Patient-Centred Approach”  stating that mature minors and mentally ill people should not be excluded from the right to “doctor-assisted death” (physician-assisted suicide).  It also states that Canadians should have the right to make an “advance request” for physician assisted suicide, termed “medical aid in dying”,  after being diagnosed with certain debilitating, but not necessarily terminal, conditions.

There is not even a requirement that the lethal overdose be oral or self-administered and the Canadian province of Quebec has already started lethal injections.

Ironically, capital punishment existed in various forms in Canada until 1998, when the federal government completely abolished the death penalty.

How can lethal injections be “cruel and inhumane” for convicted murderers but a civil right when it is chosen by an ill person?

And while physician-assisted suicide laws in the US routinely provide immunity for physicians, the Canadian recommendations also exempt nurses, pharmacists and other health care practitioners from key criminal code provisions.

Age of Consent

Although the Canadian Pediatric Society pushed to exclude minors regardless of competence, the report states that

“Given existing practices with respect to mature minors in health care and the obvious fact that minors can suffer as much as any adult, the committee feels that it is difficult to justify an outright ban on access to medical assistance in death for minors.”(Emphasis added)

Mental Illness

The report states that the right to assisted death should not be limited to physical conditions, and that Canadians with psychiatric conditions should not be excluded from “doctor assistance to end suffering” (physician-assisted suicide).

However

“As reported by Medscape Medical News, the inclusion of psychiatric suffering in assisted death laws in European countries such as Belgium has sparked significant debate, particularly with research showing that many individuals who have a history of suicide attempts later regret taking such action.

“Most people who consider or attempt suicide never die by suicide [and] the conviction that there is no alternative but to end their lives often passes with the resolution of an acute crisis,” medical ethicist Paul S. Applebaum, MD, told Medscape Medical News.

“By making the option of suicide easier, ie, a painless, certain death with medical assistance, the Dutch, Belgian, and similar laws may encourage many people, especially women, who would not have ended their lives to do so,” said Dr Applebaum, Dollard Professor of psychiatry, medicine, and law and director of the Division of Law, Ethics, and Psychiatry at Columbia University College of Physicians and Surgeons, in New York City.” (Emphasis added)

“Advance Consent” for Assisted Suicide for People with Dementia

The advocacy group Dying With Dignity Canada applauded the report’s recommendations, especially the one to allow advance consent.

“Patients deserve real choice,” said CEO Shanaaz Gokool in a release.

“Without the option to consent in advance to assisted dying, Canadians with dementia who want to die in peace with the help of a physician face a dire choice: access assisted dying prematurely, while they are still competent; or risk losing competence before their wishes can be carried out, only to be condemned to the exact fate they sought to avoid.” (Emphasis added)

Actually, that result was already on the agenda when “living wills” were first proposed by Chicago lawyer Louis Kutner in his 1969 article “Due Process of Euthanasia: The Living Will, A Proposal” .

Some people say that Holland, Switzerland and Belgium are not like the US so that their virtually unregulated euthanasia policies should not affect us. But no one can deny the potential lethal impact on our own society from this terrible “right to be killed” propagated by our neighbor to the north.

Arguing Life, Death and Assisted Suicide

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In the article “Sides discuss NY proposal for aid in dying”, the exchange between Diane Coleman, a founder of Not Dead Yet, the foremost disability organization fighting physician-assisted suicide, and  Dr Timothy Quill, who fought for the constitutionality of physician-assisted suicide in the landmark 1997 US Supreme Court Vacco v Quill decision, is very enlightening.

Diane Coleman of Not Dead Yet spoke simply and eloquently:

“I don’t think I speak for all (opponents), but the disability community’s core message is that if assisted suicide is legal, some people’s lives will be lost due to mistakes, coercion and abuse, and that’s an outcome that can never be undone.

There is inherent discrimination in assisted-suicide laws. Most suicidal people receive suicide prevention. Assisted suicide laws would carve out an exception to that, and that exception would apply to people who are elderly, ill, disabled, and those are devalued groups in society. … Assisted-suicide laws would say, ‘these certain people, we not only agree with their suicide but give them the means to carry it out.’ We’re saying it comes down to social justice. Equal rights means equal suicide prevention.”

And

“It’s really not about physical pain. If you look at Oregon reports, about reasons people want to commit suicide, the reasons are things like feeling like the person has lost their autonomy, they’ve lost their dignity, they can’t do the things they used to do. They feel like a burden on their families. Those are psychosocial reasons that relate to the disability that people have when they have an advanced stage or chronic condition.”

On the other hand, Dr. Quill portrayed assisted suicide as little more than a benign discussion:

“Whether or not this practice is legalized, seriously ill patients are asking us to talk about it, they’re asking us to consider it” said Quill, founding director of the palliative care program at URMC and a board-certified palliative care consultant. (Emphasis added)

But to the question “Why do people with a terminal illness want to end their lives?”, Dr. Quill telling states:

“Some of it has to do with severe symptoms. I would say that’s not the majority. The majority is people who are tired of dying. It’s going on way too long for them. The kind of debility and weakness that accompany it, particularly for people that are used to being in charge of their lives, is very, very, very hard. Some of those people want to talk about what options they have to accelerate the process.” (Emphasis added)

This is very different from the way physician-assisted suicide has been sold to the public as a necessary last resort for terminally ill people in “unbearable pain”. However, as a 2014 article  “Dignity, Death, and Dilemmas: A Study of Washington Hospices and Physician-Assisted Death” admits, pain is not even a requirement for receiving physician-assisted suicide  in Oregon and Washington state:

The authorizing legal statutes in both states make no reference to the experience of severe pain or intolerable suffering as an indication for a patient to make a request for physician-assisted death but rely entirely on the entitlement due a patient in respect of their personal dignity. A patient rights framework provides the primary moral structure… (Emphasis added)

Thus, physician-assisted suicide is really about power and control over death, not the  suffering of the individual. And it is this power and control that has led European countries like the Netherlands to expand physician-assisted suicide even to non-terminally ill people who cannot or have not made the death decision themselves such as babies with deformities and people with dementia, mental illness or other impairments.

Closer to the US, the Canadian Supreme Court  has legalized physician-assisted suicide but still  without formalized rules, even on conscience rights.  In the province of Quebec, legal injection euthanasia kits  can be distributed to any doctor who wants them.

The Assisted Suicide Agenda in the US

It is alarming that the influential American Academy of Hospice and Palliative Medicine that had this same Dr. Timothy Quill in the article as a recent past president and honoree of their Visionary award. But it should not be surprising that the AAHPM has changed its former position of opposition to physician-assisted suicide to a position of “studied neutrality” towards what it now calls “physician-assisted death”.  Neutrality is progress to physician-assisted suicide activists like Dr. Quill and organizations like Compassion and Choices that need to neutralize medical opposition as much as possible while quietly setting up relentless campaigns to legalize assisted suicide in every state. If enough states give in, a new Supreme Court decision may even overturn the Vacco v Quill decision and legalize physician-assisted suicide throughout the US.

But in the meantime, trying to sell “neutrality” to doctors and convincing the media to change the term “physician-assisted suicide” to  “physician-assisted death” cannot mask the inevitable and lethal damage done not only to individuals but also to our medical and legal institutions that can no longer ensure ethical protection for our lives.

Euthanasia Kits, Conscience rights and Coercion

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The country that gave us Celine Dion, Mike Myers and Joni Mitchell is now giving doctors euthanasia kits?

As I wrote in a September blog “Disaster in Canada”, this past February, the Canadian Supreme Court unanimously ruled to end the long-standing ban on physician-assisted suicide and gave federal and provincial governments 12 months to craft legislation to respond to the ruling. Despite concerns raised by opponents of assisted suicide, the Canadian supreme court agreed with the trial court that physician-assisted suicide laws like that in Oregon has curtailed such abuses and missteps. “The risks associated with physician-assisted suicide,” the high court stated, “can be limited through a carefully designed and monitored system of safeguards.”

But even before such legislation is made, Canada’s second largest province Quebec is jumping to allow to active euthanasia via lethal injections.

In a shocking article in the British Medical Journal titled “’Euthanasia kits’ are prepared for Quebec doctors as palliative care centres rebel on right to die” , new guidelines from the College of Medicine in Quebec on physician-assisted suicide include “euthanasia kits”. These kits contain three sequential injections: a benzodiazepine sedative to relieve anxiety, a barbiturate to induce coma, and a curare-type neuromuscular block to stop the heart and respiration with backup doses, and detailed instructions. These kits will be available to all licensed physicians in Quebec. (Emphasis added)

Ironically, this lethal injection protocol mimics the lethal injection protocols used in the US for executions that are now being challenged by groups like the ACLU as “cruel” and “inhumane.”

The rationale for doctor-administered lethal injections over the self-administered oral lethal overdoses just signed into law in California is explained in the BMJ article:

The college decided that doctors should administer the drugs intravenously rather than simply prescribe an oral drug. Yves Robert, secretary of the college, said that this had involved seeking advice from abroad, including speaking to the first doctor to legally prescribe life ending drugs in Oregon, USA, nearly 20 years ago. “He told us there were some bad side effects,” Robert said, including regurgitation and, in a few cases, reawakening days later.” (Emphasis added)

Apparently, the annual Oregon state health reports on assisted suicide that rely merely on the assisting doctors’ self-reporting of problems are not much of a “safeguard”. Nonetheless, all the public (and the Canadian supreme court) continues to hear is that physician-assisted suicide laws are working well without any problems.

PUSHBACK

But the existence of euthanasia kits is not the whole story.

As the BMJ article reports, all 29 of Quebec’s palliative care centers announced a collective decision not to offer physician-assisted suicide, now renamed “medical aid in dying.” At least for now.

One director stated that “There is no doctor here who’s willing to push that syringe.”

This refusal has apparently enraged physician-assisted suicide supporters like Gaétan Barrette, Quebec’s health minister, who stated:

“Once again, this is a comment that prioritizes the views of the physician, when the law is made for the patient,” said Barrette. “I have a very formal announcement to make to these doctors: physicians, nowhere in Quebec, are owners of the institution. Not of the institution, nor of the floor, nor of a single bed. In no way can a doctor say: ‘In room 326, this will never happen.’ That is completely inappropriate.”

So now there are now efforts to challenge the conscience rights of objecting doctors.

Euthanasia/assisted suicide supporters know that without enough medical professionals willing to perform medicalized killing, the movement itself is dead.

Unfortunately, such supporters have had better luck in the US with convincing groups like the California Medical Association, the American Public Health Association, The American College of Legal Medicine, American Medical Student Association and American Medical Women’s Association and The American Academy of Hospice and Palliative Medicine to support legalized physician-assisted suicide or take a “neutral” position using polls, not principles.

It is a myth that physician-assisted suicide will only ever involve oral lethal overdoses requested by terminally ill patients in unbearable pain. As we have seen with the relentless progression of medically assisted killing in Holland, Luxembourg, and Belgium, it is just a matter of time before lethal injections are considered more humane than unreliable oral overdoses and the pool of potential victims expands beyond the terminally ill and just those who request it.

Tragically, it is a very short step from saying “I would not want to live like that” to saying “No one should live like that.”

Like those doctors of conscience in Quebec, those of us in the US who are also medical professionals need to be our own Resistance Movement against medicalized killing and the efforts to coerce us into participating.