Advanced Request For Euthanasia?

This article was written by Dr Catherine Ferrier and published on June 10, 2016 by impact ethics in Canadian BioethicsDeath & Assisted DyingLaw & PolicyMental Health

Catherine Ferrier a physician in the Division of Geriatric Medicine of the McGill University Health Centre, and is the president of the Physicians’ Alliance against Euthanasia.

The June 6 deadline for legislation in response to the Carter judgment has come and gone, and our government has yet to adopt a law regulating medical assistance in dying. Too few of us have any idea what we are rushing into.

In the Carter decision the Supreme Court judges stated that the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards. In contrast, the pressure is on to offer death as a solution for all forms of suffering, available to virtually everyone, including those who fear future suffering or disability.

The Standing Senate Committee on Legal and Constitutional Affairs wants Bill C-14 amended to include the recommendation of the Special Joint Committee on Physician-Assisted Dying, “That the permission to use advance requests for medical assistance in dying be allowed any time after one is diagnosed with a condition that is reasonably likely to cause loss of competence or after a diagnosis of a grievous or irremediable condition but before the suffering becomes intolerable….”

I have spent the last 30 years diagnosing, treating, and caring for people with Alzheimer’s disease and other dementias. It takes no special insight to realize that they are the principal intended “beneficiaries” of this recommendation.

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Will Johnston: The case against physician-assisted dying

This article was published by the CanadianHealthcareNetwork.ca on June 1, 2016

Discussed: The 'wedge' cases, the language of the debate, the moral culpability of the doctor, and the question of pure autonomy
Dr Will Johnston

Dr Will Johnston

By Tristan Bronca.

The Euthanasia Prevention Coalition was officially founded in 1998 in response to rising public support for physician-assisted dying. It’s made up of about 2,000 donors—both members and organizations—who began to come together in about 1993 during the Sue Rodriguez case. One of those members is Dr. Will Johnston.

Now the chair of the B.C. chapter of the coalition, the family physician took a strong stance against euthanasia about 22 years ago, when he began writing about it and speaking to high school students and church groups. He also testified opposite euthanasia advocates in the Carter case, which led to the legalization of medically assisted death in Canada. Dr. Johnston spoke with the Medical Post about his concerns with the legislation recently passed through the house of commons, the laws around the world, and why he feels Canada is about to make a dangerous mistake.

Q: Explain the impetus for a coalition of bodies who are opposed to physician-assisted dying.

The bodies that are involved in the Euthanasia Prevention Coalition might not agree on any other issue but they share in common a sense of the huge societal mistake that is being made in euthanasia and assisted suicide. We realize that there is some strength in numbers. Obviously not enough strength to stop the freight train that ended with the Supreme Court being unanimous in its decision—which I think is a troubling sign of the shallowness of the Supreme Court’s reasoning—but nonetheless more power than we would have as individual activists.

Q: Which elements of the proposed federal legislation do you personally find most troubling?

The legislation doesn’t yet allow the euthanasia of children, psychiatric patients, or mentally incapable patients long after they consent, but the preamble to the legislation promises to explore those areas further, which is deeply troubling.

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Canada’s Bill C-14, which seeks to codify assisted suicide and euthanasia, is a recipe for elder abuse

FOR IMMEDIATE RELEASE THURSDAY MAY 19, 2016 

Margaret Dore

Margaret Dore

Proposed recommendations by the Senate Legal & Constitutional Affairs Committee do not solve the bill’s problems. The bill violates the Canadian Supreme Court case, Carter v Canada. Recent news stories have proven Carter wrong. This justifies a new look at the issue, including time for more study or a new law prohibiting euthanasia and assisted suicide. 

Contact: Margaret Dore: (613) 899-0366
margaretdore@margaretdore.com

Ottawa - Lawyer Margaret Dore, president of Choice is an Illusion, which has been fighting efforts to legalize assisted suicide and euthanasia in the United States, Canada and other countries, made the following statement in connection with Canada’s Bill C-14: 

"The Senate Committee's thoughtful recommendations include that patient 'eligibility' be defined as a 'terminal illness, disease or condition' for people at the end of life," said Dore. "In Oregon, which has a similar criteria, chronic conditions such as insulin dependent diabetes qualify, 

Dore said, "This is because the the eligibility determination is made without treatment. The typical insulin dependent 18 year old with treatment will have decades to live, but without treatment will have less than a month to live to therefor qualify for assisted suicide or euthanasia. (William Toffler, MD declaration) The Committee’s recommendation, if adopted and interpreted according to Oregon's precedent, will encourage people with years, even decades to live, to throw away their lives.”

“Doctors can, regardless, be wrong about life expectancy, sometimes way wrong,"said Dore. "This is due to actual mistakes and the fact that predicting life expectancy is not an exact science. For this reason also, the bill encourages people with years, even decades to live, to throw away their lives

"The bill is also a recipe for elder abuse, with the most obvious reason being a complete lack or oversight at the death" said Dore. "In the case of assisted suicide under the bill, no doctor, not even a witness is required to be present. This creates the opportunity for someone else, such as an heir who will financially benefit from the death, to administer the lethal dose to the patient, in private without consent. The drugs used are water and alcohol soluble, such that they can be administered to a restrained or sleeping person. Even if the patient struggled, who would know?" 

“The bill is a response to the Canadian Supreme Court decision, Carter v. Canada, which envisioned a ‘carefully designed and monitored system of safeguards, ” Dore said. “With no required oversight at the death, the bill has no such system.” The bill violates Carter. 

"Carter understood that that the 'slippery slope' phenomenon, in which restrictive legal euthanasia blooms into expansive euthanasia for all types of conditions and people, including children, would not happen in Canada," said Dore. (Carter, paragraphs 111 to 120) "Recent news stories prove this understanding wrong as euthanasia proponents now demand such expansion, This new development gives Parliament an opening to follow its own path, to protect the public. This could include more study or a new law prohibiting assisted suicide and euthanasia." Dore concluded, "This is the only sure way to protect the public." 

For more information, see: 

1. Margaret Dore, Legal/Policy Analysis of Bill C-14, May 15, 2016. Memo available here:https://choiceisanillusion.files.wordpress.com/2016/05/memo.pdf Attachments available here: 

https://choiceisanillusion.files.wordpress.com/2016/05/memo-index-final.pdf 

2. Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009, 

3. Nina Shapiro, "Terminal Uncertainty: Washington’s new ‘Death With Dignity’ law allows doctors to help people commit suicide-once they’ve determined that the patient has only six months to live. But what if they’re wrong?" The Seattle Weekly, 01/14/09.

Canada: Senate Report Recommendations Will Not Solve the Bill C-14 Problems

Margaret Dore

Margaret Dore

Canada’s Bill C-14, which seeks to codify assisted suicide and euthanasia, is a recipe for elder abuse.

Proposed recommendations by the Senate Legal & Constitutional Affairs Committee will not solve the bill’s problems. The bill will encourage people with years, even decades, to live to throw away their lives. The bill will remain seriously flawed and contrary to the Canadian Supreme Court case, Carter v. Canada, which envisioned a “carefully designed and monitored system of safeguards.” The bill must be rejected.

Contact: Margaret Dore: (613) 899-0366
margaretdore@margaretdore.com

Ottawa - Lawyer Margaret Dore, president of Choice is an Illusion, which has been fighting efforts to legalize assisted suicide and euthanasia in the United States, Canada and other countries, made the following statement in connection with Canada’s Bill C-14:

“The recommendations made by the Senate Committee’s thoughtful report will not solve the bill’s problems,” said Dore. “Consider, for example, the recommendation to define ‘eligibility’ as a ‘serious and incurable terminal illness, disease or disability [for a person who has] been determined to be at the end of life.’ In Oregon, which has a similar terminal criteria, chronic conditions such as insulin dependent diabetes qualify. This is because, in practice, the eligibility determination is made without treatment. According to Oregon doctor, William Toffler, MD, the typical insulin dependent 18 year old with treatment will have decades to live, but without treatment will live less than a month. The Committee’s recommendation, if adopted and interpreted according to Oregon’s precedent, will encourage people with years, even decades to live, to throw away their lives.”

“The recommendations also raise a valid concern that there is nothing to ensure patient consent when the lethal is administered,” said Dore. “Indeed, there is a complete lack of oversight at the death. In the case of assisted suicide, no witness, not even a doctor is required to be present.”

Dore elaborated, “People who sign up for assisted suicide or euthanasia do not necessarily intend to go through with it. Maybe it was somebody else’s idea, maybe they were ambivalent or maybe they signed up “just in case” things get bad. A patient can also change his or her mind. There are many people, including heirs, who can benefit from a patient’s death. If the patient was tricked, objected or struggled, who would know?"

“The bill is a response to the Canadian Supreme Court decision, Carter v. Canada, which envisioned a ‘carefully designed and monitored system of safeguards, ” said Dore. “The bill has no such system.”

“Under current law, the Corrections and Conditional Release Act requires that all inmate deaths be investigated,” said Dore. “Bill C-14, however, amends the Act to create an exception for inmates who die by assisted suicide or euthanasia, to thereby discourage investigations.” Dore continued, “With existing investigations discouraged, the idea of a ‘carefully designed and monitored system of safeguards’ is undermined. Carter is violated.”

Dore added, “The bill also amends the Pension Act and the Canadian Forces Members and Veterans Re-Establishment Act to deem that any deaths occurring via assisted suicide or euthanasia be treated as a result of an ‘illness, disease or disability.” Dore said, “The significance is a legal inability to prosecute criminal behavior, for example, in the case of an outright murder for the money. The cause of death, as a matter of law, is an ‘illness, disease or disability.’ The bill thereby creates the perfect crime.” 

“Under the Charter of Rights and Freedoms, ‘everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice,’” said Dore. “It is not fundamentally just to allow people to be killed for their money or due to another bad motive under a regime that has no required oversight at the death, which discourages investigations and which deems deaths to be the result of an ‘illness, disease or disability,’ as a matter of law, to thereby prevent prosecution.” Dore concluded, “The bill, which creates the perfect crime, must be a violation of the Charter. It must be rejected.”

For more information, see:

1. Margaret Dore, Legal/Policy Analysis of Bill C-14, May 15, 2016. Memo available hereAttachments available here.

2. Margaret K. Dore, "'Death with Dignity': What Do We Advise Our Clients?," King County Bar Association, Bar Bulletin, May 2009,

Garnet Genuis MP: Without amendments, euthanasia Bill C-14 "will protect no one."

Garnett Genuis is the Member of Parliament from Sherwood Park / ­Fort Saskatchewan.

Garnet Genuis   

Garnet Genuis

 

I want to be clear that I do not believe in an all-or-nothing approach. Many of my colleagues and I who have broad philosophical concerns about what is happening here are still willing to vote in favour of legislation that does not re-criminalize euthanasia, if it advances positively in the direction of saving some lives, especially minimizing the risk to vulnerable persons. However, this legislation does not contain meaningful safeguards. Without amendment, it will protect no one.

We know that this law has written exceptions. However, it has exceptions to the exceptions; and may I say it has exceptions to the exceptions that are not at all exceptional?

This legislation has a requirement for the provision of written consent. However, if people cannot provide written consent, someone else can do it on their behalf.

This legislation prescribes a waiting period. However, the waiting period does not apply in the event of possible imminent death or loss of capacity.

There is so much ambiguity here.

The government has said that mental illness is excluded. However, in section 241.2(2) the legislation clearly states that physical or psychological suffering qualifies a person to seek premature death.

The legislation says that death must be “reasonably foreseeable”. May I say that death is reasonably foreseeable for all of us? It is those who think that death is not reasonably foreseeable who probably need the medical attention. Why not put in the word “terminal”? When I was learning to drive, my mother thought that death was “reasonably foreseeable” every time we got into the car. That is no criterion.

There is a requirement that two physicians sign off. However, given the huge ambiguities, obviously doctors are likely to have a wide range of interpretations of the rules. The estimates are that there are 77,000 physicians in this country, and the likely practice of doctor-shopping will ensure that people who think they meet the wooly and ambiguous criteria can somewhere find two physicians.

The member for Victoria said earlier today that this is something doctors do every day. No, it is not. Doctors do not take lives every day. This is fundamentally different from the normal practice of medicine. When we have so many different doctors and opinions to choose from, these are not effective safeguards.

Given these five comically ridiculous exceptions to the exceptions, there is no doubt that detailed provincial legislation or regulation will be required in every case. Therefore, it is not at all clear to me what this law is supposed to accomplish.

Further, there are two key areas where the prevailing rules under this law would leave us demonstrably worse off than the Carter ruling alone.

First, there is a terrifying clause in this bill, which states that if someone kills someone else but can demonstrate, at least beyond a reasonable doubt, that he or she had a reasonable but mistaken belief that the criteria applied then that person cannot be penalized. We can find that at 241(6). Therefore, we can kill someone who did not consent and escape prosecution on the basis of reasonable but mistaken belief. Whatever is done, I implore the government to take this very dangerous section out. This is going even beyond the Belgian model.

Second, this legislation provides no protection for conscience rights, despite the court's clear statement that nothing in this decision required particular health care practitioners to be involved, and despite the clear assurance of the Canadian Medical Association that access does not require taking away section 2 conscience rights.

This legislation constitutes a perfect storm. Ambiguous criteria, no advance legal review, no conscience protection, and allowances for doctor-shopping are not meaningful safeguards at all. The bill leaves patients, seniors, the sick, and the disabled vulnerable to error and systemic abuse. We have seen this in Belgium before. I have quoted the studies during questions and comments. We do not want to go down this road in Canada at all. . . .

This article was published by Choice is an Illusion on May 2, 2016.

Transparency essential in assisted dying applications

Hugh Scher

Hugh Scher

This article was published by Advocate Daily on February 10, 2016.

While some anticipate that those seeking personal constitutional exemptions for physician-assisted suicide will want anonymity, Toronto human rights and constitutional lawyer Hugh Scher tells Lawyers Weekly that scrutiny and transparency in end-of-life practices are key to detecting and deterring abuse.

Although the Supreme Court of Canada ruled the ban on physician-assisted suicide unconstitutional in its landmark decision last year in Carter v. Canada (Attorney General), the ban has been left in force until June to allow Parliament time to draft a new law. In mid-January, the Supreme Court ruled that those who meet the criteria the court set out last year may apply to a superior court to be exempted from the Criminal Code’s blanket prohibition of assisted suicide.

In the meantime, Lawyers Weekly says some lawyers and judges could be faced with questions such as when should a lawyer take on this type of case, and should counsel seek anonymity for clients.

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Euthanasia for depression to be debated in Canada

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

Tara Brousseau-Snider

Tara Brousseau-Snider

Canada's parliament will soon debate whether to euthanasia should be permitted for psychological suffering. 

The Supreme Court of Canada, on February 6, struck down Canada's assisted suicide lawand used language that permits euthanasia. The Supreme Court did not define the terminology but it stated that an assisted death could be permitted for someone who has irremediable pain caused by physical orpsychological suffering.

CBC Manitoba reported on an unnamed Winnipeg woman who pushing the issue by requesting a euthanasia based on psychological suffering. Tara Brousseau-Snider, executive director of the Mood Disorders Association of Manitoba stated that woman who wants euthanasia said: "If it was in place, they'd apply for it."

Brousseau-Snide told CBC Manitoba that she is concerned about a law permitting euthanasia for depressed people.

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