Has euthanasia changed physician attitudes towards suicide in Québec?

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

On December 10, 2015; the province of Québec officially sanctioned euthanasia. The Québec government passed Bill 52 in June 2014 and over the next 17 months prepared their nation for doctors having the right to kill their patients.

Now we learn that some Québec physicians have been withholding life-saving treatments that could save lives with possibly no after-effects from suicide victims. In response, the Québec's College of Physicians have issued an ethics bulletin telling all physicians that there is an ethical and legal guideline to provide care even to patients seeking to end their lives.

Yves Robert, the secretary for the Québec College of Physicians told the National Post that:

an unspecified number of doctors were interpreting suicide attempts as an implicit refusal of treatment. They “refused to provide the antidote that could have saved a life. This was the real ethical issue,” 
“If there is a life-threatening situation, you have to do whatever is possible to save a life, then you treat the underlying cause.”

According to the article by Graeme Hamilton, published in theNational Post, the four page ethics bulletin states:

“From a moral point of view, this duty to act to save the patient’s life, or to prevent him from living with the effects of a too-late intervention, rests on principles of doing good and not doing harm, as well as of solidarity,” 
“It would be negligent not to act.”

According to the National Post the ethics bulletin states that treatment can only be withheld when their is irrefutable proof that the patient does not want treatment. It then states:

Once stabilized, a survivor of suicide may require psychiatric treatment, the bulletin says. “Recognition of psychological suffering can allow a person who wants to kill himself to picture his life differently,”

But the Québec euthanasia law permits euthanasia for people with psychological suffering.

Is it possible that the confusion concerning the withholding of beneficial treatment is directly related to the legalization of euthanasia in Québec?

A survey of Québec doctors (April 2015) indicated that there is significant confusion concerning withholding and withdrawing treatment and an earlier survey of Québec medical specialists (October 2009) indicated that there was significant confusion concerning what constituted euthanasia and palliative care.

The fact is that the Québec euthanasia law insists that euthanasia is a medical act, which it is not, and that patients have the right to refuse treatment and autonomy. It should not shock people when Québec physicians respond to these edicts by medically abandoning suicidal patients.

Historically Québec has a very high suicide rate. In the past few years, suicide prevention programs have led to a decreased suicide rate. Let's hope that the legalization of euthanasia will not create a suicide contagion effect, leading to higher suicide rates in Québec.

The Netherlands approves euthanasia for severe dementia

By Alex Schadenberg, International Chair - Euthanasia Prevention Coalition

The Netherlands government has decided to extend euthanasia to people with dementia who are incompetent to request death by lethal injection, if the person requested euthanasia while still competent. 

The 2014 Netherlands euthanasia statistics state that out of 5306 euthanasia deaths; 81 people were lethally injected for dementia and 41 people died by euthanasia for psychiatric reasons.

To lethally inject a person who is unable to request death undermines the "safeguard" of consent. Even if the person, while competent, requested euthanasia for dementia, now the person is unable to change their mind.

Since the person is incompetent to request death by lethal injection, the new "guide" undermines the safeguard requiring a clear request. Who will decide when the lethal injection should be done? Will it be determined that some lives are not worth living? 

The new guide appears to be designed to protect doctors who were already killing people with dementia.

Link to the full article

Euthanasia Prevention Coalition and Compassionate Community Care successfully protected the right of a woman to receive medical care

alex schadenberg

alex schadenberg

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

We won a case and we protected the rights a woman to receive medical treatment without going to trial.

Two weeks ago, I received a phone call from a woman (niece) who is the legal Power of Attorney for her Aunt. The Aunt was in the hospital.

The niece needed advise and support after a doctor placed a DNR order and the hospital refused to provide oxygen assistance for her Aunt. The doctor and the hospital did not consult the niece who is the legal Power of Attorney. 

The niece said that the doctor claimed that her Aunt (who had been considered incompetent) agreed to have treatment withdrawn even though her Aunt had clearly stated in the past that she wanted medical treatment and did not want a DNR.

The niece wanted to know how to protect the rights of her Aunt and her right to fulfill the wishes of her Aunt. 

I advised the niece to hire a competent lawyer, but the niece did not have the financial ability to do so.

What happened.

With the approval of the niece, the Euthanasia Prevention Coalition and Compassionate Community Care contacted the most experienced lawyer in Ontario to handle the case.

EPC sent an appeal to our supporters asking for donations for the legal costs.

The doctor and the hospital brought the case to the Consent and Capacity Board (Board) of Ontario. 

At the pre-trial hearing there was doubt that the Aunt was competent when the doctor said that the Aunt agreed to have treatment stopped. The niece was represented by the experienced lawyer and EPC was paying for the legal costs.

Link to the full article

Why disability rights advocates oppose assisted suicide

By Diane Coleman, President of the disability rights group - Not Dead Yet.

Diane Coleman

Diane Coleman

This past Monday, the Syracuse Post Standard published an op-ed I wrote that gives a bit of the history behind the position that so many national disability groups have taken in opposing assisted suicide laws. Our position often surprises people because we are also such strong supporters of self-determination by people with disabilities, but we also oppose discrimination, especially medical discrimination. Here’s part of the discussion:

Those of us with serious disabilities have good reasons to be skeptical about the mantra of choice being used to market assisted suicide in our profit-driven health care system. Anyone could ask for assisted suicide, but the law gives doctors the authority to decide who is eligible. 
Doctors used to exercise near-total control over the lives of people like me with significant disabilities, discouraging parents from raising such children at home, sentencing us to institutions, and imposing their own ideas about what medical procedures would improve our lives. 
Disability groups started paying attention to the problem of doctors making life and death determinations in the 1980s in high-profile court cases involving the right to refuse treatment. One involved Elizabeth Bouvia, a 26-year-old woman with cerebral palsy who had a miscarriage and marriage breakup and wanted a hospital to make her comfortable while she starved herself to death. Other cases involved men on ventilators stuck in nursing facilities like Larry McAfee, who wanted the right to live in apartments or real homes, or else “pull the plug.” The doctors, courts, media and public all viewed these severely disabled individuals as the equivalent of terminally ill. They did not get suicide prevention equal to that offered non-disabled people, nor the right to live in real homes instead of facilities, but courts uniformly granted them a “right to die.” 
Then the 1990s brought Dr. Jack Kevorkian, conducting assisted suicides using lethal drugs, with two thirds of his body count being people who were not terminally ill. As before, the difference between being disabled and dying was not recognized or considered relevant. As before, the difficulties disabled individuals faced in living – community access, getting a job, getting married – were not considered, or worse, accepted as rationales for ending their lives.

To read the whole op-ed, go here. We were told that the piece would also appear in the print edition sometime this past week. And there are a number of comments, including two from me and two from Stephen Drake in response to others.

Landmark Bill to Stop Forced Dehydration Passes Texas House, Heads to Senate

By Dr Jacqueline Harvey

Dr Jacqueline Harvey

Dr Jacqueline Harvey

The Texas House of Representatives has passed House Bill 3074, which is groundbreaking legislation that would end the forced withdrawal of feeding tubes by medical facilities. HB 3074 by Representative Drew Springer proudly endorsed by Euthanasia Prevention Coalition (EPC)will stop involuntary euthanasia by dehydration and is expected to be taken up quickly by the Senate early next week. Once signed into law, HB 3074 will be the first successful reform to the Texas Advanced Directives Act since 2003. 

HB 3074 was passed on second reading in the Texas House of Representatives on Thursday, May 14 in under three minutes by a simple voice vote due to overwhelming support from legislators. Representative Springer’s bill boasts four joint authors and 80 co-authors - well over half of the 150 House representatives. But moreover, HB 3074 is the first end-of-life bill in 12 years that has garnered universal agreementamong patient advocates, disability rights, prolife and religious organizations. 

While these groups take different approaches to reforming broader aspects of Texas end-of-life law and have filed bills on those issues since 2003, Representative Springer found common ground in that all groups wish to protect patients from forced starvation and dehydration and could therefore support a bill like HB 3074 that accomplishes that singular but vital goal. In an inspiring gesture of statesmanship, Representative Patricia Harless chose to delay consideration of her end-of-life bill,House Bill 2351 (which was supported by many groups) until after HB 3074 (which was supported by all). This sacrifice ultimately cost HB 2351 the opportunity to a floor hearing and vote to allowed HB 3074 to pass just before the deadline. 

The EPC wishes to congratulate and thank Representative Springer and Representative Harless, State Affairs Committee Chairman Byron Cook for their leadership and success passing HB 3074 to the Senate. Congratulations and thanks as well as the Texas Catholic Conference, Texas Alliance for Life and Texans for Life for leading the advocacy effort. EPC pledges its continued support. 

Dr. Jacqueline C. Harvey (Ph.D.) is a former faculty member at the University of North Texas, as well as the University of Michigan-Dearborn. Harvey, in conjunction with the EPC - International, has authored definitive works on the Texas Advance Directive Act.

Canadian Bar Association (CBA) resolution should not wade into Rasouli territory

Hugh Scher

Hugh Scher

This article was published by Advocate Daily on February 20.

By Hugh Scher

A resolution on end-of-life decision-making to be considered by the Canadian Bar Association (CBA) is poised to help lawyers, but a Supreme Court ruling addressing doctors’ roles in these choices should be kept in mind during the debate, says Toronto human rights and constitutional lawyer Hugh Scher.

The CBA is set to consider the resolution, titled Clarifying Law About End of Life Decision-Making, at its mid-winter meeting Feb. 21 and 22 in Ottawa.

As counsel to the Euthanasia Prevention Coalition, which has intervened in several high-profile end-of-life cases, including Cuthbertson v. Rasouli, 2013 SCC 53, [2013] 3 S.C.R. 341 and Carter v. Canada (Attorney General), 2015 SCC 5, Scher is no stranger to the controversial conversation around end-of-life decision-making or assisted suicide.

“We think this is an appropriate, helpful and positive contribution, but care must be taken to ensure it doesn’t extend into other unclear domains such as euthanasia and assisted suicide or unilateral authority of doctors, which has already been dealt with by the highest court,” says Scher.

In Rasouli, the Supreme Court dismissed an appeal that would have permitted doctors to end life support for a disabled man without the consent of his family or a substitute decision maker.

The decision said under Ontario's Health Care Consent Act, a plan of treatment includes the withholding and withdrawal of treatment and cannot be unilaterally withdrawn by doctors without consent.

BC Supreme Court sides with nursing home in spoon feeding case

This article was published by Advocate Daily on February 10, 2015.

   Hugh Scher

   Hugh Scher

By Hugh Scher 

(Link to the EPC factum)

Oral nutrition – like spoon feeding – should not be considered health care or medical treatment, but rather seen as basic personal care and support, says Toronto health and human rights lawyer Hugh Scher, who recently advanced this position at the Supreme Court of British Columbia.

In Bentley v. Maplewood Seniors Care Society, 2014 BCSC 165 (CanLII), the family of an 84-year-old woman with advanced Alzheimer’s disease sought an order requesting that she no longer be given nourishment or liquids by staff members at The Maplewood Seniors Care Society, where the woman resides. The family stated it was their mother’s wish while she was mentally capable that she not be fed in her current condition, reads the decision.

The care centre, the Fraser Health Authority, and the Province of British Columbia opposed the petition, along with the intervenor, the Euthanasia Prevention Coalition and the Euthanasia Prevention Coalition –  BC, represented by Scher.

The B.C. court sided with the care centre, ruling the woman is capable of making the decision to accept oral nutrition and hydration and is “providing her consent through her behaviour when she accepts nourishment and liquids.”

The Supreme Court ruled spoon feeding is “a form of personal care, not health care,” and “withdrawing oral nutrition and hydration for an adult that is not capable of making that decision would constitute neglect within the meaning of the Adult Guardianship Act.”

Link to the full article